Services | Conditions | Peripheral Arterial Disease (PAD)

The Basics

If you have a healthy circulation, oxygen-rich blood flows easily through the arteries to all parts of your body, including the ‘peripheries’ (limbs i.e. arms and legs). Peripheral arterial disease (PAD) is a condition which typically affects the arteries to the legs. They become hardened and narrowed, and the supply of oxygen is reduced. The build-up of fatty deposits in the artery walls usually causes the blockages. These deposits are often referred to as cholesterol plaques. The medical term is atherosclerosis.

Symptoms
Risks
Surgical Procedures

What are the symptoms and signs of PAD?
In the early stages of the condition, symptoms occur when there is an increase in the demand for oxygen by the muscle – this happens when you exercise. You experience leg cramps, tiredness, or ‘heaviness’ typically in the buttock, thigh, or calf. The symptoms disappear after resting for a few minutes. Others may experience sexual problems if the arteries to the pelvic organs are affected.

Over time, as the blockages get worse, the reduced circulation and poor oxygen supply can lead to the following:

wasting of the leg muscles, with weakness
loss of hair on the leg, thinning skin with colour changes and brittle toenails
a small scratch can quickly become an infected ulcer which takes a long time to heal
troublesome burning pain in the feet and toes, when resting, and especially at night in bed
toes which are numb and cold

With severe PAD, and complete arterial blockage, the area below the blockage (most often the toes) may die off from oxygen deprivation. This is called gangrene, and when it happens, amputation may be required.

What are common conditions which increase the risk of PAD?

Smoking
Diabetes
High cholesterol
High blood pressure
Obesity

If you have PAD, you are at risk for developing a heart attack or stroke, which are caused by the same mechanism i.e. clogged arteries from atherosclerosis.

In more advanced cases, where lifestyle changes and medications alone are not enough, a ‘revascularisation’ procedure may be recommended to improve the blood flow.

There are two main types of revascularisation operations:

Angioplasty and/or stenting – during this keyhole procedure, a catheter is used to deliver a balloon or a meshed metal cylinder (stent) to the exact spot where there is narrowing. The balloon is expanded to stretch the narrowing or blockage, or the stent is deployed to open the artery.
Artery bypass grafting – this involves a major operation where a section of healthy vein or a synthetic vessel is used to bypass the blockage caused by the diseased artery.

Angioplasty is a simpler procedure with faster healing but may not always be advisable or possible. At Cape Town Vascular, our surgeons will carefully explain the benefits and risks of each option. Our surgeons will then recommend the approach best suited for your situation.