Treatment of Peripheral Arterial Disease

P.A.D. Procedures

Purpose: to identify and treat symptomatic Peripheral Arterial Disease (P.A.D.)

What You Need to Know

Peripheral Arterial Disease, or P.A.D., occurs when extra cholesterol and other fats that may be circulating in your blood stream deposit along the walls of the arteries that supply blood to your limbs. This buildup – called plaque – narrows your arteries, often reducing or blocking the flow of blood. P.A.D. is most commonly seen in the legs. When this occurs, symptoms ranging from cramping in the legs when walking to poor wound healing, ulcerations and pain may be present.

P.A.D. Evaluation

Evaluation for P.A.D. most often begins with a detailed medical and family history along with a physical exam. A test called an ankle-brachial index (ABI) will be performed, comparing the blood pressure readings in your ankles to the blood pressure readings in your arms. Additionally, the arteries may need to be evaluated using Doppler ultrasound, CT angiography and/or MRI. Through history, physical findings and imaging studies, the arteries will be evaluated rendering a treatment plan, if needed.

Lower Extremity Angiography

Based on clinical findings of the non-invasive testing as described above, lower extremity angiography may be required. If required, this procedure, along with the risks, benefits and alternatives will be reviewed with you by an Open Access physician. If you desire, IV medication can be given to allow for greater sedation and pain control during the procedure.

Lower extremity angiography will be performed in one of our procedure rooms. A small catheter will be placed in one of the arteries, typically in your leg. X-ray dye will be used and images obtained. Based on the information obtained from the angiogram, a more specific treatment plan will be made. This may include angioplasty, stenting, atherectomy or surgery, to name a few.


Angioplasty and stenting are often utilized to treat the narrowed arteries causing your P.A.D. Similar to the angiography procedure described above, these procedures are performed through a small tube inserted into your artery, typically in the leg. Angioplasty, or balloon dilatation, is often the first option in treating a narrowing within the artery. A balloon is used to stretch open the artery. It is then deflated and removed when complete. If the artery remains open following angioplasty, no further treatment may be required. If however the artery does not stay open, or if other abnormalities within the artery are detected, a stent may be implanted within the vessel. This device, called a stent, is a wire mesh tubing that provides scaffolding within the vessel to help keep it open. Following angioplasty or stunting, angiography will be performed to confirm the vessel is open as desired. Following the procedure, you may be placed on special medication to help keep your arteries open. This and other care instructions will be provided to you prior to discharge.

Stenosis is a term that is used to describe the narrowing that develops within your arteries and veins. It causes the flow of blood through the vessels to decrease. It results in what is known as claudication, or leg muscle pain that occurs with walking and goes away with rest. Stenosis generally gets worse with time and can eventually lead to clotting.

If a narrow area has been found, an angioplasty balloon will be inserted into your vessel and inflated. By stretching the narrow area open, your blood flow will be restored to normal levels.

There are some instances in which the narrow spot will not stay open even after the angioplasty balloon is inflated. In these cases, a small mesh tube known as a stent will be implanted into the vessel. This device will fortify the wall of the vessel and help it stay open.

Endovascular Atherectomy

During endovascular atherectomy, cholesterol and fatty plaque are removed from the walls of the artery. If you require endovascular atherectomy, you will likely also require angioplasty and possibly stunting. Your physician will discuss this option with you prior to your procedure.

A General Note About P.A.D. Procedures

You will have most likely undergone a procedure in your artery and as such it is important to note that arterial procedure require several hours of recovery. Your artery will need time to heal and this will require you to remain immobile in our post-op area for several hours. When you are discharged, it is strongly advised that you return directly home and stay off your feet until the following day. This will give your artery ample time to heal appropriately.