Heart & Vascular:
Conditions & Treatments
The medical, surgical and catheter-based treatment of peripheral arterial disease (PAD) is a combined effort of the Emory Heart & Vascular Center, the Division of Vascular Surgery & Endovascular Therapy as well as the section of Interventional Radiology. Emory’s physicians are national leaders in the diagnosis, treatment and research of peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD). The challenge with this life-threatening disease is at least half of the people who have PAD don't have any signs or symptoms. And, unfortunately, an artery can be blocked by 60 percent before a patient even realizes something may be wrong.
Because atherosclerosis is a systemic (affects the entire body) disease, it is common for people with PAD to have blocked arteries in other areas of the body. The eight to 12 million people in the U.S. who suffer from PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions.
It is estimated that less than two million people are actually diagnosed with PAD and less than 700,000 are treated each year.
The most common symptom of PAD is leg pain that occurs when walking or exercising and improves with rest. Other symptoms include numbness and tingling in the lower legs and feet, cold lower extremities and decreased hair growth.
Because atherosclerosis is a systemic disease (affects the entire body), it is common for people with PAD to have blocked arteries in other areas of the body. People who suffer from PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also associated with diabetes and hypertension, among other conditions.
Unfortunately, PAD can close an artery by 60% before any of these symptoms present themselves. That is why Emory Heart & Vascular Center physicians focus on patient, community and physician education about PAD. Awareness and early detection are critical parts to keeping vital arteries in the arms and legs healthy.
Based on the results of your ABI, as well as your symptoms and risk factors for PAD, your physician can decide if further tests are needed. When the ABI indicates that an individual may have PAD, other imaging techniques may be used to confirm the diagnosis, including duplex ultrasound, magnetic resonance angiography (MRA) and computed tomography (CT) angiography.
- Are over age 50
- Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
- Have high cholesterol or high lipid blood test
- Have diabetes
- Have ever smoked or smoke now
- Are overweight
- Have an inactive lifestyle
- Have a personal history of high blood pressure, heart disease, or other vascular disease
- Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by resting
- Have pain in the legs or feet that awakens you at night
- Stop smoking
- Eat a low-fat, low-sodium diet
- Increase exercise under a doctor’s care
- Manage health problems such as diabetes, high cholesterol, and high blood pressure
- Practice good foot and skin care by examining legs and feet every day and applying moisturizing cream to prevent dry skin
Drug Therapy: Certain medications in combination with exercise can improve the discomfort experienced by patients with claudication (pain and cramping that leads to limping). Our board-certified interventional cardiologists coordinate this drug therapy with patients' other medications to avoid side effects.
Percutaneous Revascularization: Compared to surgery, treatment of PAD through catheter techniques, as listed below, allow for treatment of blockages in the legs with fast patient recovery time.
Balloon Angioplasty: In balloon angioplasty, a miniscule balloon attached to a thin tube (catheter) is inserted through the blocked blood vessel. Under X-ray guidance, our interventionalists direct the catheter to the site of the blocked artery, where the balloon inflates, opening the vessel.
Stenting: In many instances where balloon angioplasty is used, the blockage may fail to expand or may return quickly. In these cases, a metal stent is delivered, under X-ray guidance, to the blockage site to act as a scaffold to hold the artery open. There are many types and sizes of stents, which are individually chosen by the interventionalist to fit each specific artery being treated.
Atherectomy: Atherectomy is a minimally invasive procedure that removes plaque and blockage from sites of severe arterial narrowing. Unlike angioplasty and stent placement that push blockages aside, atherectomy involves inserting a thin catheter with a rotating blade or burr to grind away the plaque in the arteries to restore blood flow. The procedure is considered less invasive than endarterectomy, which involves surgical removal of the plaque.
Surgical Revascularization: At times of severe blockage in several leg arteries, balloon angioplasty and stent placement may not sufficiently restore circulation. In such cases, revascularization by surgical bypass is frequently the treatment of choice. The procedure usually involves removing a vein from the patient's leg and using it to route blood flow around the blocked segments of artery.
Emory has one of the first programs in the country to evaluate gene therapy for treatment of claudication. Our physicians have performed several thousand angioplasty and surgical bypass grafting procedures.
Chandan Devireddy, MD
Michael McDaniel, MD
Khusrow Niazi, MD
Arshed Quyyumi, MD
Gregory C. Robertson, MD
Bryan Wells, MD
Thomas F. Dodson, MD
Yazan Duwayri, MD
Ravi K. Veeraswamy, MD
Irwin Best, MD
Sean Dariushnia, MD
Gail Peters, MD
Roger Williams, DO
If you would like to schedule an appointment with one of Emory’s PAD physician experts, call Emory HealthConnection℠ at 404-778-7777.
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