Peripheral Artery Disease (PAD)

Catheter-based Peripheral Artery Interventions consist of arterial angiography, angioplasty and stenting. Common locations for these procedures include: 

  • carotid arteries
  • renal arteries
  • lower extremity arteries
  • aorta

Call Cardiology Associates of Bellin Health to see a physician that specializes in these techniques - (920) 433-3640.

Peripheral Artery Disease (PAD)

General Information

  • Claudication is the most common symptom of peripheral artery disease (PAD). Patients will report pain, aching, or fatigue affecting the large muscle groups of the lower extremities (calf, thigh, or buttock) that occurs with walking, not at rest and not affected by position. Some patients with PAD may have impaired mobility, without classic symptoms.
  • Critical limb ischemia includes ischemic rest pain which occurs with severe multilevel artery obstruction and tends to be worse with leg elevation. It also includes ulcers and gangrene. Without revascularization, patients with critical limb ischemia are at risk for limb loss and for potentially fatal complications from the progression of gangrene and the development of sepsis.

Diagnostic Tests To Consider

  • The ankle brachial index (ABI) with pulse volume recording (PVR) is the simplest objective measurement for diagnosis
  • Arterial Doppler provides a complete evaluation with segmental leg pressures (which include PVR, ABI and TBI (toe/ brachial index)) and post-exercise pressure measurement
  • Laboratory evaluation of atherosclerosis risk factors, including lipid panel and glucose (or hemoglobin A1C for patients with diabetes)

Indications For Referral

  • Lifestyle-limiting claudication, ischemic rest pain, leg/foot ulcers
  • Claudication is not an emergency, but new onset of severe claudication or ischemic rest pain symptoms may indicate sudden vascular occlusion due to embolization or thrombosis. These patients should be evaluated promptly.

Revascularization Options

Indications include: Lifestyle-limiting claudication, ischemic rest pain, leg/foot ulcers

  • The Bellin Health Heart & Vascular Team has all of the latest revasculariztion options available to optimize blood flow and minimize any risk of amputation including:
    • Endovascular intervention, surgical endarterectomy, surgical bypass and hybrid procedures combining surgery and endovascular intervention.
    • Endovascular options include a wide variety of balloons and stents, rotational atherectomy (Rotablator, CSI Diamondback, Jetstream), Laser atherectomy, Silverhawk atherectomy, Mechanical thrombectomy, thrombolytics, etc.

Diabetic and Non-Healing Leg/Foot Ulcers

General Information

  • Diabetics are prone to foot ulcerations due to neuropathy and vascular disease. Studies indicate that 15% of all diabetics will develop a lower extremity ulcer in their lifetime.
  • Diabetes is an important risk factor for peripheral artery disease (PAD).
  • Diabetics with PAD are at a much higher risk for amputation than nondiabetics with PAD. 7% over 5 years vs. < 2% in 5 years in the PARTNER trial.
  • Early recognition and treatment of PAD is an important part of treating leg/foot ulcers to help avoid complications that may require amputation.

Diagnostic Testing For Vascular Assessment

  • All patients with leg or foot ulcers and abnormal pedal pulses should be referred to the Bellin Health Vascular Lab for a vascular assessement
  • A good first test is: Segmental leg pressure measurements with pulse-volume recordings (PVR) including ABI (ankle/brachial index) and TBI (toe/brachial index)
  • If this test is abnormal, other testing may be considered including:
    • Arterial duplex ultrasound
    • CT angiogram of the abdominal aorta with runoff
    • Catheter angiography with possible endovascular intervention

Management of Patients With PAD And Ulceration

  • Revascularization to optimize blood flow is a very important part of optimizing the wound healing environment. Oxygen is critical for wound healing. Oxygen not only plays an important role in energy metabolism, but also is very important in polymorphonuclear cell function, neovascularization, fibroblast proliferation, and collagen deposition.
  • The Bellin Health Heart & Vascular Team has all of the latest revasculariztion options at its disposal to optimize blood flow and minimize any risk of amputation including:
    • Endovascular intervention, surgical endarterectomy, surgical bypass and hybrid procedures combining surgery and endovascular intervention.
    • Endovascular options include a wide variety of balloons and stents, rotational atherectomy (Rotablator, Predator, Jetstream), Laser atherectomy, Silverhawk atherectomy, Mechanical thrombectomy, thrombolytics, etc.
  • For those patients with small vessel disease who are unable to be adequately revascularized, another option for these patients includes Hyperbaric Oxygen Therapy, available through the Bellin Health Wound Healing Center.