Peripheral Artery Disease (PAD) is a common circulatory problem where narrowed arteries reduce blood flow, typically to the legs, causing pain and impeding walking. This reduced circulation is caused by atherosclerosis, the buildup of fatty plaque within the arterial walls. Because PAD is a systemic disease, effective management requires a multidisciplinary team to address both localized arterial blockages and the widespread risk of cardiovascular complications.
Initial Diagnosis and Primary Care Guidance
The first step in addressing suspected PAD is often a visit to a Primary Care Physician (PCP). The PCP assesses symptoms like leg pain during exercise (claudication) or non-healing foot wounds. They identify patients who have risk factors, such as a history of smoking, diabetes, high blood pressure, or high cholesterol.
A simple, non-invasive diagnostic tool used is the Ankle-Brachial Index (ABI) test, which compares blood pressure in the ankles to the arms. An ABI ratio of 0.90 or less suggests the presence of PAD. Once diagnosed, the primary care doctor manages foundational risk factors through lifestyle counseling and medication. This includes prescribing antiplatelet agents, statins, and drugs to manage blood sugar and hypertension, which are the first line of defense against disease progression.
Specialists Who Perform Interventions
When symptoms progress despite medical therapy, or if the disease presents as severe limb-threatening ischemia, intervention is necessary, leading to a referral. Three main types of specialists perform procedures to restore blood flow in the peripheral arteries, often with overlapping modern techniques. The choice depends on the patient’s anatomy, the complexity of the blockage, and the local healthcare infrastructure.
Vascular Surgeons
Vascular surgeons are physicians trained in the diagnosis and treatment of diseases affecting the vascular system, excluding the heart and brain. Their training encompasses both traditional open surgical repair and advanced endovascular (minimally invasive) techniques. They are the only specialists who can offer bypass surgery, which reroutes blood flow around a blocked artery using a graft.
Modern vascular surgeons are proficient in endovascular procedures like angioplasty, stenting, and atherectomy. Atherectomy involves removing plaque from the inside of an artery to widen the vessel. This comprehensive skill set allows them to select the most appropriate treatment, whether it is a complex open repair or a less invasive catheter-based procedure.
Interventional Cardiologists
Interventional cardiologists specialize in heart catheterization, and their expertise with coronary arteries is directly applicable to treating peripheral arteries. They use minimally invasive techniques to treat blockages in the legs, employing wires, balloons, and stents to open narrowed vessels. Their background in managing heart disease makes them suited to treating PAD patients, as many individuals with PAD also have co-existing coronary artery disease.
These specialists focus on catheter-based endovascular treatments, often utilizing devices like drug-coated balloons and specialized stents. Their understanding of systemic atherosclerosis ensures that leg artery treatment is integrated with the patient’s overall cardiovascular health management.
Interventional Radiologists
Interventional radiologists are experts in using medical imaging, such as fluoroscopy and ultrasound, to guide minimally invasive procedures, including those in the peripheral vasculature. Their strength lies in navigating complex anatomy using catheters and wires under live image guidance.
They treat PAD using endovascular tools like angioplasty, stenting, and thrombolysis to dissolve blood clots. Interventional radiologists often specialize in accessing difficult-to-reach vessels and performing procedures on patients who may not be candidates for open surgery. Their training emphasizes procedural precision achieved through imaging, a core component of modern endovascular PAD treatments.
Managing Long-Term PAD Health
Peripheral Artery Disease requires ongoing management because it indicates a systemic atherosclerotic process. The long-term care team includes specialists focused on preventing cardiovascular events and managing local complications of reduced blood flow.
Cardiologists
A cardiologist is a necessary member of the long-term care team because PAD significantly increases the risk of heart attack and stroke. Plaque buildup in the leg arteries suggests similar disease in the coronary or carotid arteries. The cardiologist focuses on optimizing medical therapy to reduce overall cardiovascular risk, including careful management of blood pressure and cholesterol.
They monitor heart function and ensure the use of medications like statins and antiplatelet drugs to stabilize plaque and prevent clot formation. This medical management is critical for improving both limb and overall survival rates.
Podiatrists (Foot and Ankle Specialists)
Podiatrists play an important role, especially in advanced stages of PAD when patients develop critical limb ischemia. This severe condition is characterized by rest pain, non-healing foot ulcers, or gangrene. Podiatrists are skilled in meticulous foot care, wound debridement, and infection management.
They work to prevent minor injuries from escalating into limb-threatening infections, a common outcome when blood flow is poor. By managing ulcers and providing specialized footwear, the podiatrist helps preserve the limb and prevent the need for major amputation.