PAD – Peripheral Artery Disease Evaluation

Finding narrowed leg arteries and opening them when needed

What is it?

Peripheral artery disease, or PAD, is narrowing of the arteries that carry blood to the legs, and sometimes the arms. Plaque builds up and limits blood flow. Evaluation starts with an exam, blood-pressure cuffs at the ankle and arm to calculate the ankle-brachial index, and often an ultrasound. A CT, MR, or catheter angiogram may map the narrow spots.

Treatment depends on how severe the blockage is. Many people start with walking, a statin, an antiplatelet medicine, and smoking cessation. If symptoms limit life, or a wound will not heal, an interventional radiologist can open the artery from inside with a balloon, a stent, or a device that removes plaque. That procedure is not open bypass surgery.

Why do I need it?

Reduced blood flow to the leg can cause:

• Calf or thigh pain with walking that eases with rest, called claudication
• Pain in the foot at rest, or a wound that will not heal
• A foot that is cool, pale, or numb
• The need to open an artery to relieve pain, heal a wound, or lower the chance of amputation

How do I prepare?

• Medicines: Tell the team about blood thinners, diabetes medicine, and all other medicines. Do not stop them unless your doctor tells you to. Metformin may be held around contrast dye.
• Allergies and kidneys: Report allergies to contrast dye, numbing medicine, or latex. We check kidney function because contrast is used.
• Eating: If sedation or a catheter procedure is planned, you will usually be asked not to eat for several hours. Drink water unless told not to.
• The leg: Tell the team about prior stents, bypasses, or groin surgery. Wear loose clothing.
• Support: Arrange a ride home. You should not drive after sedation. An ultrasound-only visit usually doesn’t require a ride.

How is it placed?

• For a catheter treatment, you lie on the table. The groin, or sometimes the wrist or ankle, is cleaned and numbed. Sedation is commonly used.
• A thin tube is placed in the artery. Contrast and X-ray show the narrow or blocked segments.
• The doctor passes a wire across the narrowing. A balloon opens it. A stent may be left in place if the artery needs support. Plaque may be shaved or drilled away in selected cases.
• The tube is removed. Pressure or a closure device seals the artery, and a bandage is placed.
• The procedure often takes 1 to 3 hours. You are watched in recovery. Some people stay overnight. An ABI or ultrasound visit has no catheter and no recovery stay.

Care instructions

• If the groin was used, lie fairly flat for the time you are told, often a few hours. Keep the bandage on for about 24 hours. You may usually shower after that. Do not soak for a few days.
• Walk as directed. Avoid heavy lifting, driving, and strenuous activity for several days after a catheter procedure.
• Take the antiplatelet or blood-thinner medicine exactly as prescribed, especially if a stent was placed. Do not stop it on your own.
• Drink fluids unless you are on a fluid limit. Keep walking, stop smoking, and care for any foot wound as taught.
• Keep follow-up ultrasound or ABI visits. A treated artery can narrow again.

What to watch out for

Call your care team promptly if you notice:

• Bleeding, a growing lump, or increasing pain at the groin, wrist, or ankle site
• A foot that becomes colder, paler, more painful, or numb
• Redness, drainage, or fever at the access site
• A wound that is getting larger, or pain with walking that suddenly returns
• Chest pain, trouble breathing, fainting, or a suddenly cold and painful leg — seek emergency care