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Peripheral Artery Disease (PAD)
Understanding Peripheral Artery Disease: From Diagnosis to Medical Malpractice
Peripheral Artery Disease (PAD) is a serious circulatory condition where narrowed arteries reduce blood flow to the limbs—usually the legs. While PAD is a common condition affecting millions, it is frequently underdiagnosed or mismanaged. When medical providers fail to recognize the signs or provide timely treatment, for peripheral artery disease, the consequences can constitute medical malpractice, and can be life-altering, leading to chronic pain, non-healing ulcers, and even amputation.
What Causes PAD and Who is at Risk?
At its core, atherosclerosis causes PAD. This is the process where fatty deposits (plaque) build up on the inner walls of the arteries. Over time, this plaque hardens and narrows the “pipe,” restricting the amount of oxygen-rich blood that can reach the muscles.
While anyone can develop PAD, certain factors significantly increase the risk:
- Smoking: Perhaps the single greatest risk factor; chemicals in tobacco smoke damage the endothelium (vessel lining).
- Diabetes: High blood sugar levels weaken artery walls and contribute to faster plaque buildup.
- Age: People over 50 are at higher risk.
- Hypertension and High Cholesterol: Both put excessive strain on and cause damage to the arterial system.
- Family History: A genetic predisposition to heart disease or stroke often correlates with PAD.
Recognizing the Symptoms
The hallmark symptom of PAD is claudication—muscle pain or cramping in the legs or hips that occurs during exercise (like walking) and stops with rest. However, as the disease progresses to Chronic Limb-Threatening Ischemia (CLTI), symptoms become more severe:
- Rest Pain: Burning or aching in the feet or toes, even while lying down.
- Color Changes: Legs may turn blue, dark red, or pale when elevated.
- Temperature Drop: One foot feeling significantly colder than the other.
- Non-healing Wounds: Sores, ulcers, or infections on the feet that do not heal.
- Gangrene: Death of body tissue due to a lack of blood flow.
Failure to recognize the symptoms of peripheral artery disease can lead to medical malpractice.
The Diagnostic Process: Providers and Tools
The journey to a PAD diagnosis usually begins with a Primary Care Physician (PCP) or a Podiatrist. If a medical provider suspects PAD, they often refer the patient to other doctors such as a Vascular Surgeon or a Cardiologist.
Common Diagnostic Tests
- Ankle-Brachial Index (ABI): This is the “gold standard” screening tool. It compares the blood pressure measured at the ankle with the blood pressure measured at the arm.
- What it shows: A ratio lower than 0.9 suggests a blockage.
- Duplex Ultrasound: Uses sound waves to visualize the structure of the arteries.
- What it shows: It identifies the specific location and severity of a narrowing or occlusion.
- CT Angiography (CTA) or MR Angiography (MRA): Advanced imaging that provides a detailed 3D map of the blood vessels.
- Catheter-Based Angiography: A contrast dye is injected via a catheter while X-rays are taken.
- What it shows: This is the most definitive map used to plan surgical interventions.
Treatment Pathways: Restoring Blood Flow
Treatment is managed by Vascular Surgeons, Interventional Radiologists, or Interventional Cardiologists. The goal is twofold: manage symptoms to improve mobility and prevent limb loss. Failure to provide timely treatment for peripheral artery disease can constitute medical malpractice.
1. Conservative Management
In early stages, doctors prescribe antiplatelet medications (like aspirin), cholesterol-lowering statins, and supervised exercise therapy to encourage the growth of “collateral” vessels.
2. Endovascular Procedures (Minimally Invasive)
- Angioplasty: A tiny balloon is inserted into the artery and inflated to push the plaque against the wall, widening the passage.
- Stenting: A doctor places a metal mesh tube (stent) in the artery to keep it propped open.
- Atherectomy: A specialized device is used to “shave” or laser away the plaque from the vessel wall.
3. Surgical Bypass
If the blockage is too long or hard for a stent, a surgeon performs a Peripheral Artery Bypass. Using either a synthetic tube or a vein harvested from the patient’s own leg, the surgeon sews a new path around the blockage, rerouting the blood.
Peripheral Artery Disease and Medical Malpractice: When Care Falls Short
Malpractice occurs when a provider deviates from the standard of care, resulting in preventable injury.
Types of Malpractice Claims in PAD Cases
| Claim Type | Description |
| Misdiagnosis or Failure to Diagnose | A PCP or Podiatrist ignores a patient’s complaints of leg pain or fails to check for pedal pulses (pulses in the feet) in a diabetic patient. |
| Failure to Refer | Recognizing signs of ischemia but failing to refer the patient to a vascular specialist until the tissue has already become necrotic. |
| Surgical Errors | During a bypass or angioplasty, the surgeon may puncture an artery (perforation) or cause a blood clot (thrombosis) and fail to recognize it immediately. |
| Inadequate Post-Op Monitoring | Failing to monitor blood flow after a procedure, leading to “re-occlusion” that goes unnoticed until the limb is unsalvageable. |
| Delayed Treatment | Waiting weeks for tests or procedures when a patient presents with “rest pain,” which is a medical emergency. |
The “Window of Opportunity”
In PAD cases, time is tissue. The most devastating malpractice claims involve preventable amputations. If a doctor misses the signs of CLTI and the patient loses a leg, the legal focus is often on whether a timely ABI test or a referral to a specialist would have saved the limb.
Conclusion on Peripheral Artery Disease Medical Malpractice
Peripheral Artery Disease is a progressive condition that requires a high index of suspicion from healthcare providers, especially when treating high-risk populations like smokers and diabetics. When diagnosed early, PAD is highly manageable. However, when medical providers ignore clinical “red flags” of peripheral artery disease, the result is often medical malpractice, and a catastrophic loss of mobility and quality of life.
If you or a loved one suffered a limb loss or severe injury due to a delayed PAD diagnosis, it is essential to have a medical expert witness review the timeline of care to determine if the standard of care was met. Contact the Kopec Law Firm now to start this process.
If you have a potential medical malpractice case, then visit our free consultation page or video. Then contact the Kopec Law Firm at 800-604-0704 to speak directly with Attorney Mark Kopec. He is a top-rated Baltimore medical malpractice lawyer. The Kopec Law Firm is in Baltimore and pursues cases throughout Maryland and Washington, D.C.