Peripheral Artery Disease (PAD)

When your arteries in your legs become blocked, your legs do not receive enough blood or oxygen, and you may have a condition called peripheral artery disease (PAD). Your arteries are normally smooth and unobstructed on the inside but, as you age, they can become blocked with plaque through a process called atherosclerosis (hardening of the arteries). This plaque is made up of cholesterol, calcium, and fibrous tissue. Eventually enough plaque builds up to reduce blood flow to our leg arteries.

Unfortunately, PAD can’t be cured. It is important to treat this disease not only because it may place you at a great risk for limb loss, but for having a heart attack or stroke.

Who gets PAD?

Certain health problems and habits can increase your chances of developing PAD. The more risk factors you have, the greater your chances of getting this disease.

  • Smoking
  • Diabetes
  • Heart disease
  • Being age 60 or older
  • High blood pressure
  • High cholesterol, eating a high-fat diet
  • Weighing over 30 percent more than your ideal weight

What are the symptoms?

PAD can cause discomfort or pain when you walk. This pain can occur in your hips, buttocks, thighs, knees, shins, or upper feet.

Intermittent claudication is the most common early symptom. This is discomfort or pain in your legs that happens when you walk and goes away when you rest. This may also feel like a tightness, heaviness, cramping, or weakness in your legs.

As the disease progresses this pain may continue even at rest. In severe PAD you may develop painful sores on your toes or feet. If the circulation in your leg does not improve, these sores can eventually become gangrenous.

What testing will I need?

You’ve probably been referred to a specialist who evaluates and treats blood vessel problems. At this point you will start your evaluation process.

  • Health History: including risk factors, medications, and symptoms.
  • Physical Exam: Plaque can form in blood vessels throughout your body. For that reason, your physician will feel for pulses and listen to blood flow in your major arteries. They will also check for nail problems, changes in color and temperature and sores that don’t heal.
  • Testing: After your exam, your physician may perform tests such as ankle-brachial index (ABI), which compares the blood pressure in your arms and legs, and blood tests for cholesterol or other markers for artery disease.

To better understand the extent of your PAD, your physician may also recommend:

  • Duplex Ultrasound – uses sound waves to measure blood flow, detect blockages or other abnormalities in the vessels
  • Pulse Volume Recording – measures the volume of blood at various points in the legs
  • Magnetic Resonance Angiography (MRA) – uses a strong magnet and radio waves to produce images of blood flow in the arteries
  • Computed Tomographic Angiography (CTA) – uses specialized x-rays and contrast dye to show blockages inside your arteries
  • Angiography – produces x-ray pictures of the blood vessels in your legs using a contrast dye to highlight your arteries

How is PAD treated?

• Lifestyle Changes. Maintaining a healthier lifestyle can help slow the disease. It can also improve the overall health of your arteries, reducing the chance of heart attack or stroke. Be sure to keep your follow-up appointments with your physician. Daily exercise improves blood flow and helps lower blood pressure. For instance, walking regularly 30 minutes three times a week, may improve your symptoms. Ask your physician if a supervised exercise program is right for you. Protect your feet by wearing a sturdy shoe, having a podiatrist trim your nails, and seeking medical attention should a sore or wound appear on your foot.

If you smoke, QUIT. Ask your physician for advice on programs and aids. Get support from family, friends, or support groups. Avoid places and situations where you’re likely to smoke. Don’t give up, keep trying.

Eating healthy foods is a good way to lower your risk of PAD. Limit all fats to one-third of your calories. Eat at least five servings of fruits and vegetables each day. Limit red meats, dairy and processed foods. Bake, broil or steam foods. Eat smaller portions to reach or maintain a healthy weight. Follow diet changes that can help control health problems such as high blood pressure and diabetes as directed by your physician.

Managing any health problems is a big part of keeping your arteries healthy. Talk to your primary care physician about the best ways to control diabetes, high blood pressure, high cholesterol, or heart disease.

  • Medication. If you do not have a disqualifying medical condition, such as heart failure, your physician may prescribe a medicine called Pletal (cilostazol). This drug may help increase your ability to walk longer distances without pain or discomfort. Other drugs may include aspirin and Plavix (clopidogrel)--both decrease your chances of developing blood clots.
  • Angioplasty and Stenting. This is a minimally invasive procedure where the physician inserts a long thin catheter into an artery in your arm or groin. This catheter is advanced to the site of the plaque, then a special balloon is inflated, pushing the plaque against the artery wall, widening the vessel. In some cases your physician may use a stent (tiny metal mesh tube) that remains permanently in your artery to keep it open.
  • Bypass Surgery. This is an invasive surgical procedure where your physician (surgeon) will use a vein or synthetic graft to bypass the area of blockage in the artery. This provides a new path for the blood to flow.
  • Endarterectomy. This is another surgical procedure where the surgeon will remove the plaque from the artery, restoring blood flow. Effectiveness of this procedure depends on the location and extent of the blockage.
  • Amputation. In the extreme case of PAD where gangrene has become a component and the extremity is not salvageable, your surgeon may recommend amputation on the affected lower leg or foot.