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Peripheral Artery Disease

Are you experiencing leg pain?
Leg pain comes in many shapes and sizes. It can be dull and aching or sharp and stabbing. Even tightness and tingling leg pain can be quite uncomfortable.

Dr. David B. Casey

Leg tightness or pain especially when you walk can be caused by poor circulation. That poor circulation has a name: Peripheral Arterial Disease (PAD).

PAD infrequently occurs with classic intermittent claudication, 50% have atypical leg pain, 10% have claudication, and 40% have no leg pain. In fact, in a Women’s Health and Aging study from the journal, Circulation, it was stated that women over the age of 65 years old had no exertional leg symptoms in a majority of the patients enrolled.

PAD occurs in 8.5 million Americans and is a common but serious medical condition that is caused by the buildup of plaque that makes it difficult for blood to circulate through the arteries of the limbs. It is commonly associated with tobacco abuse, diabetes, high blood pressure, and high cholesterol.

Why does PAD cause leg pain?
When you develop PAD, your extremities (most commonly your legs), do not receive enough blood flow and oxygen to keep up with demand. This causes symptoms, most notably pain or crampy tightness in the calves, thighs, buttocks or legs when walking. The pain of PAD will often go away when you stop walking or exercising.

The crampy pain or tightness (called Intermittent claudication), when caused by PAD, is your muscles way of telling your body that it isn’t receiving enough blood during walking/exercise to meet the increased demand. As the reduction of blood flow becomes more and more severe, the pain can happen at shorter distances. In its worst form, PAD will be painful when at rest and can form ischemic ulcers and sores. This will develop on the feet as the tissue actually starts to die causing gangrene. This is called critical limb ischemia (CLI) and occurs when symptoms occur greater than two weeks. If left untreated, 50% of individuals can progress to amputations at 6 to 12 months without intervention with revascularization.

How is PAD treated?
At Eastside Heart and Vascular, there are a number of physicians who can evaluate and treat you for PAD. PAD can be often diagnosed by obtaining an ankle-brachial index (ABI). This is simply where the blood pressure in your legs and arm is measured using a blood pressure cuff. The highest blood pressure in your leg and arm are used to calculate your ABI. We can also do three-minute exercise ABI. In addition, a non-invasive ultrasound can be performed to help identify blockages, as well as CT angiography or MRA of the lower extremities for more complicated cases.

The first line of treatment for PAD involves lifestyle changes including lowering blood pressure, cholesterol, blood sugar (if diabetic), weight loss, and stopping smoking. Supervised walking programs have been shown to be as effective as some medical treatments in relieving the symptoms of PAD. Antiplatelet therapy and cilostazol can alleviate symptoms in conjunction with supervised walking programs. However, if this doesn’t improve symptoms, there are a number of procedures that can be performed to open up the vessels without surgery. These are called endovascular techniques. It entails using small catheters and balloons to open blocked vessels. You may have heard of the term “angioplasty” when referring to opening up blocked arteries that supply the heart. We can perform similar techniques to open blocked vessels in the legs and relieve severe claudication and critical limb ischemia.

Once again, we use these techniques when exercise and medications fail to help patients with claudication. We also use these techniques to treat patients with pain at rest or if patients start to have nonhealing wounds on the legs and tissue breakdown (CLI). In many cases, amputations can be delayed or prevented with endovascular techniques, medications, and lifestyle changes. For more information, or to set up an appointment for an evaluation, you can call the team at Eastside Heart and Vascular at (770) 736-6300.

Eastside Heart and Vascular
Main Office: 1700 Tree Ln
Suite 190
Snellville, GA 30078
Additional Locations in Lawrenceville,
Loganville, Monroe, & Athens