According to the National Institutes of Health, between 8 million and 12 million Americans, most over age 65, suffer from Peripheral Artery Disease, commonly known as PAD. In addition, one in three people over the age of 50 with diabetes is likely to have PAD. Perhaps even more alarming is that PAD patients have a six to seven times greater risk of coronary artery disease, heart attack, stroke or transient ischemic attack (“mini stroke”) than the rest of the population.

PAD is caused by plaque accumulation in peripheral arteries (commonly the pelvis or leg) reducing blood flow. Symptoms include leg pain when walking or at rest. In fact, lower extremity PAD may provide an early warning sign of vascular disease throughout the body.

Left untreated, PAD can lead to severe pain, immobility, non-healing wounds and eventually limb amputation. With risk factors such as diabetes and obesity on the rise, the prevalence of PAD is growing at double-digit rates.


Symptoms

The most common PAD symptoms include one or more of these problems:

  • Claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.
  • Leg muscle fatigue, leg cramping, coldness in the lower legs and feet, or numbness.
  • Foot or toe pain at rest that often disturbs sleep.
  • Wounds on the feet or toes that are slow to heal.
  • In severe cases of PAD, called Critical Limb Ischemia, the lack of blood flow to the extremity can lead to ulcers or sores that don't heal.
  • If ulcers or sores are left untreated, these non-healing wounds could lead to amputation of a toe, foot or leg.


Risk Factors

The following risk factors can increase the risk of developing PAD:

  • Smoking. Smoking, which is more closely related to developing PAD than any other risk factor - increases the risk of developing PAD three to five times.
  • Diabetes. One in three people over age 50 with diabetes is likely to have PAD. The rate of amputation for people with diabetes is 10 times higher than for people without diabetes.
  • Age. The risk of PAD also increases with age. People over the age of 50 have a higher risk of PAD, and among adults age 65 and older, 12 to 20 percent may have PAD. 
  • Leg pain. Pain, cramps, a tired feeling or heaviness in the legs when exercising may be a sign of poor circulation in the legs, which may be caused by PAD.
  • High blood pressure.
  • Abnormal cholesterol levels.
  • Personal history of heart disease, a heart attack or a stroke. 


Treatment

Treatment for PAD depends on an overall diagnostic assessment, including patient symptoms and risk factors, the site and severity of the arterial blockages, and results of diagnostic tests. The overall goal for treating PAD is to reduce the effects of symptoms; improve walking ability; save limbs; and lower the risk of heart attack and stroke. 


Specific treatments for PAD include:

  • Lifestyle Changes
    • Quitting smoking.
    • Lowering blood pressure to less than 140/90 mmHg or less than 130/80 mmHg for diabetics.
    • Lowering LDL (bad) cholesterol to less than 100 mg/dl to delay or even reverse the buildup of plaque in the arteries.
    • Managing diabetes to lower blood glucose levels.
    • Following a healthy eating plan that reduces salt and fat intake, and includes more fruits, vegetables and low-fat dairy products.
    • Getting regular exercise such as walking for 30 minutes at least three or four times a week.
  • Medication - Medication may be prescribed to:
    • Lower high cholesterol and high blood pressure.
    • Thin the blood to prevent clots from forming due to low blood flow.
    • Dissolve blood clots.
    • Help improve walking ability and decrease pain in the legs (claudication).


If PAD progresses and symptoms cannot be controlled by lifestyle changes or medications, various procedures can be performed such as:

  • Angioplasty
    Angioplasty is a procedure where a balloon is inflated and plaque is poushed against the arterial walls, causing the artery to widen, potentially restoring blood flow through a blocked artery.
  • Stent
    A stent (tiny metal cylinder) is often placed in the artery after the angioplasty procedure with the intent to keep the diseased artery open.
  • Vascular Bypass Surgery
    Surgery may be necessary if blood flow through a limb is almost or completely blocked. In vascular surgery, a blood vessel from another part of the body or a tube made of synthetic material is used to bypass blockages in the artery. This allows blood to flow around the blockage and into the lower limb.
  • Atherectomy
    Atherectomy is a procedure to remove or debulk the built up plaque from the blood vessel. As in angioplasty, an ultra-thin wire is threaded through a catheter into the artery and across the blockage. Several types of devices may then be used to remove plaque.


Information courtesy of Cardiovascular Systems, Inc.

What is PAD?

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