PAD is caused by the buildup of plaque and/or calcium inside blood vessels
over time. These buildups cause a narrowing in the blood vessel that limits
that amount of blood flow to the downstream body part. This most commonly
effects the lower extremities. Symptoms of PAD may include, but are not
limited to, pain with walking that is relieved with rest (claudication),
skin discoloration, delayed wound healing, and occasionally numbness or
tingling. Some forms of PAD require surgical intervention. In these procedures,
your surgeon will make a small incision in the groin and sometimes along
the side of the lower leg. This allows the artery to be exposed and blood
flow restored. Often, the affected segment of the artery needs to be “bypassed”
with either a synthetic graft or a healthy segment of saphenous vein harvested
from that same leg. Average length of stay after this surgery is 2-3 days.
Pre-op routine:
Before your surgery, your surgeon will see and examine you as well as review
all pertinent labs, imaging, and tests. You will have ample opportunity
to ask questions and gain a full understanding of the nature of your disease
process and the surgery to treat that disease. You will have lab tests,
lung function tests, EKG, and chest x-ray prior to surgery. Your preoperative
instructions will be provided to you in office. Follow them, and call
the office with any needs or concerns.
Frequently Asked Questions
What are the early warning signs of PAD?
The most common early symptom is claudication — pain, cramping, or
tiredness in the legs or calves that occurs with walking or exercise and
improves with rest. Other early signs include cold feet or lower legs,
skin discoloration, weak or absent pulses in the feet, and hair loss on
the legs or feet. Because symptoms can be subtle or mistaken for normal
aging, PAD often goes undiagnosed until it becomes more advanced.
What are the risk factors for developing PAD?
The biggest risk factors for PAD include smoking, diabetes, high blood
pressure, high cholesterol, and age over 60. A personal or family history
of cardiovascular disease, stroke, or heart attack also increases risk.
Since PAD shares many risk factors with coronary artery disease, people
with PAD are often at higher risk for heart attack and stroke as well.
How is PAD diagnosed?
PAD is typically diagnosed using a combination of a physical exam, a review
of symptoms and risk factors, and non-invasive testing such as the ankle-brachial
index (ABI), which compares blood pressure in the ankle and arm. Additional
imaging, such as ultrasound, CT angiography, or MRA, may be used to pinpoint
the location and severity of blockages.
Is surgery always necessary to treat PAD?
No. Many cases of PAD can be managed with lifestyle changes and medication,
especially when caught early. Treatment often starts with a supervised
walking program, smoking cessation, and medications to manage cholesterol,
blood pressure, or blood clotting. Surgery or minimally invasive procedures
are generally reserved for more advanced blockages or when symptoms significantly
affect quality of life.
What happens if PAD is left untreated?
Untreated PAD can progress to critical limb ischemia, a severe reduction
in blood flow that can cause non-healing wounds, ulcers, infection, and
in serious cases, tissue death that may require amputation. PAD also signals
broader cardiovascular disease, so untreated PAD raises the risk of heart
attack and stroke as well.
What is recovery like after PAD bypass surgery?
Most patients stay in the hospital for 2-3 days following bypass surgery.
Recovery involves gradually increasing activity, caring for the incision
sites, and attending follow-up appointments to check blood flow and healing.
Your surgical team will provide specific guidance on activity restrictions,
wound care, and when you can resume normal daily routines.
Can PAD be prevented?
While not all cases can be prevented, the risk of developing PAD can be
significantly lowered by not smoking, staying physically active, eating
a heart-healthy diet, and managing conditions like diabetes, high blood
pressure, and high cholesterol. Regular checkups can also help catch early
signs before symptoms become severe.
How does PAD relate to heart disease?
PAD and coronary artery disease share the same underlying process —
atherosclerosis, or plaque buildup in the arteries. Because this is often
a widespread condition rather than one limited to a single area of the
body, people diagnosed with PAD are frequently screened for heart disease
as well, and vice versa. Managing risk factors for one condition typically
helps protect against the other.
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