Important facts about Peripheral Arteries Disease (PAD)

09-28-2012

There are many ads on TV today that are reaching you about Peripheral Arterial Disease (PAD), so I thought that it was important, in light of current guidelines, to talk about this:

PAD is a narrowing of the peripheral arteries, most commonly in the arteries of the pelvis and legs. PAD is similar to Coronary Artery Disease (CAD) and carotid artery disease. All three of these conditions are caused by narrowed and blocked arteries in various critical regions of the body.

Atherosclerosis is a disease in which plaque builds up in the wall of an artery. PAD is usually caused by atherosclerosis in the peripheral arteries (or outer regions away from the heart). Plaque is made up of deposits of fats, cholesterol and other substances. Plaque formations can grow large enough to significantly reduce the blood's flow through an artery. When a plaque formation becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot may either further narrow the artery, or completely block it.

If the blockage remains in the peripheral arteries, it can cause pain, changes in skin color, sores or ulcers and difficulty walking. Total loss of circulation to the legs and feet can cause gangrene and loss of a limb.

If the blockage occurs in a coronary artery, it can cause a heart attack. Heart attacks happen when an area of the heart tissue dies from lack of blood flow. When it occurs in a carotid artery, it can cause a stroke.

It's important to learn the facts about PAD. As with any disease, the more you understand, the more likely you'll be able to help your healthcare professional make an early diagnosis and start treatment. PAD has common symptoms, but many people with PAD never have any symptoms at all.

The most common symptom of PAD is painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising.

Symptoms of severe PAD include:

  • Leg pain that does not go away when you stop exercising
  • Foot or toe wounds that won't heal or heal very slowly
  • Gangrene
  • A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body

Understanding leg pain

Many people dismiss leg pain as a normal sign of aging. You may think it's arthritis, sciatica or just "stiffness" from getting older. For an accurate diagnosis consider the source of your pain- PAD leg pain occurs in the muscles, not the joints.

Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that is a burning or painful discomfort of the feet or thighs. If you're having any kind of recurring pain, talk to your healthcare professional and describe the pain as accurately as you can. If you have any of the risk factors for PAD, you should ask your healthcare professional about PAD even if you aren't having symptoms.

 

Diagnosing PAD

PAD diagnosis begins with a physical examination. Your healthcare provider will check for weak pulses in the legs and the physical examination may include the following:

  • Ankle-Brachial Index (ABI): a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test, using a FloChec™ ABI device, takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.

          If an ABI reveals an abnormal ratio between the blood pressure of the ankle and arm, you may need more testing.                 Your doctor may recommend one of these other tests.

  • Doppler and Ultrasound (Duplex) imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
  • Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.
  • Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays.
  • Angiography: (generally reserved for use in conjunction with vascular treatment procedures) During an angiogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present.
    Learn more about peripheral angiogram.

As stated earlier, PAD often goes undiagnosed. Untreated PAD can be dangerous because it can lead to painful symptoms, loss of a leg, increased risk of Coronary Artery Disease and carotid atherosclerosis. Because people with PAD have this increased risk for heart attack and stroke, the American Heart Association encourages people at risk to discuss PAD with their healthcare professional to ensure early diagnosis and treatment

Quick Facts about PAD (summary)

The most common symptoms of PAD are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.

  • Many people mistake the symptoms of PAD for something else.
  • PAD often goes undiagnosed by healthcare professionals.
  • People with PAD have four to five times more risk of heart attack or stroke.
  • Left untreated, PAD can lead to gangrene and amputation.

Added risks for PAD

  • If you smoke, you have an especially high risk for PAD.
  • If you have diabetes, you have an especially high risk for PAD.
  • People with high blood pressure or high cholesterol are at risk for PAD.

The good news for PAD patients

  • PAD is easily diagnosed in a simple, painless way starting with an ABI which your physician can do in the office setting using a FloChec™ ABI device.
  • You can take control by leading a heart-healthy lifestyle and following the recommendations of your healthcare professional.
  • Most cases of PAD can be managed with lifestyle changes and medication.

Is PAD dangerous or life threatening?

Yes, PAD is dangerous because these blockages can restrict circulation to the limbs and organs. Without adequate blood flow, the kidneys, legs, arms and feet suffer damage. Left untreated, the tissue can die or harbor infection such as gangrene.

Does PAD cause additional health problems?

PAD may be the first warning sign of atherosclerosis— chronic fatty deposit build-ups throughout your arteries. The whole circulatory system, including your heart and brain, are at risk when arteries are blocked and narrowed. Fatty deposits also increase the risk for vascular inflammation and blood clots that can block the blood supply and cause tissue death.