Scripps is at the national forefront of treating people with peripheral artery disease (PAD). In addition to offering evidence-based surgical approaches that have stood the test of time, newer minimally-invasive procedures available at Scripps are giving patients hope and relief — even among difficult cases that were once nearly impossible to treat with standard methods.
Patients from outside San Diego (including Orange County, Los Angeles, and many other western states) travel to Scripps for their PAD care, because our wide range of treatment options have helped many people eliminate pain, heal chronic wounds and avoid amputation.
Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD), occurs when arteries in the legs, arms, kidneys, or neck become narrowed due to the buildup of fatty deposits and calcium. These narrowed arteries restrict blood flow, which often causes feelings of heaviness and discomfort in the legs. Over time, walking may become difficult.
In severe cases, PAD can lead to limb-threatening situations such as continuous resting pain, poorly healing wounds or even gangrene. Many patients with advanced peripheral artery disease face the possibility of amputation if they don’t receive timely and appropriate care.
Scripps doctors are experts at diagnosing the many symptoms of peripheral artery disease. They provide specialized care for the following symptoms and conditions:
- Claudication, which is the pain, fatigue or weakness that can occur in your legs during physical activity such as walking. Symptoms typically begin when you start to exercise, and go away a short time after you rest. Some people also experience tightness, heaviness or cramping in one or both legs.
- Ischemic ulcers, also known as arterial or vascular ulcers, are open sores that are slow to heal or won’t go away. They often occur on the feet due to poor blood circulation.
- Rest pain, or pain in the lower legs that is often severe, even at rest. It’s caused by insufficient blood flow to the muscles, due to narrowed or blocked arteries in the legs.
- Infrainguinal occlusive disease refers to narrowing or blockage within a group of arteries found in the lower extremities, specifically the femoral, popliteal, or infrapopliteal arteries in the legs.
The following conditions, while rare among the general population, have a higher incidence among people who are active, including both amateur and professional athletes. Scripps vascular surgeons are experienced in recognizing and treating these peripheral artery disorders:
- Popliteal artery entrapment syndrome (PAES), a condition that occurs when the popliteal artery (the main artery that runs behind the knee) is compressed by the muscles and tendons near the knee. Compression of this artery causes reduced blood flow to the lower leg, resulting in pain, numbness or cramping in the calf muscle.
- Popliteal artery aneurysm, which is a bulge in the popliteal artery that runs behind the knee. These aneurysms can result in blood clots that restrict or reduce blood flow to the lower leg.
- Compartment syndrome is a painful condition that occurs when extreme pressure builds within muscles, which decreases blood flow and prevents blood and oxygen from reaching the affected muscles and nerves. Chronic compartment syndrome worsens over time, often in people who run or participate in athletic activities. Acute compartment syndrome, typically caused by a severe injury, is considered a medical emergency.
- Iliac artery endofibrosis refers to leg pain and weakness caused by damage to a group of major blood vessels, known as the iliac arteries, which supply blood to the pelvis, groin and lower legs. The condition is most common in high performance cyclists and can result in significant loss of function.
Patients with PAD typically do not experience symptoms until later in life because plaque and calcium deposits slowly build up in the arteries over many years. Patients who smoke tobacco or who have diabetes, however, may develop significant PAD even at younger ages. People with peripheral artery disease may experience no noticeable symptoms, or they may experience one or more of the following:
- Poorly healing or non-healing wounds on the toes, feet, or legs
- Lack of healthy blood flow in the feet, legs and arms
- Absence of pulses in the legs, arms, or feet
- Painful or heavy muscles in the legs or arms with activity
- Significant pain in the feet and toes while trying to sleep at night
- Onset of gangrene in the feet or legs
- Family history of vascular disease
- Tobacco use
- High blood pressure
- High cholesterol
- Age (50 or older)
Scripps physicians can diagnose PAD using one or more of the following tests:
- Ankle/brachial index (ABI), which measures blood pressure at the ankle and arm
- Doppler ultrasound, an imaging study that evaluates blood flow through a blood vessel
- Extremity angiography
- Computed tomography angiography
- Magnetic resonance angiography
Our vascular surgeons work closely with other specialists, including interventional cardiologists, to offer a wide range of treatment options no matter how complex your condition. Scripps offers the following open surgical and endovascular approaches to treat PAD:
- Angioplasty and stenting. Traditional angioplasty and stenting helps inflate and prop open a narrowed artery.
- Drug-coated balloon angioplasty. During the procedure, a tiny balloon coated with medication is threaded into the narrowed artery. Once inflated, the balloon flattens the plaque to allow for improved blood flow, while the medication is deposited into the artery wall. The balloon is then removed with only the medication left behind. Scripps was the first in California to treat PAD with this procedure.
- Endarterectomy, a surgical procedure in which plaque is removed from an artery so it is no longer narrowed or blocked.
- Vascular bypass surgery, a procedure that allows your surgeon to create a detour around the narrowed or blocked portion of an artery. This “bypass,” made from one of your own veins or from synthetic material, allows blood to flow around the blockage.
- Thrombolysis, or thrombolytic therapy, treats PAD by breaking up clots that have formed inside an artery. Clot-dissolving medication can be injected directly into the blood vessel, or deposited via a catheter that is threaded into the artery. The catheter may also carry a device that can help break up the clot mechanically.
At Scripps, our focus is about more than treating your arterial blockage. We also aim to reduce other existing risk factors that may continue to affect your vascular health, including high blood pressure (hypertension), high cholesterol, diabetes, tobacco use and poor dietary habits. Serious conditions associated with PAD include heart attack and stroke, among others, so it’s vital to see your doctor if you believe you may be
developing or already have peripheral artery disease.