Peripheral arterial disease (PAD) simply is blockage in the arteries of your legs. This is normally due to cholesterol particles and fats that form plaque. This plaque buildup in-turn narrows the artery walls causing poor circulation throughout the legs. When plaque obstructs nutrient and oxygen rich blood from transport to leg arteries and on to muscles and tissues, limb cells can die. In these severe cases, PAD can cause pain in the legs with or without walking and can even lead to a more serious condition called critical limb ischemia (CLI). Inadequate treatment or delay in care for CLI can result in amputation and leg loss. According to the national Institutes of Health (NIH), PAD affects between 8-12 Million people in the U.S. and up to 2 Million suffer from CLI.
- Among adults age 65 and older, 12 to 20 percent may have PAD
- Up to 85 percent of all amputations occur in people over the age of 60
- One in three people over the age of 50 with Diabetes is likely to have PAD
Common Risk Factors for PAD
PAD cases range from mild symptoms consisting of leg or calf pain while walking or immediately thereafter to serious CLI ailments including sores on the foot or leg that just will not heal, gangrene and pain when at rest. Four Main Risk Factors for PAD:
If left to progress, CLI can result in foot or leg amputation. Up to 650,000 amputations due to CLI occur yearly in the U.S. More than half of these patients had not been re-vascularized meaning they did not have blood flow to their limbs improved prior to amputation. Prompt recognition of CLI and aggressive treatment by optimizing blood flow, leads to amputation prevention. This type of vascular care called limb salvage is a procedure performed by vascular surgeons to improve the blood circulation to a limb in an effort to save the leg. This re-supply of blood can help the leg and any wounds on the affected area heal from the limb down to the toes.
- Up to 650,000 lower-limb amputations are performed each year in the U.S. for critical limb ischemia (CLI)
- Of all lower-limb amputation, more than 60 percent occur among people with Diabetes
- Up to 50 percent of people who have had an amputation, have never had a diagnostic angiogram to determine if blood flow could be restored
Early Screening of Patients for PAD
Non-invasive diagnostic testing can be completed as an outpatient in the office such as ankle-brachial index, segmental pressures, pulse volume recordings and arterial duplex. Computer tomography angiography (CTA) and angiography are also tools used to diagnose PAD in the hospital setting. Common factors of PAD and CLI include:
Endovascular and Surgical Treatment
Patients who have non-healing wounds are more likely to require future hospital care. In fact, more people die each year from CLI/PAD then stroke, cancer or heart attacks. Throughout our U.S. communities, PAD Awareness is very low. Patients who undergo amputation have a very high mortality rate. Preventing amputation saves lives and decreases mortality. Before a decision on amputation, each patient should undergo a thorough evaluation for best medical therapy, which can include lifestyle changes, medication, or open surgical or endovascular revascularization. Endovascular treatment is a minimally invasive procedure that is performed using a small needle puncture through which the blockage in the arteries can be removed using balloons and/or stents. Over the past decade, as endovascular treatment and technologies have become more widely available and implemented, amputation rates have decreased.
Treatment Options for PAD include:
*Endovascular treatments (fixing the problem from the inside with balloons and stents) has reduced the amputation rate.
Joseph J. Ricotta, MD, MS, FACS, DFSVS, is the National Medical Director of Vascular Surgery and Endovascular Therapy for Tenet Healthcare, and Professor of Surgery and Program Director of the Vascular Surgery Fellowship at The Charles E. Schmidt College of Medicine at Florida Atlantic University. Dr. Ricotta’s medical office and office-based laboratory are located at the Prime Vascular Institute in Delray Beach and he is on-staff at Delray Medical Center where he operates in a state-of-the-art $7 Million Hybrid Operating Room. Experienced, highly skilled and trained in general surgery from Johns Hopkins, fellowship-trained in Vascular and Endovascular Surgery from the Mayo Clinic College of Medicine and in Endovascular Surgery by the Cleveland Clinic Foundation, Dr. Ricotta uses the latest technology and provides vascular and endovascular care that is unsurpassed in South Florida. Dr. Ricotta specializes in minimally invasive endovascular therapy, endovascular robotic surgery, aortic and peripheral aneurysms, carotid/cerebrovascular disease, transcarotid artery revascularization, peripheral arterial disease (PAD)/limb salvage, venous disease, thoracic outlet syndrome, renal/mesenteric disease, dialysis access and pulmonary embolism care.
Dr. Ricotta is board-certified in vascular surgery and general surgery and has pioneered several different treatments for patients with vascular disease, as well as having authored over 200 publications, been an investigator in over 60 clinical research trials, and delivered over 300 lectures both on the national and international stage.