Peripheral Arterial Disease (PAD) is a serious condition that occurs when blood flow through the arteries is decreased due to the build-up of plaque along the arterial walls. This narrowing of the arteries is referred to as atherosclerosis. PAD most commonly occurs in the legs, feet, and toes. It is estimated that approximately 8 to 12 million persons in the United States are affected with PAD.
Persons who suffer from Peripheral Arterial Disease (PAD) have an increased risk of heart attack or stroke. Additionally, if left untreated, PAD can lead to critical limb ischemia. Critical limb ischemia (CLI) occurs when not enough blood is being delivered to the leg to sustain the tissue. Patients who suffer from CLI are at risk of amputation of the toes, feet, and legs.
Although anyone can develop Peripheral Arterial Disease (PAD), patients with diabetes are among those with the highest risk of developing the condition. However, according to a consensus statement issued by the American Diabetes Association (ADA), many diabetics fail to be diagnosed with PAD due to a lack of symptoms. As a result, the ADA now urges PAD screening for all diabetic patients over the age of 50 and those under 50 who have other risk factors.
Ashcott is dedicated to the early assessment of Peripheral Arterial Disease (PAD). We offer a wide range of noninvasive vascular Dopplers for performing vascular arterial studies such as Ankle Brachial Index (ABI) and Segmental Pressures. We also recommend and support the use of PPG toe pressures to assess PAD in patients with unsuspected lower extremity vascular disease and in diabetic patients when vessel calcification may result in falsely elevated ankle pressures. PPG for toe pressures and PV modules for Pulse Volume Recordings (PVR) are available for many of our non-invasive Dopplers.
Signs & Symptoms
Intermittent claudication Cold pallid limbs Hair loss on legs or feet Slow wound healing Changes in the nails on toes Numbness or tingling in the toes, feet, or legs
Age Smoking Diabetes Hypertension High cholesterol (hyperlipidemia) Family history Obesity
Diagnosis & Treatment of Peripheral Arterial Disease (PAD)
Peripheral Arterial Disease (PAD) is evaluated in several ways. Begin by taking a thorough patient history noting any risk factors which may be present. Check for apparent symptoms. If the patient displays signs of possible PAD a screening exam should be performed.
Screening for PAD
Typically, an Ankle Brachial Index (ABI) is performed to screen for Peripheral Arterial Disease (PAD). An ABI uses a vascular ultrasound Doppler to assess the ratio of ankle pressure to arm pressure. An ABI of .96 or greater is generally considered normal. However, an ABI of 1.3 or higher may indicate vessel calcification, especially in diabetic patients and those with undiagnosed atherosclerosis. In this case a PPG toe pressure study may be useful.
A PPG toe pressure and related Toe Brachial Index (TBI) uses an infrared photoplethysmograph (PPG) module to determine the small vessel vascular condition distal to the ankle. Toe pressure studies are also useful to determine ulcer-healing potential in the diabetic foot.
Segmental Pressure studies are used to localize the site of atherosclerosis. A significant pressure difference between two adjacent cuff sites indicates a narrowing of the artery along that portion of the leg. Segmental Pressures are performed similar to an Ankle Brachial Index study, but with three additional cuffs placed above and below the knee and on the upper thigh.
Pulse Volume Arterial (PVR) waveforms use pulse volume (pneumoplethysmography) to identify changes in leg blood volume. Rather than temporarily occluding blood flow, the cuffs are only inflated slightly so that blood continues to flow. Blood pulses in the arteries cause the vessels to expand which changes the air volume in the cuff. PVR studies are particularly useful in patients where vessel calcification can cause inaccurate Doppler signal processing and falsely elevated pressures.
Treatment of PAD
Although there is no cure for PAD, early diagnosis and treatment can help restore mobility, decrease incidents of heart attack and/or stroke and lower the incidence of having to perform amputations.
Treatments for PAD include:
Quit Smoking Lower blood pressure and cholesterol Start exercising Follow a healthy eating plan Weight control Medications
If blood flow in one or both legs becomes almost or completely blocked, a surgical procedure may be necessary.