Perspectives on Peripheral Artery Disease

By Daniel Tamez, MD, Vascular Surgeon, Peripheral Vascular Associates
Friday, September 8, 2017

In the medical community, September is dedicated to bringing awareness of peripheral artery disease (PAD) and its process.

Patients at high risk include those who suffer from diabetes, hypertension and hyperlipidemia, have a history of smoking, and have a family history of atherosclerosis. PAD has other terminologies such as peripheral vascular disease, atherosclerosis, hardening of the arteries and bad circulation.

Since the inception of my career as a vascular surgeon in 1982, I have encountered that leg pain and various symptoms of lower extremity complaints are usually misdiagnosed and misunderstood by the medical profession. Patients with leg problems and symptoms comprise nearly 40 to 50 percent of office visits in our vascular practice. I believe peripheral vascular surgeons perform the most thorough assessments of the patient because of our extensive training and knowledge in the field.

Identifying PAD

Daniel Tamez, MD, Vascular Surgeon, Peripheral Vascular Associates

The Mayo Clinic lists 48 common causes of leg pain. Consequently, the diagnosis can be difficult to obtain. The most common that I see are circulatory, back problems radiating to legs, bone and joint problems involving hips, knees, ankles and feet, diabetes with central and peripheral neuropathy, chronic and acute venous disease, edema secondary to systemic diseases, and finally fibromyalgia and other connective tissue diseases.

Listening to the patient for a complete history will result in a diagnosis 90 percent of the time. We focus on keywords patients use to reduce possible etiologies of their complaints.

A complete, head-to-toe physical examination will add to the accuracy of the diagnosis. This increases identification of the problem to 95 percent. This examination includes a thorough evaluation of all pulses of the extremities, abdomen and neck, blood pressure in both arms, and auscultation for bruits and murmurs.

Tailoring Treatment

As vascular surgeons, we have the capabilities and training to cover the entire spectrum of treatment: conservative management, endovascular intervention with balloons, wires, and stents, open surgical procedures such as bypass or endarterectomy, and a hybrid approach that involves both endovascular techniques and open surgery. There is no need for an invasive procedure such as an arteriogram. Arteriograms are usually reserved for patients with disabling claudication, which means that a patient can hardly walk, rest pain of the distal legs and feet, and/or skin changes such as ulcers or gangrene of the feet or toes.

The conservative approach is always the recommended choice in treating vascular problems. Primum non nocere — First, do no harm. Any intervention in the arterial system can have a complication.

The patient and family can also be instructed on different modes of therapy once a diagnosis is made. Cessation of smoking, a regular walking program, emphasis on foot care and proper footwear, and occasionally a prescribed medication will improve the distance a patient with PAD can walk (claudication).

A diagnosis of PAD could also signify problems involving the heart (heart attacks), carotid arteries (stroke), and in intestinal/renal arteries (mesenteric insufficiency and renal failure). Consequently, PAD diagnosis should ensure that the patient is considered as a whole person, not just his or her issues in the lower extremities.

To learn more about Peripheral Vascular Associates or to schedule an appointment, visit or call 210-237-4444.