Peripheral Arterial Disease (PAD)
Peripheral Arterial Disease Care at UVM Health
Peripheral arterial disease (PAD) occurs when the blood vessels (arteries) that supply blood to the legs narrow or become blocked.
This is most commonly caused by plaque buildup in the blood vessels (atherosclerosis). If you have PAD, you most likely have plaque buildup in other arteries, raising your risk of heart attack or stroke.
Why Choose UVM Health?
At University of Vermont Health, we take a coordinated, team-based approach to diagnosing and treating peripheral arterial disease.
Our network of heart and vascular providers gives you access to advanced treatment options, so no matter where you live in Vermont or northern New York, you can get personalized care that helps you live a full and healthy life.
As one of the leading vascular programs in the region, we offer:
- Expert physicians: Our vascular specialists provide expert treatment with excellent outcomes which meet — and even exceed — national benchmarks. As a health system anchored by an academic medical center, our physicians are also active researchers.
- Advanced treatments: We offer a range of treatment options, including both minimally invasive and open-vascular surgery. Your provider will work closely with you to determine the care plan that best meets your needs.
- Coordinated care: UVM Health specialists are located throughout the region, so you’re always connected to a larger network of experts who provide specialized care for peripheral arterial disease. We coordinate network referrals quickly so that you get the care you need, when and where you need it.
What Causes Peripheral Arterial Disease?
In most cases, peripheral arterial disease is caused by atherosclerosis, “hardening of the arteries.” This condition occurs when plaque (made up of excess cholesterol, calcium and other substances) builds up in the walls of the arteries. The arteries begin to narrow or become blocked, affecting blood flow to the rest of the body.
Atherosclerosis is associated with the following risk factors:
- Smoking
- Diabetes mellitus
- High cholesterol
- High blood pressure
- A family history of atherosclerosis or coronary artery disease
The risk for PAD also increases with age. In rare cases, PAD can be caused by inflammation of the blood vessels (vasculitis).
Symptoms of Peripheral Arterial Disease
Many people with peripheral arterial disease do not initially have symptoms. However, as the disease progresses, symptoms may develop. Common signs and symptoms of PAD include:
- A tight, aching or squeezing pain in your calf, thigh or buttock (intermittent claudication), usually while you are walking
- Pain in your foot or toe while at rest
- Weak or tired legs
- Difficulty walking or balancing
Diagnosing Peripheral Arterial Disease
If your vascular surgeon suspects you have peripheral arterial disease, they will discuss your symptoms with you and conduct a physical exam. During this exam, they will check your pulse at multiple points on your leg (typically the groin, behind the knee, on the inner ankle and on the top of the foot). An absent or weak pulse in these spots is a sign of PAD.
Your vascular surgeon will likely order one or more tests to confirm your diagnosis. These may include:
- Ankle-brachial index (ABI) test: Checks blood flow by comparing blood pressure in the ankles and the arms, and other non-invasive studies to evaluate circulation
- Stress tests: Measures your heart’s response to exercise
- Pulse volume recordings (PVR): Measures blood flow and blood pressure in your legs
- Duplex ultrasound: Uses high-frequency sound waves to show the structure of your blood vessels and how blood moves through them
- Magnetic resonance angiogram or computerized tomography (CT) angiography: Detects narrowed or blocked arteries
- Skin Perfusion Test (TcPO2): Assesses if blood vessels are blocked or damaged
- Blood tests: Checks your cholesterol and blood sugar and identify related conditions such as high cholesterol and diabetes
Wellness & Prevention
Evidence shows that proactive health care focused on preventing illness leads to better outcomes. We're here to help you live a healthier, happier life. We offer wellness and prevention services to empower you to take control of your health.
Peripheral Arterial Disease Treatment
Once your vascular surgeon has obtained an accurate diagnosis, they will work with you to create an individualized treatment plan. The goal of treatment for peripheral arterial disease is to:
- Reduce symptoms
- Reduce your risk of heart attack, stroke, and other complications such as limb loss
- Improve your quality of life, including better walking capability
Your vascular surgeon may recommend some or all of the following treatment options.
Making healthy lifestyle changes can help you lower your risk of heart attack and stroke, and prevent your condition from worsening. Your doctor may ask you to:
- Quit smoking
- Get regular exercise
- Eat a heart-healthy diet filled with vegetables, fruits and whole grains
- Limit salt, fat and sugar
- Stay at a healthy weight, and lose weight if necessary
Your vascular surgeon may refer you to cardiac rehabilitation to create a personalized plan for implementing and maintaining these lifestyle changes.
Medicines may be used to treat symptoms of PAD or to help manage other health problems that can raise your risk of heart attack and stroke. These can include:
- Blood thinners to prevent blood clots
- Statins to lower cholesterol levels
- Medicines to control high blood pressure
- Medicines to control diabetes
- Medicines to help increase walking distance
Surgery is only done in cases of severe PAD. Your doctor will discuss surgical options with you if lifestyle changes and medications are not managing your condition.
The type of surgery used to treat PAD will depend on the size and location of the affected arteries. Your vascular surgeon will likely recommend bypass surgery, which is done to redirect blood through a grafted blood vessel to go around (bypass) the damaged blood vessel. Common types of bypass surgeries include:
- Aortobifemoral bypass: Treats PAD that affects the major abdominal artery (aorta) and the large arteries that branch off of it
- Femoropopliteal (fem-pop) bypass: Treats PAD that affects the arteries above and below the knee
- Femoral-tibial bypass: Treats PAD that affects the arteries in the lower leg and foot
Other non-bypass surgical options include:
- Angioplasty: Your vascular surgeon will insert a small, thin tube (catheter) through a blood vessel in the groin and guide it to the affected artery. Once there, they will inflate a balloon to press plaque buildup against the wall of the artery to improve blood flow.
- Endarterectomy: This procedure treats PAD that affects the large femoral artery in the groin and upper thigh by removing plaque to increase blood flow to the leg. It can be done on its own or at the same time as a bypass surgery or angioplasty.
Locations Near You
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62 Tilley Drive
Suite 101
South Burlington, VT 05403
115 Porter Drive
Middlebury, VT 05753
75 Park Street
Elizabethtown, NY 12932
101 Adirondack Drive
Suite 1
Ticonderoga, NY 12883
66 Park Street
Elizabethtown, NY 12932
130 Fisher Road
Berlin, VT 05602
210 Cornelia Street
Ste 104
Plattsburgh, NY 12901
62 Tilley Drive
Suite 101
South Burlington, VT 05403-4407
115 Porter Drive
Middlebury, VT 05753-8527
111 Colchester Avenue
Main Campus, Main Pavilion, Level 5
Burlington, VT 05401-1473
