Peripheral Artery Disease

You’ll work with a specialist with years of experience and training in diagnosing and treating vascular (circulatory system) diseases. Your doctors include:

• Vascular surgeons and vascular interventionists: These experts specialize in vascular disease and can diagnose peripheral artery disease in specialized vascular labs. Vascular surgeons are trained to treat PAD with medication management and lifestyle changes. They also offer minimally invasive, catheter-based procedures such as angioplasty and stenting, as well as open surgery. By offering all treatment options, vascular surgeons can tailor your care to your individual symptoms and needs.
• Vascular medicine specialists: These doctors specialize in diagnosing vascular conditions, as well as managing less severe disease. Vascular medicine specialists offer medications, supervised exercise therapy, wound care and lifestyle changes.
• Preventive cardiologists and interventional cardiologists: Some cardiologists use minimally invasive procedures to diagnose and treat peripheral artery disease. Other cardiologists work to slow or stop the disease’s progression, as well as to diagnose it. Some people with PAD also have coronary artery disease, which our cardiologists can treat.
• Interventional radiologists: At times, some imaging specialists perform minimally invasive procedures to treat complex peripheral artery disease. Learn more about interventional radiology.

PAD is also sometimes called peripheral vascular disease (PVD). It affects arteries carrying blood to the limbs, most commonly the legs. In PAD, the arteries become narrowed, which reduces blood flow.

When the legs don’t receive enough blood, two conditions can develop:

• Intermittent claudication: In its early stages, PAD causes leg pain and fatigue. You might notice these symptoms when walking, climbing stairs or doing other physical activity.
• Critical limb ischemia (CLI): In advanced PAD, blood flow becomes severely and dangerously restricted. Pain, typically in the foot, worsens and occurs even at rest. CLI can lead to more severe problems including open sores (ulcers) that don’t heal and gangrene (tissue death). These problems increase your risk of losing your limb.

Complications of PAD

• If left untreated, PAD can lead to serious or even life-threatening conditions, including:
• Blood clots or abrupt cutoff of blood flow through the artery
• CLI
• Heart attack
• Stroke

PAD results from atherosclerosis, also known as hardening of the arteries. Cholesterol and other fatty substances in the blood can build up on artery walls, causing them to narrow.

The buildup, called plaque, also causes arteries to stiffen. Hardened arteries can’t widen to handle more blood flow when you need it, such as during exercise. Atherosclerosis keeps the legs from receiving enough blood and oxygen.

Certain factors can increase your risk of developing PAD, such as:

• African-American heritage
• Age (60 or older)
• Diabetes
• Family or personal medical history of atherosclerosis, heart disease or stroke
• High blood pressure
• High cholesterol
• Smoking

The symptoms of PAD depend on whether the disease is in its early stages or has progressed. Symptoms typically occur in the legs, but can also occur in the arms if arteries become clogged there.

Usually, the first symptom to appear is occasional leg pain (intermittent claudication), which:

• Varies from mild to severe
• Can feel like calf or thigh cramping with walking
• Goes away with rest

Other early PAD symptoms:

• Coldness
• Numbness, especially at rest
• Pale skin

Late-stage symptoms:

• Hair loss or slower hair growth on the legs
• Pain and muscle cramps even at rest or when lying down
• Shiny skin
• Sores that don't heal
• Tingling that can become severely painful

At Henry Ford, our vascular specialists conduct a thorough evaluation, usually with advanced diagnostic imaging, to determine what’s causing your symptoms. With an accurate diagnosis, we develop a treatment plan tailored to your needs.

Starting with your first visit, we get to the source of your symptoms so you can start to feel better. Here’s what to expect in this visit:

• Review of your family health history
• Questions about your symptoms, medical history and possible risk factors
• Physical exam to look for signs of PAD, such as slow-to-heal wounds and changes in the hair, skin or nails on your legs and feet

Imaging and other tests for PAD

We may perform one or more diagnostic tests to look for atherosclerosis in leg arteries and rule out other conditions. Our experts use special equipment and sophisticated techniques to confirm a diagnosis.

Advanced diagnostic testing may include:

• Ankle-brachial index (ABI): We compare blood pressure measurements in your arm and ankle to check for differences. A difference can mean a blockage or narrowing in your leg arteries. Our doctors typically perform ABIs using Doppler ultrasound, which uses sound waves to measure movement, such as blood flow, inside the body.
• Duplex ultrasound: Traditional ultrasound (still images) combined with Doppler ultrasound looks at blood flow in the legs and feet for signs of narrowing or blockage. Duplex ultrasound provides a noninvasive method to view leg arteries without the need for contrast or a catheter.
• Computed tomography angiography (CTA): This angiography procedure uses CT, a type of specialized X-ray equipment, to produce images of the leg arteries. CTA is minimally invasive because the contrast agent is injectable.
• Angiography/arteriography: In rare cases, the doctor makes a small incision to access an artery, then inserts a catheter (thin, flexible tube) and guides it to the affected area. After injecting a substance called a contrast agent that highlights arteries, the doctor takes X-rays.
• Magnetic resonance angiography (MRA): MR scanning uses a large magnet and radio waves to produce detailed images and look for blockages in leg arteries. MRA is noninvasive, as it doesn’t require a catheter procedure.
• Treadmill test: You walk on a treadmill to evaluate your leg pain and determine the level of exercise that causes it.
• Blood tests: We take a blood sample to test for risk factors such as diabetes (high blood sugar) and high cholesterol.

At Henry Ford, our vascular doctors offer every available treatment for PAD. Your care team works closely with you to customize a treatment plan based on your symptoms, risk factors and test results.

The treatment goals for PAD are to:

• Relieve leg pain and other symptoms so that you can exercise and do everyday activities
• Treat atherosclerosis to help prevent complications such as heart attack, stroke and critical limb ischemia, which can lead to amputation
• Maintain your overall health to help improve your quality of life

Exercise therapy and medications for peripheral artery disease

When possible, our vascular specialists begin treatment with noninvasive therapies, which can include:

Counseling about healthy lifestyle habits

Small lifestyle changes can effectively relieve your symptoms. Our preventive specialists have years of experience helping people with PAD develop realistic goals that can improve the way they feel.

You can work with us one-on-one, or we can refer you to Henry Ford programs such as:

• Tobacco Treatment Service, which includes options for individual coaching by phone and Freedom From Smoking® classes
• Henry Ford PREVENT Program, a medically supervised exercise program with individual and group options, nutrition classes and education on healthy habits

Supervised exercise therapy for PAD

You have access to supervised exercise therapy (SET), approved and covered by Medicare. Research has shown that SET can help people with PAD walk farther after they complain of occasional leg pain (intermittent claudication).

Our 12-week SET program includes:

• Supervised therapy with our exercise physiologist three times per week on a treadmill
• A plan to continue walking on your own, with or without a treadmill

Medication to treat peripheral artery disease

Medication can help relieve your symptoms and manage other health conditions that contribute to PAD. Depending on your specific needs, our team carefully selects medications such as:

• Blood thinners to improve circulation and prevent blood clots, stroke or heart attack
• Insulin or other drugs to manage elevated blood sugar
• Medications to lower blood pressure
• Pain medications to ease leg pain
• Statins to control high cholesterol
• Vasodilators to help improve blood flow to your muscles during walking or other exercise

Wound care for legs and feet

If you have PAD, you may have a higher risk of developing chronic, nonhealing wounds on your legs and feet. The risk can be even higher if you also have diabetes.

Chronic wounds can become infected and lead to tissue death. In severe cases, this condition may require limb amputation.

Henry Ford offers comprehensive treatment at our Wound Care Centers across southeast and south-central Michigan. Learn more about our team and the services available at our Wound Care Centers.

Minimally invasive treatments for peripheral artery disease

If medications and other conservative treatments don’t control your symptoms, we offer the latest minimally invasive procedures to treat PAD.

Our board-certified specialists have extensive training and experience in these endovascular procedures, which go inside the artery to provide treatment. They only require small incisions, so most people can go home the same day. You heal faster after a minimally invasive procedure, for an easier recovery.

The endovascular procedures we offer for PAD include:

• Angioplasty and stenting: We usually perform angioplasty at the same time as a diagnostic angiogram. After taking pictures, your doctor guides a catheter (thin, flexible tube) tipped with a tiny balloon to the treatment site. The doctor inflates the balloon to widen the artery and press any blockages against its walls, improving blood flow. Sometimes, we insert a stent (tiny mesh tube) to help keep the artery open. Some stents are coated with medication that slowly releases to prevent future blockages.
• Atherectomy: In some cases, we remove plaque during an angiogram rather than compress it, using a catheter tipped with a tiny blade. Your doctor captures larger pieces of cut plaque, while smaller pieces safely wash away in the bloodstream.
• Thrombolysis: Also called thrombolytic therapy, this treatment uses medications to dissolve blood clots blocking a leg artery. Your doctor can deliver the medication into the artery by injection or with a catheter procedure.

Surgery to treat peripheral artery disease

You may need surgery for severe blockages or blockages that worsen after receiving angioplasty and stenting. Our expert vascular surgeons perform open surgery to restore blood flow and reduce the risk of losing a limb to amputation. Learn more about vascular surgery at Henry Ford.

The vascular surgeries we offer include:

• Endarterectomy: To start, your surgeon makes an incision to open the artery at the blocked area. The surgeon then removes the plaque and, in some cases, the diseased part of the artery. If needed, the surgeon closes the artery with a patch made of synthetic material or a portion of another blood vessel.
• Bypass: Your surgeon makes an incision to access the artery and attaches an implant (graft) above and below the blockage. The graft provides a new path for blood to flow around the blockage. Surgeons use either a synthetic tube or a portion of a blood vessel from elsewhere in your body.