Heart & Vascular:
Conditions & Treatments

Peripheral arterial disease (PAD), also called peripheral vascular disease (PVD), is a life- and limb-threatening condition that develops as a result of atherosclerosis, a buildup of fatty deposits and plaque in the lining of blood vessels. When plaque builds up in the blood vessels that carry blood from the heart to the rest of the body, they harden, narrow and clog, causing poor circulation. This diminished blood flow can result in a number of serious conditions, including leg ulcers or sores, infections and gangrene (death of soft tissue).

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.

The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity. Other symptoms of PAD include: numbness and tingling in the lower legs and feet, cold lower legs and feet, and ulcers or sores on the legs or feet that don't heal.

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.

The most common test for PAD is the ankle-brachial index (ABI), a painless exam in which a special stethoscope is used to compare the blood pressure in your feet and arms. The blood pressure in your arms and ankles is checked using a regular blood pressure cuff and a special ultrasound stethoscope called a Doppler. The pressure in your ankle is compared to the pressure in your arm to determine how well your blood is flowing and whether further tests are needed.

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.

You should be tested if you:

• 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

Have You Been Diagnosed with PAD? If so, here’s what you can do-the following lifestyle changes can make a difference:

• 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

Exercise Training: With peripheral arterial disease, muscles receive only limited amounts of oxygen due to impaired circulation. This lack of oxygen causes pain while walking called claudication. Over time, intensive exercise training can train muscles to use oxygen more efficiently and to grow new blood vessels; gradually allowing the patient to walk further and with less pain.

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 physicians were among the first in the country to offer a minimally invasive artherectomy procedure for people suffering with PAD. The treatment, which uses new technology to grind away plaque in the arteries, is ideal for patients who have heavily calcified plaque blockages, which other technology cannot remove because the calcification is too hard. Emory’s interventional cardiologists were involved in the multi-center research study that tested the safety and effectiveness of this new technology, which helped the FDA approve the device.

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.

Interventional Cardiologists
Chandan Devireddy, MD
Michael McDaniel, MD
Khusrow Niazi, MD
Gregory C. Robertson, MD
Bryan Wells, MD

Vascular Surgeons
Luke Brewster, MD
Michael Clark, MD
Thomas F. Dodson, MD
Yazan Duwayri, MD
Peter B H'Doubler, MD
William D. Jordan Jr., MD
Charles Lewinstein, MD
Mark Mittenthal, MD
Ravi Rajani, MD
Joseph Zarge, MD

Interventional Radiologists
Zachary Bercu, MD
Irwin Best, MD
Sean Dariushnia, MD
Jonathan Martin, MD
Michael Miller, MD
Janice Newsome, MD
William O’Connell, MD
Gail Peters, MD
Roger Williams, DO

Emory physicians see PAD patients at Emory University Hospital, Emory University Hospital Midtown and Emory John’s Creek Hospital and The Emory Clinics located at these sites.

If you would like to schedule an appointment with one of Emory’s PAD physician experts, call Emory HealthConnection℠ at 404-778-7777.