Peripheral Artery Disease (PAD)
Basic Information & Questions and Answers
What is Peripheral Artery Disease (PAD)?
PAD is the narrowing or blockage of arteries in the legs and groin due to a build up of plaque. These narrowings and blockages do not allow enough blood or oxygen to get to the legs and can cause discomfort, tightness, heaviness, cramping or pain in the hips, legs or feet. Common arteries to become blocked are the iliac arteries in the lower abdomen, the femoral arteries in the groin, and the popliteal arteries in the back of the knee.
If left untreated, what are symptoms of advanced PAD?
Untreated PAD can lead to ischemia, which is pain in the feet or toes even when you are not walking. You can also develop painful sores on your toes or feet. These sores can turn into ulcers that can ultimately become dead tissue (gangrene). In extreme cases of gangrene and only as a last resort, the surgeon may recommend limb or foot amputation if circulation is severely reduced and cannot be improved by any of treatment methods discussed below. More than 90 percent of patients with ischemia can avoid amputation.
What causes PAD?
Atherosclerosis causes peripheral artery disease. Other factors that increase your chances of developing the disease include:
Treatments for PAD:
- high blood pressure
- high cholesterol
Angioplasty and stenting, Endarterectomy, and Bypass Surgery
Stenting and angioplasty
Stenting is a minimally invasive procedure involving a small incision in the groin, where a balloon and stent are individually inserted and guided to the diseased artery to be treated. First, a balloon is inserted and positioned inside the artery at the location of the blockage. The balloon is inflated to press the plaque against the wall of the artery. This is called angioplasty. A stent (which is a metal implantable device) is then guided up to the site of the blockage and is opened up. Lastly, a second balloon is inserted and guided to the site to secure the stent against the walls of the artery. Patients receiving this type of treatment typically find themselves turning to their regular, daily activities more quickly than with open surgical procedures.
In some instances, only angioplasty may be performed without the stenting.
An endarterectomy is an open, surgical procedure used to remove plaque from the blocked arteries. The procedure involves making an incision to access the diseased artery, clamping both sides of the artery to isolate the site of the stenosis and to prevent blood from flowing through the artery, opening the artery to reveal the plaque, cleaning out the plaque, and sealing up the incision with a patch. Steps in the endarterectomy procedure are shown in the following pictures. This same procedure can be used to treat carotid artery disease.
Bypass surgery creates an alternate route for blood to travel so that the portion of the diseased artery (with the blockage) is bypassed. To create this bypass, the surgeon sews one of your veins (taken from another area of your body) or a synthetic tube above and below the blocked area. This creates a new, unobstructed route for blood to flow to the legs and feet.
What is the Silverhawk procedure?
The Silverhawk procedure is an innovative technique for removing plaque in patients diagnosed with peripheral artery disease. It involves inserting a device through a small incision typically in the groin that is guided to the site of the blockage to remove the plaque buildup. The device contains a tiny rotating blade that can remove and collect the plaque. Click on the video clip to see how the procedure works.