Peripheral Artery Disease (PAD)

There are a number of factors that may contribute to the development of peripheral arterial disease, including:

• Diabetes
• High blood pressure (hypertension)
• Smoking
• High cholesterol
• Older Age

Half of patients diagnosed with peripheral arterial disease are symptom free. For those experiencing symptoms, the most common is intermittent claudication in the calf (painful leg cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs, depending on the location of the clogged or narrowed artery.

Other symptoms of peripheral artery disease include:

• Diminished pulses in the legs and the feet
• Non-healing wounds over pressure points, such as heels or ankles
• Numbness, weakness, or heaviness in muscles when walking
• Pain in the toes or feet, often at night while lying flat
• Gangrene (dead tissue due to lack of blood flow)

Our vascular specialists provide expert evaluation and diagnosis with the aid of the latest in advanced imaging technologies. Along with performing a careful physical examination, your physician may order one or more of the following tests or procedures:

• Ankle-brachial index (ABI) compares the blood pressure in the ankle with the blood pressure in the arm by using a regular blood pressure cuff and a Doppler ultrasound device.
• Doppler ultrasound flow studies
• Magnetic resonance angiography (MRA)
• Pulse volume recording (PVR) waveform analysis calculates blood volume changes in the legs by using a recording device that displays the results as a waveform.
• Segmental blood pressure measurements measure blood pressure in various parts of the body by using a Doppler device in the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow.
• Standard exercise tolerance test

Specialists in our Division of Vascular and Endovascular Surgery develop individualized treatment plans for patients based on:

• Age
• Overall health
• Medical history
• Severity and form of the disease
• Tolerance for specific medications or procedures
• Expectations for course of the disease
• Presence of other conditions

There are two main goals for treatment of peripheral arterial disease: control the symptoms and halt the progression of the disease to lower the risk of heart attack, stroke, and other complications.

Treatment may include:

Lifestyle modifications to control risk factors

• Regular exercise
• Proper nutrition
• Smoking cessation

Medication

• Antiplatelet agents
• Cholesterol lowering medications
• Medications for improving blood flow, such as Cilostazol
• Medications to control blood sugar
• Thrombolytic Therapy

Procedures

• Peripheral artery angioplasty and stenting

Surgery

• Peripheral bypass surgery

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH’s main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Watkins Clinic for pre-operative information and tests.

The day of surgery, you care will be provided by vascular and endovascular surgeons, anesthesiologists and nurses who specialize in surgery for patients with peripheral artery disease. After surgery, you will go to the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

During your surgery, family and friends can wait in the Shapiro Family Center. Staff members will provide surgery updates and caregivers who leave the hospital will be contacted by cell phone.

Patients benefit from the teamwork of vascular and endovascular surgeons, medical cardiologists, interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in peripheral artery disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

• Our Heart & Vascular Team
• Request Heart & Vascular Appointment
• Heart & Vascular Locations

Learn more about peripheral artery disease in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.