Controlling Peripheral Arterial Disease

Peripheral Arterial Disease, or PAD, affects as many as 12 million Americans. With PAD, the blood vessels that supply your legs, feet and arms with fresh blood become narrowed by fatty deposits. This slows blood flow and can lead to blockages, increasing your risk of heart attack or stroke by four to five times. Ultimately, PAD may lead to ulcers, gangrene and amputation if left untreated.

Symptoms that may indicate the presence of PAD include leg pain while walking or climbing stairs, numbness, and cramping. When the legs are at rest, the pain goes away. However, as the disease progresses, the pain can persist even when the legs are at rest, especially at night. Because diabetics are prone to neuropathy, PAD is sometimes misdiagnosed as neuropathy, which is a burning or painful discomfort in the feet or thighs. 

The two biggest risk factors for PAD are diabetes and cigarette smoking. Other contributing factors include obesity, physical inactivity, high cholesterol, kidney failure, heart disease, hypertension and genetics.
Diagnosing PAD involves a physical examination followed by a series of tests. First, a Doppler, or simple ultrasound, allows us to see the vessels and measure pressures. The next test is an angiogram, an X-ray that uses a special dye and camera to take pictures of the blood flow in an artery.

Once diagnosed, patients are started on a conservative course of therapy that involves behavior modification. Depending on the individual, risk factors to be controlled include lowering blood pressure, getting sugars under control, or quitting smoking. There are some excellent smoking cessation programs in the area, such as the one offered by WellGroup Partners in Olympia Fields.

One of the most important things patients can do to help themselves, if they are able, is to walk. Walking 30 to 40 minutes, three to four times a week can make a significant difference in controlling PAD. While the blockages in the arteries will never go away, walking can help build up existing small vessels that can take over for the blockage.

If conservative therapy fails, patients are put on a daily aspirin and a cholesterol medication. The next steps include options that range from minimally invasive to major surgery to a hybrid procedure. Minimally invasive procedures include balloon angioplasty, stent insertion, atherectomy, or thrombolitic therapy. Considered major surgery, a bypass involves creating a new pathway through which blood can flow that goes around the blockage. A hybrid procedure, endarectomy, combines minimally invasive and minor surgery to core out the obstructing plaque inside the artery.

Following minimally invasive procedures, typically 80% of the vessels are still open after a year. This gives patients an opportunity to capitalize on the positive effects of having an increased bloodflow, start walking, and take charge of whatever controllable factors are affecting their condition, be it blood sugar, smoking or others.

WellGroup Partners implements my LEA-UP program, which stands for lower extremity amputation and ulcer prevention. Using a team approach, the patient’s endovascular surgeon, internist and other physicians involved in the patient’s medical care work together. In addition to addressing pertinent issues such as smoking cessation, patients are sent to a podiatrist for a foot check.

A significant benefit of such a team approach is the communication between doctors and the accompanying ability that provides to aggressively monitor conditions. Patients experience fewer ulcer and antibiotic days and fewer days off work. LEA-UP can help stop the progression of PAD as well as improve other conditions. In the four years this program has been implemented, at St. James has seen a 30% drop in its amputation rate.

Eugene Tanquilut, DO, is a vascular surgeon at WellGroup Partners in Olympia Fields, and is affiliated with Franciscan St. James Health, which is a member of the Southland Health Alliance.