Treatment of Peripheral Arterial Disease

Our program is catalyzed by investigating unique treatment options

Emory at the Forefront of Peripheral Arterial Disease

The medical, surgical and catheter-based treatment of peripheral arterial disease is a primary focus of the Division of Vascular Surgery and Endovascular Therapy. In 2000, the division was one of the first programs in the country to evaluate gene therapy for treatment of claudication, a condition characterized by poor circulation in the legs caused by PAD. Clinical trials to develop and test new pharmacologic agents for peripheral arterial disease have been ongoing in the division for over two decades. To date, division physicians have performed several thousand angioplasty and surgical bypass grafting procedures for patients with PAD.

Description and Diagnosis

Peripheral arterial disease is caused by an increase of plaque in the blood vessels initiated by hardening of the arteries (atherosclerosis), resulting in reduced supply of oxygen and nutrients to any and all tissues of the body, most often effecting the legs and feet. While difficulty walking may be the primary symptom, peripheral arterial disease can advance to complete arterial blockage and critical limb ischemia (CLI), causing painful foot ulcers, infections or even gangrene requiring amputation. Peripheral arterial disease is also associated with high blood pressure, diabetes, heart disease and stroke.

A physical examination by a skilled physician can often detect peripheral arterial disease, though the degree of severity cannot always be precisely determined, particularly in patients with other conditions such as diabetes. For more accurate measurements in order to determine a course of treatment of peripheral arterial disease, the Emory Non-Invasive Vascular Laboratory provides Doppler flowmeter or ultrasound scans that take just minutes to do without risk or discomfort. To schedule a session at the lab, prospective patients can call (404) 778-3712. Referring physicians should contact Annette Gunnoud, RVT, at (404) 778-3326.

In severe cases that have progressed to CLI, division physicians perform an arteriogram to evaluate the exact status of the blockage. The study involves the injection of contrast dye into the arteries of the legs for imaging.

Medical Peripheral Arterial Disease Treatment

When claudication due to peripheral arterial disease causes pain and cramping but is not yet a critical threat to a patient's limbs, division physicians recommend the following conservative approaches:

Exercise Training: With peripheral arterial disease, muscles do not receive normal levels of oxygen because circulation is impaired. Over time, a regular exercise regimen can train muscles to use lower levels of oxygen more efficiently, gradually allowing the patient to walk further and further without pain.

Drug Therapy: Certain medications in combination with exercise can improve the discomfort experienced by patients with claudication. However, these medicines can be contraindicated in patients taking medications for high blood pressure, heart problems or diabetes, making the involvement of a board-certified vascular specialist imperative to the decision of whether or not to initiate and/or maintain this peripheral arterial disease treatment.

Angioplasty and Surgical Revascularization

When peripheral arterial disease has progressed to CLI despite courses of treatment, medical approaches alone are often insufficient. Fortunately, 90 percent of CLI cases can be improved with the following interventions:

Balloon Angioplasty With or Without Stent Placement: An arteriogram can determine whether or not these procedures are appropriate for the particular case. On occasion, the procedures are performed directly after the study. In balloon angioplasty, a very small balloon attached to a thin tube (catheter) is inserted into a blood vessel through a small puncture. The catheter is threaded under X-ray guidance to the site of the blocked artery and inflated. Depending on the condition of the artery, a small metal scaffold or tube known as a stent may be inserted to keep the artery open.

Surgical Revascularization: CLI is often characterized by severe blockage in several leg arteries. At times, balloon angioplasty and stent placement may not be sufficient to restore circulation. In such cases, revascularization by surgical bypass is frequently the treatment of choice. The procedure usually involves removing a superficial vein from the patient's leg and using it to route blood flow around the blocked segments of artery.

Scheduling a Consultation

Following a positive diagnosis of peripheral arterial disease, an initial consultation with a division physician to determine a course of treatment can be scheduled by calling (404) 778-3712. Another scheduling option is to contact Emory HealthConnection^SM at (404) 778-7777 or 1-800-75-EMORY. HealthConnection^SM offers immediate access to information on Emory services and physicians and can assist in making appointments.

Referring physicians should contact Julie Bumgardner, NP-C, clinical coordinator for the division, at (404) 778-3022.