Peripheral Arterial Disease (PAD)
Peripheral arterial disease involving the lower extremity arteries is a relatively common condition and is caused by atherosclerosis. The most typical symptom is intermittent claudication. This symptom is usually described as an aching or pain in the muscles of the calf or thigh associated with walking. The symptom is typically reproducible at about the same walking distance each time the patient walks. More severe symptoms of lower extremity occlusive disease may include ischemic pain at rest or ischemic ulceration of the foot or toes. The occurrence of these symptoms tend to increase with advancing age. They are often associated with risk factors such as cigarette smoking, diabetes mellitus and abnormal elevations of cholesterol and triglycerides.
Atherosclerosis tends to occur in a segmental fashion involving the lower extremity arteries. It is often characterized as involving the aortoiliac segment, the femoral popliteal segment or the tibial outflow segment. Individual patients may have disease isolated to a single segment or have multilevel disease, other individuals such as those with diabetes may have disease confined primarily to the smaller tibial vessels beyond the level of the knee. Symptoms associated with atherosclerosis may occur very gradually over long periods of time. Without noticing it very much, an individual may have a progressive decrease in their walking distance until their activities are almost sedentary. Some people may attribute their condition to "arthritis" or simply being "out of shape." When pain or tissue ulceration in the lower extremity make it apparent that the arteries are obstructed with atherosclerosis, more objective tests can be obtained to define the extent and severity of the occlusive process. These studies may involve non-invasive pulse volume recordings or Doppler interrogation of the lower extremity arteries as well as invasive tests such as arteriograms. The information obtained from these specialized studies will delineate the severity and extent of the occlusive process.
Treatment: Most patients with claudication can be managed conservatively with exercise and medication. Risk factor modification may also help to stabilize their disease. Patients with more severe symptoms such as disabling claudication or limb threatening arterial insufficiencey require a more aggressive approach. If vascular surgery is necessary, the vascular surgeons at Danbury Hospital have a large experience with both primary and reoperations for lower extremity occlusive disease. They have the ability to utilize a wide array of surgical techniques tailored to the individual patient. Other treatment options include balloon angioplasty, stenting and laser atherectomy or a combination of these therapies. Diabetic patients tend to have disease which affects the smaller vessels in the leg and may not have a surgical option. Laser atherectomy has been especially useful for these patients.
