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Peripheral Artery Disease (PAD) / Peripheral Vascular Disease (PVD)

Peripheral Arterial Disease (PAD) is a result of plaque build-up in the major arteries of the legs and is often mistaken for arthritis. Untreated, PAD causes leg pain when walking and can lead to gangrene and amputation.

Risk factors

  • Cigarette smoking
  • Obesity
  • Diabetes
  • High blood pressure
  • Physical inactivity
  • Elevated cholesterol
  • Advanced age
  • Family history of PAD
  • Cardiovascular disease oer stroke

Symptoms

Symptoms include foot pain that does not go away, Claudication (leg cramping or pain with walking), lack of warmth in the lower leg or feet.

Diagnosis

The ankle-brachial index test is a non-invasive approach to identifying the presence of PAD. A comparison is made between the blood pressure in the patient's arms and feet. If the ankle pressure is significantly less, then further testing may be required to evaluate the severity of the disease.

Doppler and Ultrasound imaging is a non-invasive exam used to measure blood flow through the arteries of the legs.

CT Angiography is a non-invasive x-ray study used to evaluate the arteries throughout the body.

MR Angiography is a non-invasive, non-x-ray study used to examine the arteries throughout the body.

Angiography is an invasive procedure that involves the injection of dye followed by x-rays to determine the location of plaque build-up or a blockage. Angiography can also be used as a treatment.

State-of-the-Art Treatment

It is important for primary care physicians to know that the vast majority of patients with PAD who require an intervention can now be treated with an ever-expanding and improving array of endovascular approaches that substantially reduce patient pain and morbidity.

For the past seven years, Drs. Gooding, Ponec and Saxon have been at the forefront of new device development for the treatment of PAD by participating in research trials. They helped pioneer the use of e-PTFE (“ Teflon “) covered stents (the Viabahn endoprosthesis or stent-graft, W.L. Gore, Inc.) to treat PAD in the femoral and popliteal arteries and have achieved results in long lesions that are far better than angioplasty alone or other available stent designs.

In fact, the patency of this technique rivals femoro-popliteal bypass with substantially lower morbidity. Dr. Saxon was the principal investigator, who led the team in analyzing the Multi-center data for femoropopliteal stent-grafting that led the FDA to approve this technique in June 2005.

As a result of this expertise in the field of PAD, the interventionalists were selected with 10 other centers of excellence to begin a new pivotal study on drug-coated stents for PAD. This trial is the first in the U.S. to test whether Paclitaxol drug-eluting stents have benefits in treating arteries outside the heart.

Drug-eluting stents that combine a metal scaffold with a drug were first applied in the heart and the results have been outstanding. Currently, drug-eluting stents are the primary therapy for obstructions in the coronary circulation as they markedly reduce restenosis or re-narrowing of the artery. It is hoped similar technology, used in the legs, will help those who suffer from peripheral arterial disease. By participating in this trial, the interventionalists at North County Radiology are bringing this potentially landmark treatment to patients in Southern California much earlier than would otherwise be possible. We are currently the leading enrollment site in the county on this trial and the only center in Southern California selected to participate.

Drs. Gooding, Ponec and Saxon perform these cutting-edge procedures at Tri-City Medical Center in Oceanside. The interventionists are experts in the diagnosis, work-up and treatment of PAD and are always available for consultation, office visits and treatme