Peripheral Artery Disease (PAD) and Amputation Prevention
What is PAD and what causes it?
Peripheral Artery Disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. It is typically a result of aging and numerous risk factors that result in the build-up of plaque inside the lining of your blood vessels that results in them becoming narrow.
Peripheral Artery Disease (PAD) is caused by a build-up of plaque (fatty deposits and cholesterol) on the walls of the arteries which is called atherosclerosis. Arteries can become so narrow over time that the blood flow bringing oxygen to the muscles, organs and tissue is restricted. If plaque breaks off and gets into the bloodstream, clots can form, causing further problems. PAD is considered a risk factor for heart attack and stroke.
What are the symptoms?
PAD is typically asymptomatic. If the narrowing becomes bad enough, one can have difficulty walking—resulting in significant cramping pain that improves after resting. This can limit a person’s ability to exercise or in some cases ability to work. In more severe cases, it can also result in wounds (ulcers) that do not heal. These are typically in the feet, and less commonly in hands.
While PAD is known for affecting the blood vessels to the legs, it can affect nearly any artery in the body, including the abdomen, brain, kidneys or pelvis.
Risk factors for PAD include:
- Diabetes Mellitus
- Coronary artery disease
- Family history of high blood pressure and high cholesterol levels
- Lack of exercise and sedentary lifestyle
- Family history of heart or vascular disease
- Overweight (body mass index over 30)
- Over 70 years old (or over 50 if you also smoke and/or have diabetes)
How is PAD diagnosed?
A medical history and physical exam will be conducted by your interventional radiologist.
Tests may include:
- Taking a sample of your blood to check for diabetes by measuring your cholesterol and triglycerides.
- Checking the pulse in your feet and perform a non-invasive test called ankle-brachial pressure index (ABI). It compares the blood pressure in your ankle to blood pressure in your arm.
- Based on test results, your interventional radiologist may recommend an ultrasound to evaluate blood flow.
- In specific circumstances, an MRI (magnetic resonance imaging) or CT angiography using a contrasting dye may help identify the extent of narrowing in your blood vessels due to atherosclerosis.
What is limb salvage?
Limb salvage refers to medical care performed to give patients the best possible chance to avoid amputation that has resulted from severe PAD.
Wounds that are a result of peripheral arterial disease with additional risk factors such as diabetes and kidney disease may not heal spontaneously. A non-healing wound can be at risk for infection, with the biggest concern being infection extending to the bone.
In these cases the risk of minor and major amputations increases. A team effort is required to successfully treat these wounds, this includes a foot and ankle doctor, an interventional radiologist and a vascular surgeon.
Limb salvage centers are dedicated to saving limbs and preserving quality of life. We often receive second and third opinion requests and are proud to offer the expertise to treat the most challenging cases.