Author: Western Vascular Institute

Peripheral Artery Disease is a severe form of vascular disease that affects the arteries outside of the heart, primarily the lower extremities. Peripheral Artery Disease or PAD is a gradual build-up of plaque on the walls of the arteries. This gradual build-up of plaque hardens the arteries, making them less flexible and narrows the opening for blood to flow from the heart to all the appendages freely. Many PAD patients have burning, aching pain after walking or pain in the calf, thigh, or buttocks. Treatment for PAD is varied and depends on the seriousness of the disease.

Your Vascular Surgeon will discuss an individualized systematic review of all available treatment modalities, generally from the least invasive to most invasive, and suggest the most appropriate treatment based on how the disease has progressed and what is in the best interest of each patient. Vascular Surgeons are the only specialist able to provide all treatment options ranging from medications to open surgical bypass but generally try to provide the least invasive form of treatment first.

Most common treatments for PAD 

Lifestyle Changes:

1. Walking is one of the most effective measures a patient can take to reduce the symptoms of PAD. Walking has been found to reduce the symptoms and stop further disease progression. Although PAD cannot be totally healed, its progression can be slowed to the point that it does not affect the patient’s activities of daily living. Walking reduces plaque build-up and helps to lower cholesterol and blood pressure, and aids in maintaining a healthy weight.
2. Smoking cessation – Smoking is one of the main risk factors for PAD. Smoking damages blood vessels and makes it difficult for the blood to flow compressed arteries. Smoking also increases the risk for blood clots by decreasing the movement of cholesterol through the arteries and hardening the arterial walls.
3. Diet – A healthy diet plays a serious role in overall vascular health. Avoiding foods high in fat and adding fresh fruits and vegetables dramatically reduces the effects of PAD.

Medications Symptom relief medication- Your doctor may prescribe medication to increase blood flow, thin the blood, and assist in widening the vessel body.

1. Blood clot prevention – Medications such as Plavix are used to reduce the chance of blood clots and improve overall blood flow.
2. Medication to control blood sugar – For patients with diabetes (Another top risk factor for PAD), reducing sugar levels in the blood is paramount. High levels of sugar in the blood damage the arteries’ lining, making it much more susceptible to atherosclerosis.
3. Medication for high blood pressure – High blood pressure over time can weaken the arterial walls. Reducing the pressure where/when possible is essential in keeping the arterial walls healthy.
4. Medication to lower cholesterol – LDL cholesterol is the fatty substance that builds up in your bloodstream and forms a plaque on the arterial walls that reduce the artery’s diameter, making it much more difficult for blood to flow through.

Minimally Invasive (In-office procedure)

When lifestyle changes and medications do not sufficiently reduce PAD symptoms, your Vascular Surgeon may suggest a minimally invasive vascular procedure to widen the artery at the location where the plaque has reduced the flow of blood. These procedures are done in the “In-Office” angiography suite at our Mesa and Phoenix locations.

1. The first option of in-office PAD treatment is Angioplasty. In an Angioplasty your Vascular Surgeon will insert a small catheter into your artery, using the artery as a raceway, and place a wire within the catheter that has a balloon on the tip down to the disease area. Once in the disease or narrowed area, the balloon is expanded, pressing the plaque against the wall and opening the artery for a more effortless blood flow.
2. Another treatment offered in the angiography suite is the use of an atherectomy device. An atherectomy device is guided through a catheter inserted into the artery similar to an angioplasty; then, the device uses high-energy laser light to vaporize the plaque blockage resulting in increased blood flow to the peripheral vessels and tissues.
3. Stents are another minimally invasive in-office treatment offering vascular surgeons use to improve symptomatic PAD patients. Stents are also placed via a catheter in the artery and are guided to the diseased area after ballooning to create a structural scaffold to hold the diameter of the artery wall open for patent blood flow.

These minimally invasive treatments are used in concert to provide patients with minimally invasive yet highly effective treatments for PAD by a Vascular Surgeon. This form of treatment is almost always performed before taking the patient into the hospital, hoping that a less invasive procedure will provide relief and vascular improvement in a more comfortable setting. Patients who have angio procedures in our in-office angiography suite leave the same day as their treatment, generally within a few hours of the operation.

Hospital-based surgical procedures are the last level of treatment when the other treatments options have not been sufficient, or the disease has progressed past their efficacy. Vascular Surgeons are the only “vascular specialist” that can provide all the other procedures and hospital-based open and endovascular surgical procedures. Our surgeons are Board Certified and Fellowship Trained, holding hospital privileges at all local hospitals with vascular capabilities. These in-hospital vascular treatment options are as follows:

1. Bypass surgery – Your vascular surgeon may choose to perform bypass surgery to treat your PAD. Bypass is accomplished by redirecting the flow of blood around the diseased area. In bypass surgery, a Vascular Surgeon will either use a synthetic graft or the patient’s vein to make a new route around the blocked or narrowed area “bypassing” to the site of best blood flow.
2. Endarterectomy – A Vascular Surgeon performs this treatment in the hospital by making an incision at the site of the arterial blockage. The blood from the artery will be rerouted around the blocked area during the surgery. The artery is opened at the blockage site and then removed. After removal, the artery is stitched up, and the reroute removed. The artery now has open blood flow throughout, improving the patients’ symptoms.