What is peripheral arterial disease?
PAD is sometimes called peripheral vascular disease, or PVD. Many people also refer to the condition as "hardening of the arteries." This interferes with the normal flow of blood, sometimes causing pain but often causing no symptoms at all.
What causes peripheral arterial disease?
The most common cause of PAD is atherosclerosis (often called hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels.
In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow
How common is peripheral arterial disease?
PAD affects about one in 20 people over the age of 50, or eight million people in the United States. More than half the people with PAD experience leg pain, numbness or other symptoms, but many people dismiss these signs as "a normal part of aging" and don't seek medical help. Only about half of people with these symptoms have been diagnosed with PAD and are seeing a doctor for treatment.
What are the symptoms of PAD?
The most common symptom of PAD is painful cramping in the leg or hip, particularly when walking. This symptom, also known as "claudication," occurs when there is not enough blood flowing to the leg muscles during exercise. The pain typically goes away when the muscles are given a rest. Other symptoms may include numbness, tingling or weakness in the leg. In severe cases, you may experience a burning or aching pain in your foot or toes while resting, or develop a sore on your leg or foot that does not heal.
People with PAD also may experience a cooling or color change in the skin of the legs or feet, or loss of hair on the legs. In extreme cases, untreated PAD can lead to gangrene, a serious condition that may require amputation of a leg, foot or toes.
If you have PAD, you are also at higher risk for heart disease and stroke. Unfortunately, the disease often goes undiagnosed because many people do not experience symptoms in the early stages of PAD or they mistakenly think the symptoms are a normal part of aging.
What are the risk factors for PAD?
As many as eight million people in the U.S. may have PAD. The disease affects everyone, although men are somewhat more likely than women to have PAD. Those who are at highest risk are:
- Over the age of 50
- People who do not exercise, or people who have high blood pressure or high cholesterol
- People with a family history of heart or vascular disease.
Do I have PAD?
Answering the following questions will help you assess whether or not you are at risk for developing PAD:
- Do you have cardiovascular (heart) problems such as high blood pressure, heart attack, stroke?
- Do you have diabetes?
- Do you have a family history of diabetes or cardiovascular problems (immediate family such as parent, sister, brother)?
- Do you have aching, cramping or pain in your legs when you walk or exercise, but then the pain goes away when you rest?
- Do you have pain in your toes or feet at night?
- Do you have any ulcers or sores on your feet or legs that are slow in healing?
- Do you smoke?
- Have you ever smoked?
- Are you more than 25 pounds overweight?
- Do you eat fried or fatty foods three times a week or more?
- Do you have an inactive lifestyle?
The more "Yes" answers you have, the more important it is for you to contact an interventional radiologist.
How is PAD diagnosed?
The most common test for PAD is the ankle-brachial index (ABI), a painless exam in which a special stethoscope is used to compare the blood pressure in your feet and arms. Based on the results of your ABI, as well as your symptoms and risk factors for PAD, the physician can decide if further tests are needed. When the ABI indicates that an individual may have PAD, other imaging techniques may be used to confirm the diagnosis, including duplex ultrasound, magnetic resonance angiography (MRA) and computed tomography (CT) angiography.
The ABI is a simple, painless test to help your physician determine if you have PAD. The blood pressure in your arms and ankles is checked using a regular blood pressure cuff and a special ultrasound stethoscope called a Doppler. The pressure in your ankle is compared to the pressure in your arm to determine how well your blood is flowing and whether further tests are needed.
If you suspect that you may have PAD, it is important that you see your personal physician or an interventional radiologist for an evaluation.
You also may want to participate in Legs For Life - National Screening for PAD Leg Pain. To find out about this free screening program near you, visit the Legs For Life website.
How can PAD be treated?
The best treatment for PAD depends on a number of factors, including your overall health and the seriousness of the disease. In some cases, lifestyle changes are enough to halt the progress of PAD and manage the disease. Sometimes, medications or procedures that open up clogged blood vessels are prescribed to treat PAD.
What type of lifestyle changes can treat PAD?
In many cases, changes in lifestyle are enough to slow the progression or even reverse symptoms of PAD. Most treatment plans will include a low fat diet and a program of regular exercise. If you are a smoker, it is absolutely essential that you stop the use of all types of tobacco. If decreased blood flow to the legs is causing injury to the feet and toes, a foot care program to prevent sores or infection may be prescribed. This may include referral to a podiatrist.
Research has shown that regular exercise is the most consistently effective treatment for PAD. In study after study, patients who have taken part in a regular exercise program for at least three months have seen substantial increases in the distances they are able to walk without experiencing painful symptoms. Exercise programs that have been effective include simple walking regimens, leg exercises and, most commonly, treadmill exercise programs three to four times every week for a period of several months. Some people may have a medical condition that prevents them from participating in an exercise program. Consult with your physician before undertaking any exercise or other treatment program.
Like many patients with coronary artery disease caused by atherosclerosis, PAD patients frequently have elevated cholesterol levels that contribute to the disease. A low fat diet and other cholesterol-lowering strategies are often part of a treatment plan.
There is no doubt that cigarette smoking is a strong risk factor for PAD. On average, smokers are diagnosed with PAD as much as 10 years earlier than non-smokers. Stopping smoking now is the single most important thing you can do to halt the progression of PAD or prevent it in the future.
Can medications help?
For many patients, lifestyle changes combined with medication can control the symptoms of PAD. Drugs that lower cholesterol or control high blood pressure may be prescribed. New medications that help prevent blood clots or the build up of plaque in the arteries, or that reduce the pain of PAD, also are appropriate for some patients.
What procedures are available to help?
There are a number of ways that physicians can open blood vessels at the site of blockages and restore normal blood flow. In many cases, these procedures can be performed without surgery using modern, interventional radiology techniques. Interventional radiologists are physicians who use tiny tubes called catheters and other miniaturized tools and X-rays to do these procedures.
Sometimes, open surgery is required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons.
Interventional Radiology Treatments for PAD
- Angioplasty: A tiny balloon is placed in the blood vessel at the site of the blockage. It is then inflated to open the blood vessel.
- Stents: A tiny metal cylinder, or stent, is inserted in the clogged vessel to act like a scaffolding and hold it open.
- Thrombolytic therapy: This treatment is implemented by an interventional radiologist if the blockage in the artery is caused by a blood clot. Thrombolytic drugs, sometimes called "clot busters", dissolve the clot and restore blood flow. Usually, the drugs are administered through a catheter directly into the clot. These drugs are frequently combined with another treatment, such as angioplasty.
- Stent-grafts: A stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.
Are there any surgical treatments for PAD?
Most cases of PAD can be treated with lifestyle changes, medications, non-surgical interventional radiology procedures, or some combination of these treatments. In some severe cases surgery may be required.
Procedures performed by a vascular surgeon include:
Thrombectomy: This procedure is used only when symptoms of PAD develop suddenly as a result of a blood clot. In the technique, a balloon catheter is inserted into the affected artery beyond the clot. The balloon is inflated and pulled back, bringing the clot with it. Thrombectomy usually requires surgery.
Bypass grafts: In this procedure, a vein graft from another part of the body or a graft made from artificial material is used to create a detour around a blocked artery.
How do I know which treatment will be the best for me?
The best treatment for PAD depends on a number of factors, including your overall health, the location of the affected artery, and the size and cause of the blockage or narrowing in the artery. You should discuss all your treatment options with your physician. Some questions to ask are:
- Can my PAD be controlled with lifestyle changes?
- What medications might be appropriate for me?
- If a procedure is required, am I a candidate for a less invasive, interventional radiology treatment?
- What are the risks and benefits of the treatment plan prescribed for me?