Minimally Invasive Care for Leg Pain
The Interventional Radiology (IR) team at Rochester Regional Health offers minimally invasive treatments for leg pain from peripheral artery disease (PAD). PAD is caused by narrowing in leg arteries which can lead to leg claudication (pain while walking) as well as other symptoms, such as non-healing arterial leg ulcers, caused by poor circulation. Left untreated, PAD may result in a need to amputate the leg.
Our IR team offers the full spectrum of treatments to avoid late complications of PAD and restore circulation and improve symptoms.
What is Peripheral Artery Disease (PAD)?
Peripheral artery disease (PAD) is a disease that occurs in the arteries of the leg. In PAD, the walls of the leg arteries become stenosed (narrowed) or occluded (blocked). The most common cause of this blockage is plaque, typically from atherosclerosis.
PAD is extremely common, especially in older patients, immobile patients, smokers, and patients with diabetes. It is the same general condition that causes heart attacks and strokes.
Initially, patients will notice pain in the legs when walking, known as claudication. This will start to occur with shorter and shorter distances, and when advances may even occur at rest. Skin changes including hardening and darkening of the skin, along with hair loss, may occur. If left untreated, late stages include poor wound healing and skin breakdown, known as ulcers, which may be incredibly challenging to treat. As these worsen, infections occur, and this may ultimately result in the need for amputation.
Symptoms of Peripheral Artery Disease (PAD)
Many people have minimal or no signs of PAD in the early stages. However, as PAD progresses the symptoms typically include the following:
- Claudication, is defined as leg pain or cramping after walking a certain distance or climbing stairs
- Leg numbness, heaviness, and/or weakness
- Constantly cold legs and feet, especially in comparison to the other side
- Wounds on the ankle or foot that take a long time to heal or do not completely heal
- Changes in your skin – thin, brittle, shiny skin on your legs and feet
- Hair loss on your legs and poor/slow toenail growth
- Paleness when legs are elevated
- Erectile dysfunction in men
- No pulse or a weak pulse in your legs or feet
Risk Factors for Peripheral Artery Disease (PAD)
You should consider calling the IR clinic for evaluation if you have one or more of the above symptoms that are interfering with your life. Additionally, if you have mild or minimal symptoms you should consider getting screened if you have one or more of the following risk factors:
- smoking
- diabetes, especially if poorly controlled
- high blood pressure
- high cholesterol
- obesity (BMI > 30)
- genetic predisposition, including a history of peripheral artery disease, heart disease, or stroke
- increasing age, especially after age 65
People who smoke and/or have diabetes have the greatest risk of developing peripheral artery disease and should consider it.
Complications of PAD
When initial PAD is left untreated, the complications can be devastating. As the cause of PAD is the buildup of plaque in your blood vessels, oftentimes patients with PAD are also at a high risk of developing the following:
Late-stage PAD: The advanced stages of PAD include leg pain/claudication at rest as well as open wounds that will not heal and typically result in an infection of the feet or legs.
Critical limb ischemia (CLI): Critical limb ischemia is end-stage PAD and occurs when the wounds, ulcers, lack of blood flow, and/or infections progress and cause tissue death, oftentimes requiring amputation (cutting off) of the affected limb.
Stroke and Heart Attack: Same atherosclerosis that causes PAD typically results in the narrowing of other arteries in your body, often in your heart (coronary arteries) and arteries leading to your brain. Ultimately, these are the cause of heart attacks and strokes.
Treatment for Peripheral Artery Disease
By far, the best and most effective way of reducing your symptoms of PAD or reducing your chance of even getting peripheral artery disease is prevention. The mainstay of this is to maintain a healthy lifestyle, including diet and exercise as well as a lifestyle choice. That includes the following:
- do not smoke, or quit smoking if you're a smoker
- lose weight to reduce your BMI <30, and maintain a healthy weight via a balanced diet (not quick weight loss or fad diets)
- if you are diabetic, keep your blood sugar in good control and keep your hemoglobin A1C less than 7
- exercise regularly up to your ability, including a specified exercise regimen prescribed by your doctor
- get your blood pressure levels under control if you have hypertension
- lower your cholesterol
Sometimes, PAD can be treated or at least improved with the above lifestyle modifications and taking the proper medicine. However, in those situations where PAD progresses or the symptoms persist, schedule a consultation with a vascular specialist.
Our interventional radiology team will help diagnose and treat you with minimally invasive interventions, and we work with vascular surgeons and wound care teams to help you get further treatment with surgery or wound care as needed.
During your consultation in our IR clinic, we will perform a history and physical exam to determine if PAD is the correct diagnosis and to assess your stage. Next, we may perform certain diagnostic studies to confirm the diagnosis and again assess for severity. These tests often include ankle-brachial index (ABI) with segmental pressures, arterial ultrasound of your legs, and special CT or MRI known as CT or MR Angiography (CTA or MRA). The IR physician will then be able to interpret these studies and see what treatment is best for your unique situation.
If medication and lifestyle modification aren’t enough, then typically the next step is called angiography. Angiography is a minimally invasive treatment technique where a small tube is inserted into the arteries in your legs and images are obtained after injection of contrast. Based on the images, state-of-the-art treatment can often be performed directly through those small, inserted tubes. This is typically an outpatient procedure that is performed under moderate sedation.
Some of the potential cutting-edge treatments include the following, and often more than one of the following is utilized once the blockage is passed with a wire:
- Angioplasty balloon – using a balloon to open up a narrowing or blockage
- Atherectomy device – using a spinning blade or rotating shaver to remove plaque
- Stenting – placing a metallic stent to maintain open the lumen of an artery
- Reentry device – a specialty device to get by completely occluded portions of an artery
- Lithotripsy – using specialty “shockwaves” to create small fractures within plaque to “soften” it and allow blood flow
- Lysis – the process of breaking up a clot in an artery using specific medications
- Aspiration thrombectomy – physically removing acute clot from an artery through a catheter
Finally, if the above procedures do not work or cannot be performed, surgical interventions such as a bypass can be performed. In CLI cases where nothing else can be done, amputation is typically the final straw. We are working hard to prevent CLI amputation in the greater Rochester region.