Peripheral Arterial Disease

Interventional Radiologists are Vascular Disease Experts. Interventional Radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional Radiologists are board-certified physicians with extensive training in vascular disease diagnosis, management and treatment. Their board certification includes both Vascular and Interventional Radiology and Diagnostic Radiology which are administered by the American Board of Radiology. This training marries state-of-the-art imaging and diagnostic expertise, coupled with clinical experience across all specialties and in-depth knowledge of the least invasive treatments.

Peripheral Arterial Disease or PAD is a condition in which the arteries that carry blood to the arms and legs become narrowed resulting in decreased blood flow. The cause of PAD is atherosclerosis. Atherosclerosis is the gradual build-up of plaque, consisting of cholesterol, blood cells, calcium, and scar tissue that over time narrows and clogs the arteries.

What are the symptoms of PAD? The most common symptom of PAD is called intermittent claudication. Intermittent claudication occurs when there is not enough blood flowing to the leg muscles during exercise. Intermittent claudication is usually described as fatigue, discomfort, weakness or cramping in the calves, thighs or hips when walking and is usually relieved with rest.

Who is at risk for PAD? PAD affects more than 10 million people in the U.S. with men and women being equally affected. People at highest risk are those that are over 50 and those with a family history of heart or vascular disease. Other risk factors that a person can change include:
  • Smoking
  • Diabetes
  • Obesity
  • High Blood Pressure
  • High Cholesterol
  • High blood levels of Homocysteine

How is PAD diagnosed? The most common test for PAD is the ankle brachial index (ABI). This is a simple test that compares the blood pressure in the arms to the blood pressure in the ankles. Sometimes a more extensive duplex / ultrasound test is done with the ABI test. Additional tests may include magnetic resonance angiography (MRA) or computed tomography angiography (CTA).


(A) Lifestyle Changes: In some cases PAD can be successfully controlled with lifestyle changes but the key is consistency. The most important lifestyle change to make is to stop the use of any and all tobacco products. There are multiple treatments on the market including medications, nicotine patches, behavior modification programs, or hypnosis. Any or all of these can be used simultaneously. Exercise is key to treating PAD as it can, over time, increase blood flow by creatine a natural "bypass" around the blocked artery. It also "tunes up" the muscles, making them more efficient at using blood, thereby increasing exercise tolerance. Exercise also helps to achieve weight loss goals and lower blood cholesterol and blood pressure.

(B) Medications that control high blood pressure or lower cholesterol may be prescribed. Medications such as cilostazol (Pletal), may improve the distance you are able to walk without pain. Aspirin or clopidogrel (Plavix), either of which can lower your chances of blood clots. Everyone over the age of 50, unless contraindicated because of allergy or history of intestinal bleeding, should be on an aspirin daily. Statins are a class of medications that your physician may use to control your cholesterol levels.

What if lifestyle changes and medications are not enough?

Interventional Radiologists use a number of modern minimally invasive techniques to open blocked blood vessels. These procedures are performed during angiography. In this procedure a small nick is made in the skin, usually at the groin, and a small tube is threaded through the artery using x-ray guidance and dye is injected to locate the blocked blood vessels. During angiography the following procedures may be completed to open the artery and improve blood flow: Angioplasty, Stenting, Thrombolytic Therapy, Stent Grafts, Atherectomy.

Angioplasty, Stenting, Thrombolytic Therapy, Stent Grafts, Atherectomy, or Surgery?

Angioplasty is a minimally invasive method of opening blocked arteries it may be used alone or in combination with stenting aratherectomy (removing plaque). A balloon is inflated at the site of the narrowing to open the blood vessel and then deflated and removed.


A stent or small metal tube is inserted and stays in permanently to act as "scaffolding" to hold the vessel open.

Thrombolytic Therapy

When the blockage is caused by a blood clot, these medications, also called "clot busting medications" (thrombolytic therapy), are delivered directly to the site to dissolve the clot and restore blood flow.

Stent Grafts

A stent covered with sythetic material (stent graft) is inserted into the artery to bypass the blockage. Sometimes surgery is required to either remove or bypass the blocked artery. This is performed by a Vascular Surgeon.


Artherectomy is a procedure for opening a coronary artery (via "roto-rooter" like device), blocked by plaque, the buildup of cholesterol and other fatty substances in the inner lining of the artery.

Surgery is often used when the length of arterial blockage is too long to fix with angioplasty, stenting or atherectomy.