Peripheral Arterial Disease (PAD)

Hardening of the arteries, peripheral vascular disease (PVD), and peripheral arterial disease (PAD), are all synonyms for atherosclerosis, the disease that blocks arteries. We will use the term PAD, which is the result of atherosclerotic plaque formation that obstructs the arteries in the legs thereby depriving the tissues of oxygen and nutrients. PAD can come from smoking, diabetes, high cholesterol, genetics, and advanced age. PAD is often confused with and can be masked by peripheral neuropathy. The most common symptom of early PAD is intermittent claudication. Patients with claudication describe pain, heaviness, and fatigue in the the calf or buttocks that occurs with walking. It is worse going up a hill or steps, worse carrying something and is relieved by rest. When you stop walking the pain goes away, but it will return once you start walking again.

Patients often attribute these symptoms to the aging process, when in fact they may be tell tale signs of a real problem.

Intermittent claudication results from a lack of oxygen to the muscles of the calf or buttocks due to restricted blood flow. The muscles need extra oxygen when they are working, when they run out of oxygen they ache and usually make you stop to rest and pay back the oxygen debt. Claudication is best treated with medications, exercise, control of glucose, blood pressure, and cholesterol and of course cessation of all tobacco. Rarely claudication can be disabling and in such cases may be treated with angioplasty, stents, atherectomy, or surgery.

More advanced PAD leads to burning pain in the feet and toes that disturbs sleep. This nighttime rest pain is a result of severe PAD that starves the nerves and small muscles of the feet for oxygen. The pain makes you sit up and dangle the foot, rub it, or get up and walk on it, all of which drives a little more oxygen to the foot to quiet the nerves. At this point, some form of procedure is usually required to get more blood to the foot. If PAD is allowed to progress from here, then the result will be tissue loss, painful ischemic wounds, sores that fail to heal, or even gangrene. 

If you have symptoms such as claudication or rest pain or risk factors such as diabetes, high cholesterol, high blood pressure, a history tobacco use or any other form of vascular disease, then talk to your doctor. A referral to Dr. Tapper may be in order. He is an expert in making the correct diagnosis of the severity of PAD. A thorough history and physical examination, supplemented by non-invasive Doppler studies will allow Dr. Tapper to fully assess your vascular status. He may advise you to start medication and an exercise program or recommend a procedure to restore blood flow depending on your circumstances. If you need a revascularization procedure, then rest assured that Dr. Tapper is an expert at all minimally invasive techniques such as angioplasty, stent, and atherectomy and he is highly skilled at surgical bypass as well. He will discuss all of the options, risks, and benefits of the procedure with you. He is committed to providing safe, ethical treatment to help you preserve your leg and regain function. 


Be careful, do your homework. Some limb salvage "experts" recommend highly profitable minimally invasive procedures that are not durable. If you have had multiple procedures or have gotten worse after treatment you deserve a second opinion.