peripheral artery disease

Takeaways from the Peripheral Arterial Disease (PAD) Treatment Options Live Chat

pad-260x200Thank you to everyone who attended and participated in our Peripheral Arterial Disease (PAD) live chat on Tuesday, January 24th with the Emory Heart & Vascular Center’s Chief of Vascular Surgery, Dr. William Jordan. Peripheral Arterial Disease (PAD) affects 8 to 12 million people in the United States, especially those over 50. Those who suffer from PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions.

Dr. William Jordan was able to answer all of your questions about PAD and the various treatment options available. We received a lot of awesome questions which you can find in the full chat transcript here. Below are some highlights from our live chat.


Question: How do I get tested for PAD?

Dr. Jordan: A thorough physical exam would be the first test. Non-invasive testing with blood pressure cuffs on the legs along with low-grade treadmill walking can usually confirm the diagnosis. It is best to see a vascular specialist to be tested.

Question: Are there clinical trials for PAD?

Dr. Jordan: Yes, Emory participates in the BEST-CLI study which is an NIH sponsored study to compare open vs. endovascular treatment for PAD. We also are constantly evaluating new treatment modalities as new devices become available.

Question: What do you think the best way to treat PAD is?

Dr. Jordan: The first line would be medical therapy, including lifestyle changes such as exercise, diet and nicotine cessation. If there is not improvement from medical therapy, we will consider the patient for reconstruction- bypass or stent.


Thank you again to everyone who joined us for our PAD live chat! You can learn more about the Emory Heart & Vascular Center here.

Peripheral Arterial Disease (PAD) Treatment Options Live Chat: January 24, 2017

pad-260x200Peripheral Arterial Disease (PAD) affects 8 to 12 million people in the United States, especially those over 50. Those who suffer from PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions.

Join us on Tuesday, January 24th at 12pm when the Emory Heart & Vascular Center’s Chief of Vascular Surgery, Dr. William Jordan,  will answer all of your questions about PAD and the various treatment options available. All are welcome to attend this open chat with our physicians.


Takeaways from Dr. Robertson’s PAD Live Chat

PAD Leg PainThanks to everyone who joined us Tuesday, March 24 for the live online chat entitled “What’s causing your leg pain?,” hosted by Emory Heart & Vascular Center physician Greg Robertson, MD.

According to the American Heart Association, many people mistake the symptoms of peripheral artery disease (PAD) for something else, which is why it can easily go undiagnosed. Having the correct diagnosis is important because people with PAD are at a higher risk of heart attack or stroke, and if untreated, PAD can lead to gangrene and amputation. Check out the conversation with Dr. Robertson regarding PAD by viewing the chat transcript! Here are just a few highlights from the chat:

Question: Exercise makes the pain in my left leg worse. What are some suggestions to help alleviate the pain and still be able to exercise? How do I fix this problem for good?

Gregory Robertson, MDDr. Robertson: My first recommendation would be to see your doctor to pursue the cause of the pain. There are many causes of exercise-related leg pain, and it may be solved as simply as talking to your physician about your health history and getting a physical. Some simple testing may also be recommended by your physician. PAD is one possibility for exercise-related pain, and if the patient has diabetes, a history of smoking, or is over 70 years old, the possibility of PAD is more likely.

Question: My right leg from my lower back all the way down to my foot hurts. What makes it hurt?

Gregory Robertson, MDDr. Robertson: There are many different causes for these symptoms, First and foremost I would suggest making an appointment with your physician so he/she can get a feel for your medical history and perform a physical. This will help your physician narrow testing recommendations in order to make an accurate diagnosis. One possibility is that you have sciatica, but unfortunately, I can’t speak to your situation accurately without seeing you in person. An accurate diagnosis would have to be made by your physician.

Question: What precautions need to be taken when diagnosed with PAD?

Gregory Robertson, MDDr. Robertson: Patients diagnosed with PAD should be under the care of a vascular physician. Preventative care with healthy living habits and risk factor modification is of the utmost importance. Depending on the severity and each individual’s case, your vascular physician will review the options of medical treatment vs. minimally invasive procedures or surgery.


Question: I keep getting pain in my calves, told I have no clots but it’s getting worse. What do I do?

Gregory Robertson, MDDr. Robertson: Does the pain in your calf come on only with exercise, and if yes, does it promptly go away with rest? If this is the pattern of your calf pain, it strongly suggests the possibility of peripheral artery disease (PAD) and the chances of this are increased if you also have the risk factors of diabetes, smoking, and/or are over the age of 70.


Question: Just diagnosed with neuropathy. No diabetes or alcohol disease. I am 72. Any advice?

Gregory Robertson, MDDr. Robertson: There are many different causes of lower extremity neuropathy. PAD, especially in a diabetic and occasionally in non-diabetics, can be one cause. Usually a simple PAD screening test such as the ankle- brachial index (ABI) can clarify whether there is significant PAD as a potential cause of your lower-extremity neuropathy.


If you missed this chat, be sure to check out the full list of questions and answers on the web transcript. For more information on peripheral artery disease, visit

If you have additional questions for Dr. Robertson, feel free to leave a comment in our comments area below.





What’s Causing Your Leg Pain? – Join Us for a Live Web Chat!

PAD Live ChatPeripheral artery disease (PAD) is a commonly undiagnosed disease affecting about 8.5 million Americans. Symptoms vary from cramping in the lower extremities, as well as pain or tiredness in leg or hip muscles. According to the American Heart Association, many people mistake the symptoms of PAD for something else, which is why it can easily go undiagnosed. Having the correct diagnosis is important because people with PAD are at a higher risk of heart attack or stroke, and if untreated, PAD can lead to gangrene and amputation.

Many people think their leg pain is due to arthritis, sciatica or just a part of aging. People with diabetes may even confuse PAD pain with a neuropathy, a common diabetic symptom that causes a burning or painful discomfort of the feet or thighs. It is important to know that, while PAD is potentially life-threatening, it can be managed or even reversed with proper care. If you’re having any kind of recurring pain, talk to your healthcare professional.

Join me on Tuesday, March 24, at 12:00 p.m. for an interactive web chat entitled “What’s causing your leg pain?” Dr. Robertson will be available to answer questions and discuss various topics about PAD, including symptoms, diagnosis and misdiagnosis, prevention and treatment.

During this interactive web chat, you’ll be able to ask questions and get real-time answers from our Emory Healthcare professional.

Register now for our March 24 chat at

About Dr. Robertson

Gregory Robertson, MDGreg Robertson, MD, is the chief of the Emory Heart and Vascular Clinic at Johns Creek. At the Emory Johns Creek Hospital he is chief of cardiology and the medical director of the Cardiac Catheterization laboratory and interventional program. He is board certified in Vascular Medicine, Endovascular Medicine, Interventional Cardiology and Cardiovascular Medicine.

Dr. Robertson’s research has had a focus on the development of new technologies and techniques to treat blocked leg arteries in patients with peripheral arterial disease, helping patients walk farther and prevent limb amputation in diabetic patients. While in the San Francisco Bay Area for 16 years before moving to Atlanta, he practiced with the well-known medical device inventor Dr. John Simpson, whose development teams invented the atherectomy procedure and the first percutaneous arterial closure device. Atherectomy is a procedure which allows the physician to remove plaque in blocked arteries without major surgery. His newest project is with Dr. Simpson’s invention of the Avinger Ocelot and Pantheris devices which open blocked arteries using smart laser imaging.

Dr. Robertson’s clinical expertise is oriented on performing minimally-invasive procedures to avoid major surgery. He has developed many of the vascular programs at the new Emory Johns Creek Hospital including 1) carotid artery stenting, 2) percutaneous repair of abdominal aortic aneurysms and 3) limb preservation for those at risk of limb amputation. He has also developed the cardiac intervention programs for emergency heart attack victims and elective procedures to include PCI and PFO/ASD closure.

Understanding Peripheral Vascular Disease

PVDDo you experience painful muscle cramps in your hips, thighs or calves when moving around? You may be surprised to learn that this is the primary symptom of peripheral vascular disease (PVD). PVD is defined as diseases of the arteries outside of the heart and brain. PVD is a term used interchangeably with peripheral artery disease, or PAD, but PVD encompasses diseases of the arteries AND veins.

Arteries move blood away from the heart, and PAD typically involves the narrowing of the arteries that transport blood to the arms and legs. Veins take the blood back to the heart and generally don’t get narrowed with cholesterol, but rather develop another very common condition called chronic venous insufficiency (varicose veins).

PAD – Arteries

Many patients go undiagnosed because the symptoms can be attributed to something else, such as arthritis, a neuropathy or normal stiffness that occurs with aging. Patients with PAD may also experience numbness, weakness or coldness in one or both legs. Often the symptoms come on slowly and the patient starts altering their life style and become more sedentary.

On the other hand, at least half of people who suffer from PAD have no signs or indications at all. Risk factors for PAD include aging, personal or family history, cardiovascular disease or stroke. Controllable risk factors include:

  • Cigarette smoking
  • Obesity
  • Diabetes mellitus
  • Physical inactivity
  • High blood cholesterol
  • High blood pressure Renal failure

Chronic Venous Insufficiency

This is more common than PAD and may start at an early age. The symptoms of this may include any one or more of the following: legs feeling heavy or tired especially at the end of the day, mild swelling of ankles, severe cramps at night time, restless legs, itching of legs, or formation of visible veins on the leg. In severe cases the skin around the ankle area may get darker in color and sores may form, generally above the ankle, which are slow to heal.

Some of the risk factors include age, family history of varicose veins, obesity, standing for long periods on hard surfaces and history of blood clots or phlebitis in the leg.

If you have any of the above symptoms or would like to discuss your risk factors, talk to your healthcare provider. PVD diagnosis begins with a physical examination.

At Emory, treatment of PVD is a combined effort within the Emory Heart & Vascular Center, the Division of Vascular Surgery and Endovascular Therapy and Interventional Radiology. To make an appointment, call 404-778-7777.

About Khusrow Niazi, MD

Khusrow Niazi, MDDr. Niazi specializes in interventional cardiology, carotid artery disease, peripheral artery disease and venous disease of the legs. He has been practicing at Emory since 2003. He has been involved in many trials in treating blockages in the carotid arteries and leg arteries with less invasive options. Dr. Niazi is involved in trials focused on the removal of plaque from the leg arteries with less invasive methods. He also has treated many patients with chronic venous insufficiency and varicose veins.

New PAD Resources: 7 Peripheral Artery Disease Ask the Expert Videos & Live MD Chat

Peripheral Artery Disease ResourcesAs we have discussed in previous posts on PAD, millions of people in the United States suffer from this life, and potentially limb threatening, disease. What is unfortunate is that many people don’t know they have it.  In our Peripheral Artery Disease “Ask the Expert” video series we answer many questions about PAD including:

  • What is PAD?
  • What are common symptoms of PAD?
  • How do you test for PAD?
  • When should someone be tested for PAD?
  • What are the treatment options for PAD?
  • What physicians are involved in treating PAD?
  • What kind of research is being done at Emory for PAD?

If watching the PAD videos sparks questions, join my colleague Dr. Khushrow Niazi on Monday, April 25 from 12:30p.m. – 1 :15p.m. for an interactive, online Q&A web chat on the topic of PAD. He will answer questions and discuss various topics about PAD including prevention, detection, symptoms, testing, treatment options and innovative new research.

If you think you may have PAD after viewing the videos, please call Emory HealthConnection℠ 404-778-7777 to schedule an appointment.

Do you have questions about PAD in general? If so, please let me know in the comments section.

About Ravi Veeraswamy, MD:

Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Recently, Dr. Veeraswamy has published articles in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

Peripheral Artery Disease: Donna Seaman’s Story

My name is Donna Seaman, and I’d like to share my story of Peripheral Artery Disease with you.

First—a little background for you: I’m from Massachusetts, and I’ve lived in Atlanta for over 35 years now. I attended Emory University and majored in business before becoming a buyer for Rich’s (now Macy’s). I enjoyed the best of both worlds in that I spent several years as both a working Mom, and several as a stay-at-home Mom. I live in Dunwoody, and I have two children—a 26-year-old daughter, and a 23-year-old son.

I’ve been playing tennis now for over 20 years, and once I hit my late 40s I began to notice some leg pain and swelling. At the time, I attributed it to normal wear and tear, and assumed it was also due to all of the years I spent on my feet working in the retail industry. When the pain worsened after about a year or so, I knew it was time to seek medical help.

When Dr. Niazi asked me if I was experiencing any other symptoms, I shared the fact that my tennis game had been really “off”, and that I had noticed that I was stumbling around more and feeling clumsier in general. I would also pick up items and unintentionally drop them. I didn’t think much of these particular symptoms, but the folks at Emory really took notice when they heard me mention them, and decided to run some more tests.

After the tests, Emory called me with the results and informed me that not only did I have peripheral artery disease in my legs, the carotid artery in my neck was 97% blocked. (My neck artery blockage was what was causing the stumbling and clumsiness.) Dr. Niazi immediately warned me not to have any neck rubs or massages, and to exercise caution when I was getting my hair washed at the salon or bending my neck. With 97% of the artery blocked, I was dangerously close to experiencing a stroke.

Initially, I had less invasive procedure that involved the physician going through my groin area and then up into my neck in order to place a stent. However, after reviewing the results of the procedure, Dr. Niazi realized that my condition was worse than he anticipated. He recommended that I undergo total carotid artery surgery, which was necessary given my younger age and the severity of the blockage.

A week later (in October of 2009), I was back at Emory for the carotid artery surgery that would clean out the build-up of plaque.  I was in the hospital for three days for the procedure. I left Emory with a scar on my neck and the knowledge that I’d come dangerously close to having a potentially fatal stroke. In my mind, it’s a sort of miracle that my condition was discovered the way it was—if it weren’t for Dr. Niazi’s proactive treatment of my PAD, I’m not sure I’d be here to tell you my story today.

About a month later, I was treated for the PAD that was present in my legs. This was a much simpler procedure—and was practically right in and out of the hospital for it.

Since the surgery, I started taking medication for cholesterol and high blood pressure, and I have yearly checkups to the doctor. I no longer feel any pain in my legs when I exercise. My walking is better, and my balance has improved greatly.

I can’t say enough good things about Dr. Niazi and the team at Emory who treated me. They’re personable, professional, and top-notch, and they took a personal interest in me and carefully listened to me speak about my concerns and symptoms. I feel very fortunate that I was in such good hands and that I escaped the life-threatening repercussions of PAD.

Treatment Options for Peripheral Artery Disease

In this post, we’ll continue our blog series by examining the various treatments for treating peripheral artery disease (PAD).


Before we delve into the various medical treatment options for PAD, we must point out the importance of taking control of your own health. If you’re suffering from diabetes, this means that you must carefully monitor your blood sugar levels. If you’re a smoker, we cannot stress the importance of doing everything in your power to quit the habit. PAD is very common among smokers, and smoking only exacerbates the effects of the condition.

Additionally, we strongly encourage regular exercise as a means of treatment—it increases blood flow to your legs and can actually alleviate symptoms. For some, exercise may be painful; however, you can often work your way up to a level of exercise that’s extremely beneficial as well as tolerable.


Medication may be necessary to offset the effects of PAD and lower the risk of heart attacks and stroke.

Antiplatelets affect blood platelets, causing them to be less likely to stick together to form blood clots. One of the most common antiplatelets is aspirin.

Anticoagulants prevent blood clotting, but must be monitored carefully for side effects. Two examples of anticoagulants are heparin and warfarin.

Cholesterol-lowering drugs have also proven to be effective in preventing heart attacks and stroke. Additionally, they can improve atherosclerosis and alleviate painful symptoms resulting from claudication. Statins and niacin are both examples of cholesterol-lowering drugs.

Angioplasty & Surgery

Many times, PAD patients require treatments such as angioplasty or surgery. As we described in our last blog post, angioplasty involves the insertion of a catheter into the groin area and then into the narrowing arteries. Partially blocked arteries can be opened through the insertion of a tiny stent or balloon.

For patients with more severe instances of PAD, more invasive means of surgery may be necessary, such as endarterectomy, which removes the buildup of plaque within the affected arteries. Bypass surgery may also be performed, which involves the replacement of blocked arteries with a graft. This encourages blood flow to move around the narrowed or blocked arteries.

If you have questions on any of these procedures or treatments, please be sure to let us know in the comments.

About Gregory Robertson, MD:

Dr. Robertson specializes in Cardiology and Internal Medicine, and is an Assistant Professor of Medicine at Emory. Some of his areas of clinical interest include atherosclerosis, cardiac catheterization, cardiovascular disease, valve disease, and peripheral artery disease. Dr. Robertson holds an organizational leadership membership at The American College of Cardiology, and has contributed to multiple publications in his field.

About Ravi Veeraswamy, MD:

Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Dr. Veeraswamy had major or recent publications in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

Diagnosing Peripheral Artery Disease

In previous blog posts, we’ve discussed patient stories and described symptoms of peripheral artery disease (PAD). Today, we’ll focus on what types of patients are candidates for screening and treatment, and the types of screening methods available.

Risk factors for PAD include people who are over the age of 70, over the age of 50 and suffering from diabetes, and smokers. In some cases, people under the age of 50 may be at risk, particularly if they’re obese, suffering from diabetes, or if they have high blood pressure.  High cholesterol or a family history of the disease also increases the risk of developing PAD.

If we suspect that you have PAD, we’ll perform one or more of the following tests:

General physical exam:

Here, we’ll examine your body in an attempt to pinpoint any potential signs of PAD. This typically includes checking the pulse (particularly below the suspected weakened artery), listening for sounds over your arteries, checking your blood pressure, and tapping areas of your body to assess the level of fluid in your organs.

Doppler Ultrasound:

The Doppler Ultrasound test gauges the blood flow within the arteries in your arms and legs. It can diagnose arteriosclerosis, blood clots and artery blockages, and venous insufficiency or occlusion.


With angiography, we insert a dye into your blood vessels, which enables us to view the flow of blood though your arteries. During the procedure, X-rays are taken, or MRA (magnetic resonance angiography) may be used to follow the flow of the dye. Additionally, a catheter may be used (this is referred to as catheter angiography), and inserted into the groin area and into the area of the body being examined. While this particular method is a bit more invasive, it’s also beneficial in that we can treat the area in question while we examine it by inserting medication or opening partially blocked arteries with a stent or balloon.

Ankle-brachial index:

The ankle-brachial test measures the blood pressure at your ankle and compares it to the blood pressure in your arm. Your blood pressure is measured before and after you walk on a treadmill to determine whether PAD is present. The ABI test is considered to be one of the most reliable for determining the presence of PAD.

These are the main tests that we typically perform in order to diagnose and evaluate PAD; however, additional tests may be necessary.

Do you have questions about how we diagnose PAD? If so, feel free to ask away in the comments section.

About Dr. Joseph Ricotta, MD:

Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010.  His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases. He holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery, and the Society for Vascular Surgery.