Peripheral Arterial Disease (PAD) / Peripheral Vascular Disease (PVD)

Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a very common condition affecting 12-20 percent of Americans age 65 and older.4 PAD develops most commonly as a result of atherosclerosis, or “hardening of the arteries,” which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries that narrows and clogs the arteries. This is a very serious condition. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking, and eventually gangrene and amputation.

Because atherosclerosis is a systemic disease, people with PAD are likely to have blocked arteries in other areas of the body.2 Thus, people with PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions. This is a major public health issue and the Society of Interventional Radiology recommends greater screening efforts through the use of the ankle brachial index (ABI) test. This simple, painless test compares the blood pressure in the legs to the blood pressure in the arms to determine how well the blood is flowing and whether further tests are needed. Each September, during Peripheral Vascular Disease Month, interventional radiologists participate in Legs For Life®, a nationwide screening program sponsored by the Society of Interventional Radiology Foundation.

Symptoms
  • The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.2
  • Other symptoms of PAD include: numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don’t heal.

Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor. If you, or someone you know, are experiencing any of the symptoms above, please call our Memphis office now and schedule what could be a potentially life-saving screening test today.

Prevalence
  • PAD is a disease of the arteries that affects 10 million Americans.1
  • PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.2
  • PAD affects 12-20 percent of Americans age 65 and older.4
Risk Factors

Get tested if you:

  • Are over age 50
  • Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
  • Have high cholesterol or high lipid blood test
  • Have diabetes
  • Have ever smoked or smoke now
  • Are overweight
  • Have an inactive lifestyle
  • Have a personal history of high blood pressure, heart disease, or other vascular disease
  • Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by resting
  • Have pain in the legs or feet that awakens you at night
Treatments

Lifestyle
Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.

Angioplasty and stenting
Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then the interventional radiologist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.

Balloon angioplasty and stenting has generally replaced invasive surgery as the first-line treatment for PAD. Early randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions, and in the past five to seven years, a very large clinical experience in centers throughout the world has shown that stenting and angioplasty are preferred as a first-line treatment for more and more processes throughout the body.5,6,7

The long-term clinical results of stent placement to treat PAD are comparable to those of aortofemoral artery bypass surgery, with a much lower risk of associated morbidity and mortality. Surgery should be reserved for the rare patient in whom stenting can’t be done or fails.5

Women and Vascular Disease

Early Warning Symptom for the #1 Killer of Women Is Under-recognized
Heart disease is the #1 killer of women in the United States. Peripheral arterial disease (PAD)—clogged or narrowed arteries in the legs—is a red flag that the same process may be going on elsewhere because PAD is associated with other life-threatening vascular diseases. Through early detection, interventional radiologists can save women from future stroke, heart attack, and early death. To combat this major public health issue, the Society of Interventional Radiology recommends greater screening efforts by the medical community through the use of the ankle brachial index (ABI) test.

Like heart disease, peripheral arterial disease is under-recognized in women. According to a survey of primary care physicians conducted in 2002, nearly all recognized that older people are more susceptible to PAD, and identified men as being susceptible to PAD. However, they mostly excluded women as likely to have PAD, which is incorrect.1 The prevalence is actually equal on the diagnostic ABI test.3 As vascular experts, interventional radiologists are partnering with primary care physicians to increase early screening.

Twelve to 20 percent of Americans older than 65 suffer from peripheral arterial disease but only one-third are symptomatic. Symptoms can include pain when walking that subsides at rest, leg cramps, pain at rest, numbness and skin discoloration, sores or other symptoms of skin breakdown. Women may be more likely than men to have PAD without experiencing symptoms; 50 to 90 percent are asymptomatic or have unrecognized symptoms of the disease, which could put them at greater risk of developing serious disease before it is diagnosed and treated.3 Specifically, women are also less likely to have intermittent claudication symptoms, i.e., pain when walking that subsides at rest.

However, identifying PAD while asymptomatic may be life-saving for women, since it allows the easy, cheap identification of a systemic disease that may be treated. Treatment may greatly influence the woman’s outcome. These treatments may include further investigation into the state of disease in the coronaries, which could lead to heart disease, and carotids, which could lead to stroke, as well as the legs, and treating the significant areas of blockage that are found. Treatment with lifestyle modification and medication may slow the natural advancement of the disease.

Risk for Heart Attack, Stroke and Death

The ABI, a comparative blood pressure reading in the arm and ankle, is used to screen for peripheral arterial disease. It is a direct measure of fatty plaque buildup in leg arteries and an indirect gauge of plaque accumulations throughout the entire cardiovascular system. Because atherosclerosis is a systemic disease, women developing plaque in their legs are likely to have plaque building up in the carotid arteries, which can lead to stroke, or the coronary arteries, which can lead to heart attack. Early detection of PAD is important because these women are at significantly increased risk, and preventive measures can be taken.

  • Women with PAD have four times the risk of heart attack and stroke.3
  • A person with an ABI of 0.3 (high risk) has a 2 to 3 fold increased risk of 5-year cardiovascular death compared to a patient with an ABI of 0.95 (normal or low risk).
Legs for Life® Data and Gender Differences

The influence of gender on PAD has not been studied and is not defined in the medical literature. However, there is some data collected by the Society of Interventional Radiology Foundation through its Legs For Life® national PAD screening program. From 1999 to 2002, 3,762 people were screened: 2,786 (74%) women and 976 (26%) men. Of the women screened, 1,067 (38%) were at moderate to high risk for PAD compared to 284 (29%) of men screened. Neither smoking nor diabetes was an independent risk factor for PAD by gender, i.e., the risk of having PAD for smokers and diabetics was similar, in both males and females.

Legs For Life has been successful at attracting women to free screenings and is identifying previously under-diagnosed women who are at moderate to high risk for PAD. This SIR Foundation program provides the opportunity to identify asymptomatic and symptomatic women earlier, allowing women to benefit from the same aggressive approach to risk reduction and treatment as men.

Providing a list of risk factors for PAD to women may enable them to be more active in their health care and seek an ABI test and consult with an interventional radiologist to be assessed for vascular disease.

Legs For Life® Free National Screening Program

Interventional Radiologists Screen For Disabling and Life-Threatening Vascular Diseases
Legs For Life is the largest, longest running and most inclusive national vascular disease screening program in the United States. The program has been held annually since 1998 in September, which is Vascular Disease Awareness Month.  Interventional radiologists have screened nearly 322,000 people to date for a variety of vascular diseases:  peripheral arterial disease, abdominal aortic aneurysm, carotid artery disease and venous disease.  Legs For Life is a program of the Society of Interventional Radiology Foundation.  Collaborating organizations include the American Diabetes Association, the American Radiological Nurses Association, the American Heart Association’s Council on Cardiovascular Radiology and Intervention, and the Society for Vascular Nursing.

The program was initially designed to screen patients for peripheral arterial disease (PAD), which is a red flag for several life-threatening vascular diseases, such as heart attack (the #1 cause of death in the United States), stroke (#3) and abdominal aortic aneurysms (#17).

Ten million Americans have PAD – clogged or narrowed arteries in the legs due to atherosclerosis.  Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called plaque that clogs the arteries.  This causes decreased blood flow in the legs and can result in pain when walking, and eventually gangrene and amputation. With more than 50 percent of PAD patients asymptomatic or with atypical symptoms, screening is essential for diagnosis and early treatment. Because atherosclerosis is a systemic disease, people with PAD are likely to develop blocked arteries in other areas of the body.  Vascular diseases caused by atherosclerosis, commonly called “hardening of the arteries,” account for more deaths in the U.S. than any other cause.

The Legs For Life program has expanded to include screenings for abdominal aortic aneurysm (AAA) and venous disease, as well as carotid artery disease which can lead to a stroke.  Since 1998, more than 322,000 people have been screened for PAD.  Screenings for AAA have been given to more than 58,000 people since 2000.  More than 10,500 have been screened for venous disease since 2003.  In 2004, screenings for carotid artery disease were made available and given to nearly 5,000 individuals.

Program Facts
  • Nearly 400,000 free screenings provided (some participants are screened for multiple diseases)
  • 3,825 sites have screened for PAD, AAA, carotid artery disease and/or venous disease
  • One in four screened for PAD were at risk for developing the disease
  • Interventional radiologists lead cardiologists, vascular surgeons, podiatrists, nurses, technologists, medical students and other health care providers during the screenings
  • More than 3.6 million dollars has been distributed by the SIR Foundation to run this health initiative

Local interviews, medical illustrations and broadcast quality video footage are available.
More information can be found at www.LegsForLife.org or www.SIRweb.org.

Public Lacks Awareness of Vascular Damage from Smoking

Minimally Invasive Treatment Options Available for Many Smoking-related Diseases
In the United States, nearly one in five deaths, or an estimated 440,000 deaths per year, are related to tobacco use.1 Approximately half of all Americans who continue to smoke will die due to smoking-related complications.1 Second-hand smoke alone causes 150,000 to 300,000 lower respiratory tract infections, such as bronchitis and pneumonia, in young children each year.1 Of these, between 7,500 and 15,000 result in hospitalization.1 Plus, a pregnant woman can harm or kill her unborn child by smoking.

Of the more than 4,000 chemicals that are emitted by a lit cigarette, 43 are known to cause cancer. Tar that can cause cancer in the tissues it reaches, highly addictive nicotine which affects the nervous system and carbon monoxide that reduces the ability of blood to carry oxygen throughout the body are the most dangerous chemicals. When the chemicals come into direct contact with tissues or organs, such as the mouth, throat, or lung, the rate for cancer is from twice to 14 times as high as that for non-smokers. Although most people are well aware of the risk of cancer from smoking, few people realize the damage smoking causes throughout the body’s vascular system.

Smoking and Vascular Disease

Smoking damages the blood vessels and smokers are at risk for all vascular diseases including peripheral arterial disease, stroke, heart attack, abdominal aortic aneurysm and subsequent death.

In a healthy blood vessel, the inner lining of the arteries, known as the endothelium, constricts and dilates with blood flow. Smoking damages the endothelium, making arteries prone to spasms and deposits of diffuse plaque that diminish their ability to dilate properly.  This condition is known as atherosclerosis, often called “hardening of the arteries.” Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called plaque that clogs the blood vessels and makes them less elastic.

Smokers are at increased risk for peripheral arterial disease, clogged arteries in the legs, that cause insufficient blood flow to get to the leg muscles. This causes pain, especially when walking and, left untreated, this insufficient blood flow can lead to limb amputation. While this may require angioplasty and stenting to improve blood flow, many people can avoid these procedures and alleviate their symptoms just by quitting smoking and beginning a specific exercise regimen. Smoking makes that big a difference in vascular disease.

Treatments

Interventional radiologists provide treatment for many smoking-related diseases. Since they are first trained in diagnostic radiology, they use imaging to understand, visualize, and diagnose the full scope of the disease’s pathology and to map out the procedure tailored to the individual patient. Then during the procedure, they image as they go, literally watching and guiding their catheter through the vascular system or through the skin to the site of the problem. Following are some of the conditions that can be treated by interventional radiologists:

Aortic Abdominal Aneurysm – A weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges like a balloon and can burst resulting in death if it gets too big. An interventional radiologist can perform a stent graft to reinforce the weak artery wall and avoid major abdominal surgery.

Peripheral Arterial Disease – Hardening of the arteries (atherosclerosis) in the legs that can cause intermittent claudication—pain that occurs when a person walks and subsides when s/he stops. Atherosclerosis causes the arteries that carry blood to the arms or legs to become narrowed or clogged. Interventional radiologists can treat this by performing a balloon angioplasty to open a blocked artery and placing a stent to hold the artery open, if needed. However, many people are treated just with smoking cessation and a medically supervised exercise program.

Carotid Artery Disease and Stroke – In some patients, atherosclerosis in the carotid artery in the neck can lead to ischemic stroke. Plaque build-up in the carotid artery may result in a stroke by either decreasing blood flow to the brain or by breaking loose and floating into a smaller vessel, depriving a portion of the brain of blood flow. In patients at high risk of having a stroke, the narrowed section of artery may be reopened by an interventional radiologist through angioplasty and reinforced with a stent, thereby preventing the stroke from occurring.

Stroke – Most commonly caused by a blood clot in the brain that starves the brain from receiving oxygen, which can cause the affected sections of the brain to die. If caught in time, within six hours of the symptoms, an interventional radiologist can deliver a clot-busting drug directly into the brain to the site of the clot to dissolve it and restore blood flow to the brain. This treatment can often prevent the disabling effects of a stroke.

Lung Cancer – Cigarette smoking is the most common cause of lung cancer.2 Interventional radiologists can treat lung cancer patients nonsurgically by “freezing” tumors with cryotherapy or “cooking” them with radiofrequency heat.

Kidney Cancer – 32,000 Americans are diagnosed with kidney cancer each year.2 Although surgical removal of the kidney offers the best chance for a cure, some patients are not surgical candidates. Interventional radiologists offer nonsurgical treatment using radiofrequency heat that “cooks” and kills the tumor.

Osteoporosis – Because smokers have lower levels of estrogen, smoking is bad for their bones and is a risk factor for osteoporosis, which can result in spinal fractures.3 By injecting bone cement through a needle into fractured vertebrae, interventional radiologists can shore up the vertebra and relieve pain. This procedure, known as vertebroplasty, is a pain treatment for people with spinal fractures that have not responded to medical management.

Benefits of IR Treatments
  • Often no general anesthesia is required
  • Procedures are often outpatient
  • Less risk
  • Less pain
  • Less risk for infection
  • Shorter hospital stay