The expansion of treatment options for peripheral artery disease (PAD) at Penn Medicine Lancaster General Health means that Lancaster County residents do not need to leave the area for care—even for complex cases.
Offered by the Vascular and Endovascular Surgery team at LGH, the therapy options can help avoid serious PAD complications and ease post-surgical recovery, explains vascular surgeon Meghan Dermody, MD.
“There is no case too complicated for us to handle,” she says. “We offer everything patients need.”
An atherosclerotic and progressive condition, PAD affects an estimated 21 million Americans, reflecting an aging population and a surge in diabetes—key risk factors for the disease. That figure, from a 2023 paper in Vascular Disease Management, represents nearly 1 in 5 people 65 or older and could grow to 24 million by 2030.
Without effective treatment, early-stage PAD can cause lower extremity pain (claudication), cramping, and fatigue. In its most severe stage, chronic limb-threatening ischemia (CLTI), PAD can lead to mobility loss, nonhealing ulcers, infection, gangrene, and lower extremity amputation.
Fortunately, behavioral interventions and evidence-based drug therapies can help patients avoid these complications, Dr. Dermody explains. If claudication continues to hinder daily life or CLTI poses an amputation risk, the medical teams at LGH can attempt to restore blood flow through revascularization and other procedures. LGH offers the most revascularizations options locally, including innovative approaches, Dr. Dermody notes.
“There’s no need to send a patient out of Lancaster County for anything related to peripheral artery disease,” she adds.
PAD Identification: Classic claudication is not the only presentation
Despite its prevalence and similar potential to cause serious complications, PAD often goes undiagnosed and untreated compared to coronary artery disease, cerebrovascular disease, and other atherosclerotic conditions.
Given this discrepancy, it is important to appreciate the range of PAD case presentations, Dr. Dermody advises. Up to 40 percent of patients are asymptomatic, though they may still develop PAD complications. Another 10 percent experience intermittent claudication in the calves, considered a classic warning despite its relative infrequency.
More commonly, patients have symptoms that linger after exercise, form in other leg muscles, or start at rest, particularly with leg elevation. Pain may also manifest in the hips, back, or buttocks, which may lead providers to investigate other potential causes.
Of the latter situation, Dr. Dermody observes, “After seeing back specialists and sometimes even going through multiple rounds of physical therapy, it turns out the pain is actually related to their leg circulation.”
PAD diagnosis guided by pulse exams, foot checks, and ankle brachial index test
Another key aspect of PAD identification comes from its risk factors—not only diabetes and advanced age but also smoking, a family history of PAD, hyperlipidemia, and hypertension. Concomitant disease may also provide guidance, with chronic kidney disease and other atherosclerotic diseases common.
When encountering suspicious symptoms or multiple risk factors—especially smoking and uncontrolled diabetes—devoting time to a dorsalis pedis pulse check and a short foot exam can pay off, Dr. Dermody says.
“Otherwise, the patient could end up with festering toe ulcers that get missed because the shoes stayed on during the visit,” she explains. Other common ulcer locations include the bottoms of the feet and the ankles.
Potential PAD signs should prompt a resting ankle brachial index (ABI) test, a noninvasive way to diagnose the condition with Doppler ultrasound. Local physicians can request a standalone ABI or comprehensive PAD consultation. Testing is performed at certain LGH Radiology locations across Lancaster County and parts of Chester and Lebanon counties, with results then interpreted by a vascular surgeon.
“If you don’t think you can feel a lower extremity pulse, that’s a reason to order the test—especially if you’re questioning anything,” Dr. Dermody says.
Supervised exercise therapy and medications can help many PAD patients
Many early-stage PAD patients respond to the lifestyle changes and medical therapy recommended in joint AHA/ACC guidelines to maintain leg function, lower cardiovascular event risk, and prevent disease progression.
Lancaster General Hospital offers smoking cessation support, and its vascular surgeons can help patients optimize medical therapy. Additionally, LGH’s Heart and Vascular Institute also offers accredited outpatient vascular rehabilitation, with exercise physiologists who tailor treadmill workouts to individual PAD patients.
Medicare typically covers 12 weeks of sessions for this type of supervised exercise therapy (SET), which the AHA/ACA guidelines point to for initial claudication treatment. Evidence shows that supervised exercise can relieve symptoms, improve leg function, and support quality of life.
“When patients are motivated, rehabilitation works,” Dr. Dermody says. “It improves their ABI results, helps them walk better, and gives them the education to keep exercising on their own.”
Innovative PAD revascularizations locally available for advanced cases
Advanced PAD patients may require revascularization—either to relieve persistent claudication or to limit tissue loss, fully heal lower extremity wounds, and preserve limbs as much as possible. Access to the optimal approach can pose a challenge at times in Lancaster County, Dr. Dermody says.
Dr. Dermody and her colleagues provide open, percutaneous, and endovascular procedures for a complete range of local PAD care. They also partner with surgical podiatrists and Hyperbaric Medicine specialists for advanced wound care.
“With such innovations, patients can stay closer to home while still benefiting from the best outcomes,” Dr. Dermody says, adding that the latest options can even provide revascularization for patients whose only prior option was amputation.
“For example, with deep vein arterialization (DVA), our vascular surgeons can use an open or percutaneous approach to convert healthy veins into vessels that can restore foot perfusion,” Dr. Dermody says. “Complex anatomy issues or advanced disease progression previously meant they were contraindicated for revascularization.”
In other cases, arteries in the foot provide the only route for crossing total occlusions. The team at LGH now uses pedal access for endovascular therapy—another option that sets it apart for advanced local care.
Partnering with local physicians in PAD care
Penn Medicine makes it easy to refer patients for a PAD workup or consultation but still stay involved in their care. By confirming an accurate diagnosis and accessing the latest therapeutic approaches, local physicians can secure the best outcomes for their patients.
To transfer or refer a patient, call the 24/7 provider-only line at 877-937-7366 or submit a referral through our secure online referral form.