Peripheral Arterial Disease

with Bradley Mays, M.D., and Craig Siverhus, M.D., Vascular Surgery, Columbia St. Mary’s

Posted: May 1, 2004

Peripheral arterial disease (PAD) is a blockage of arteries in areas of the body other than the heart or brain. The lower extremities are the most frequent site of disease.

The blockages are characterized by narrowing and hardening of the artery over many years. The result is a loss of blood flow to those areas, which can ultimately lead to nerve and tissue damage and loss of limb. This process can occur in any peson of advanced age, but seems to be accelerated by smoking and diabetes.

Bradley Mays, M.D., (shown left) and Craig Siverhus, M.D., (shown right) Vascular Surgery, Columbia St. Mary's

Symptoms
The symptoms of PAD in the legs usually follow a predictive course. Claudication isn’t a common word, but knowing what it is and what it means could potentially save your life or that of someone you love. Defined as leg pain that occurs while walking and stops soon after the walk is over, claudication is one of the earliest signs of PAD.

“The pain stops when you stop,” said Dr. Bradley Mays, a vascular surgeon with Columbia St. Mary’s. “It’s very reproducible.” This pain is thought to be due to build-up of lactic acid in the muscle deprived of adequate blood flow. If ignored, the pain can get worse, occurring even when a person is at rest.

The simplest way to diagnose PAD is by physical examination and usually is distinguished by he absence of pulses in the foot. However, one can still have pulses in the feet in the presence of PAD.

A simple and fairly reliable test is the ratio of ankle blood pressure to arm blood pressure, commonly called the ankle-brachial indices (ABI). An abnormal result is less than 1.0.

Treatment
The treatment of PAD ranges from lifestyle modification and a walking exercise program to medication and finally, invasive procedures. “Many facors contribute to PAD,” said Dr. Craig Siverhus, a vascular surgeon at Columbia St. Mary’s. “We’ve created the Columbia St. Mary’s Vascular Institute to provide a multidisciplinary approach to best care for these patients.”

If PAD is treated early by controlling risk factors like hypertension, diabetes and high cholesterol, along with lifestyle changes, symptoms may not progress and may improve.

Invasive procedures include angioplasty (balloon dilation) and stenting for short segments of arterial blockage and surgical bypass when more extensive areas of arterial blockage are present.

Invasive procedures are usually reserved for patients with severe blockage resulting in open sores or constant pain which is not relieved by rest. Prior to undergoing an invasive procedure, patients will need to have some type of imaging study such as magnetic resonance (MRI) or catheter angiography.

The outcomes of these procedures are variable depending on the disease severity and patients should always inquire about the long-term results of the particular procedure their physician is recommending. While angioplasty and stenting have made great strides in treating vessels of the heart, there are no long-term studies comparing this technology to bypass surgery in treating non-healing wounds or rest pain of the lower extremities.

Surgery is done on an in-patient basis, said the doctors, but discharge and recovery times can vary widely depending on the patient’s situation. “Some patients can leave the hospital in one day, others may be in the hospital for as long as a week,” Dr. Mays said.

Vascular Institute
Siverhus, Mays and other doctors at the Vascular Institute will treat PAD patients whose conditions are complicated by other issues, such as diabetes, hypertension or hypercholesterolemia. They’ll also treat patients whose symptoms are primarily lifestyle-related.

Both doctors emphasized that patients with diabetes need to be carefully monitored since their condition increases the chance for complications, such as non-healing wounds, and raises the possibility of amputation.

Smoking, both doctors said, is a major contributing factor in PAD. “And the risk factors are additive,” Dr. Siverhus said, “so if you have diabetes and you smoke or have hypertension it significantly increases your risk for PAD.”

Dr. Siverhus emphasized, “Many of our patients are frail and elderly. We can provide a tremendous service if we can keep people walking and living independently. We find it exceedingly satisfying to help them maintain their independence and quality of life.”

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