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Peripheral Arterial Disease (PAD)

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Hardening of the Arteries Is a Red Flag for Vascular Disease, Including Heart Attack and Stroke

Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a very common condition affecting 12–20 percent of Americans age 65 and older. PAD develops most commonly as a result of atherosclerosis, or hardening of the arteries, which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries. This is a very serious condition. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking, and eventually gangrene and amputation.

Because atherosclerosis is a systemic disease (that is, affects the body as a whole), individuals with PAD are likely to have blocked arteries in other areas of the body. Thus, those with PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes, hypertension and other conditions.

PAD may also be caused by blood clots.

Symptoms

  • The most common symptom of PAD is called intermittent claudication, which is painful cramping in the leg or hip that occurs when walking or exercising and typically disappears when the person stops the activity.
  • Numbness, tingling and weakness in the lower legs and feet
  • Burning or aching pain in feet or toes when resting
  • Sore on leg or foot that won’t heal
  • Cold legs or feet
  • Color change in skin of legs or feet
  • Loss of hair no legs
  • Have pain in the legs or feet that awakens you at night

Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.

Prevalence

  • PAD is a disease of the arteries that affects 10 million Americans.
  • PAD can happen to anyone, regardless of age, and is most commonly seen in men and women over age 50.

Risk Factors

Those who are at highest risk for PAD are

  • Over age 50
  • Smokers
  • Diabetic
  • Overweight
  • Inactive (and do not exercise)
  • Have high blood pressure or high cholesterol or high lipid blood test
  • Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke

Diagnosis

The most common test for PAD is the ankle-brachial index (ABI), a painless exam in which ultrasound is used to measure the ratio of blood pressure in the feet and arms. Based on the results of an ABI—as well as one’s symptoms and risk factors for PAD—a doctor can decide if further tests are needed. PAD also can be diagnosed noninvasively with an imaging technique called magnetic resonance angiography (MRA) or with computed tomography (CT) angiography.

Ankle-Brachial Index

PAD is a major public health issue, and the Society of Interventional Radiology recommends greater screening efforts through the use of the ankle-brachial index (ABI) test.

The ABI is a simple, painless test that compares the blood pressure reading in the arm and ankle. It is a direct measure of fatty plaque buildup in leg arteries and an indirect gauge of plaque accumulations throughout the entire cardiovascular system.

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 foot is compared to the pressure in your arm to determine how well your blood is flowing and whether further tests are needed.

Because atherosclerosis is a systemic disease, individuals developing plaque in their legs are likely to have plaque building up in the carotid arteries, which can lead to stroke, or the coronary arteries, which can lead to heart attack. Early detection of PAD is important because these individuals are at significantly increased risk, and preventive measures can be taken.

  • An individual with an ABI of 0.3 (high risk) has a two- to three-fold increased risk of five-year cardiovascular death compared to a patient with an ABI of 0.95 (normal or low risk).

Treatments

Lifestyle Changes

Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.

Medication

Medications that lower cholesterol or control high blood pressure may be prescribed. Medication also is available that been shown to significantly increase pain-free walking distance and total walking distance in individuals with intermittent claudication. Other medications that prevent blood clots or the buildup of plaque in the arteries are available as well.

Interventional Radiology

  • Angioplasty and stenting
    Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then the interventional radiologist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.
    Balloon angioplasty and stenting have generally replaced invasive surgery as the first-line treatment for PAD. Early randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions, and in the past years, a very large clinical experience in centers throughout the world has shown that stenting and angioplasty are preferred as a first-line treatment for more and more processes throughout the body.
  • Atherectomy
    With this treatment, a tiny catheter is inserted into the artery at the site of blockage that is able to “shave” or “cut” the plaque from the inside of the artery and remove it from the patient.
  • Stent-grafts
    A stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.
         
  • Surgery
    Sometimes, open surgery is required to remove blockages from arteries or to bypass the clogged area. These procedures are performed by vascular surgeons.