Peripheral Artery Disease - Better Know As "PAD"
PAD affects more than 10 million Americans, most of who are over age 50. A common and potentially deadly disease, PAD occurs when blood flow to the arteries of the legs is blocked — commonly known as “hardening of the arteries.” The risk of heart attacks and strokes may be as much as eight or nine times higher if you have PAD.
Symptoms include pain, cramping, or swelling of the legs, difficulty walking, numbness, and skin discoloration. But many people, including doctors, sometimes mistake it for arthritis or other non-life-threatening conditions.
“Most people think it’s just part of the aging process, and they usually don’t seek attention until very late in the course of the disease,” says Karl
Late signs of PAD can include your toes turning black or ulcers that don’t heal developing on the foot or leg. Left untreated, the foot or leg may have to be amputated.
Who's At Risk for PAD?
Although anyone can be at risk, factors that can significantly increase your risk of PAD include:
- Having high blood pressure, diabetes, or high cholesterol
- Having a family history of heart or blood vessel disease
- Being overweight
Smokers and diabetics between the ages of 50 and 60, or people over age 70, have a one-in-three chance of developing PAD, (PERIPHERAL ARTERY DISEASE) according to a recent study.
Many people with PAD can barely walk, while others may have mild symptoms that are easily overlooked.
“People are aware of diseases like heart attacks and strokes, which are caused by the same disease process that causes hardening of the arteries. Most people wouldn’t wait to get their heart attack or stroke treated, but they wait to get their legs looked at and treated.”
Many Treatment Options Exist
Various treatments are available for PAD depending on the severity of the disease. In mild cases your doctor may suggest doing nothing and conducting periodic screening to see if the disease is progressing. Lifestyle changes may be necessary, including eating a healthier diet, quitting smoking, and getting more exercise.
Medications such as anti-blood-clotting drugs are another option. Other medications that may be prescribed, depending on the individual needs of the patient, are drugs that lower high blood pressure and drugs that lower high cholesterol.
In cases of more severe disease, “keyhole” surgery may be necessary to improve blood flow. This type of treatment involves using a tiny balloon device to widen the artery — a process called an angioplasty — or inserting a metal cylinder called a stent to hold a closed artery open. In more severe cases, bypass surgery may be necessary to create a detour around the blocked artery.
The National Council on the Aging reports that more than 50% of people with symptoms commonly associated with PAD are not being tested. What’s more, about two-thirds of Americans over age 50 aren’t aware of the dangers of PAD and the need to get tested.
The survey of 1,500 Americans also found that people appear to be far less concerned about PAD than about other diseases. Only 34% said they were “very or somewhat concerned” about developing PAD compared with 58% and 57% who were “very or somewhat concerned” about stroke and heart disease, respectively.
What is the First Thing I Might Notice If I Have PAD?
For many, the first noticeable symptom of PAD is a painful cramping of leg muscles during walking called intermittent claudication. When a person rests, the cramping goes away. This leg pain can be severe enough to deter a person from normal walking.
Some individuals will not feel cramping or pain but might feel a numbness, weakness or heaviness in the muscles.
What are Some Other Symptoms of PAD?
In patients whose PAD is more severe, insufficient blood flow to the feet and legs may cause a burning/aching pain in the feet and toes while resting. The pain will occur particularly at night while lying flat. For more information, visit our section on critical leg ischemia. Other symptoms include:
- Cooling of skin in specific areas of legs or feet
- Color changes in the skin and loss of hair
- Toe and foot sores that do not heal
Many people are affected by PAD yet they do not have symptoms. These individuals are at a high risk for suffering an early heart attack or stroke. Research has proven that the life expectancy for a person with PAD is greatly reduced. For example, the risk of dying from heart disease is six times higher for those with PAD compared to those without. Therefore, it is important to discuss the possibility of PAD with a health care professional if someone has several of the risk factors for PAD.
The ABI Exam
The ABI test is used to document the presence or absence of PAD, and can be performed every year to quickly assess whether PAD is getting worse. Obviously, treatment for the disease tries to slow the rate at which leg arteries become blocked.
The ABI can also predict how severe an individual’s atherosclerosis is and the risk of future leg problems (such as development of future leg rest pain, poor healing of foot wounds, need for leg bypass surgery, or amputation). It can also predict the risk of future problems from atherosclerosis in other parts of the body (such as heart attack and stroke). Lower ABI values are associated with a higher risk. In fact, the ABI value can be an accurate predictor for patients with coronary heart disease (such as the blood cholesterol value, coronary calcium score, and C-reactive protein value).
Segmental Vascular Testing
It is similar to the ABI test, with the addition of two or three additional blood pressure cuffs. These additional cuffs are placed just below the knee and one large cuff or two narrow cuffs are placed above the knee and at the upper thigh. These cuffs are then inflated above your normal systolic blood pressure, and then slowly deflated.
Using the Doppler instrument, blood pressure measurements are taken. The blood pressure at each cuff location on your leg is noted in your physician’s report. A significant drop in pressure between two adjacent cuffs indicates a narrowing of the artery or blockage along the arteries in this portion of your leg. This allows the vascular technologist and doctor to identify more precisely the location of such blockages in the arteries of your leg.