You’re most likely aware of the symptoms and dangers of stroke, heart attack, and obesity. You’ve probably seen ads on TV and in print media generated for national campaigns about these conditions. But if someone asked you what you know about Peripheral Arterial Disease (PAD), what would you be able to tell them?
Although it affects more than 8 million people, there has been no national campaign to educate patients or health care professionals about PAD. As a result, PAD often goes unrecognized until it reaches advanced stages. People often mistake its symptoms for other conditions.
“PAD is like an iceberg,” says Dr. Jonathan Sherman, a cardiologist with Pikes Peak Cardiology. “We’re treating only the tip of the iceberg.”
That’s unfortunate, because patients with PAD are at risk for limitations to their lifestyle and in later stages of the disease, gangrene and limb loss. They have a higher incidence of cardiac and cerebrovascular disease, leading to higher rates of heart attack a stroke and increased mortality from heart attack and stroke.
Because the at-risk population—those over 50—is growing, more and more people will be affected in the next decade.
With early diagnosis and treatment, patients can be spared the harmful effects of PAD. At the same time, the lifestyle modifications that are the mainstay of PAD treatment can help prevent heart attack and stroke and improve patients’ quality of life.
What is Peripheral Arterial Disease?
Peripheral Arterial Disease is the most common type of Peripheral Vascular Disease and generally refers to disease that involves the arteries of the pelvis and lower limbs. It occurs when fatty deposits build up in the artery walls and impair circulation. Risk factors for PAD include the following:
- Age 70 years or older
- Age 50-69 with a history of smoking or Diabetes Mellitus (DM)
- Age under 50 with DM and one other atherosclerosis risk factor (excess fats in the blood, high blood pressure, smoking)
- Leg symptoms with exertion, or pain at rest without any apparent cause
- Abnormal lower leg pulse
- Known coronary, carotid, or renal arterial disease
- Family history of PAD, coronary artery disease, or cerebral vascular disease
Sometimes patients’ symptoms are subtle, or the patient doesn’t recognize that their leg pain indicates a serious condition. Many people with PAD have mild or no symptoms, which makes it difficult to diagnose. About 1 in 10 people suffer leg pain, characterized by muscle pain or cramping when walking that stops after a few minutes of rest. Other symptoms of PAD include:
- Leg numbness or weakness
- Cold leg, especially when compared to the other leg
- Sores on the toes, feet, or legs that won’t heal
- Change in color of the leg
- Hair loss on feet or legs
- Changes in the toenails
In advanced cases, pain can occur when you are at rest or lying down and may interrupt sleep. Generally the pain improves when you dangle your legs off the bed or walk around.
Diagnosing and treating PAD
Your doctor should do a thorough medical history and physical exam if PAD is suspected. You should be asked about, or tell your physician about any walking impairment, poorly healing or non-healing wounds of the legs or feet, and any pain at rest that is localized to the leg or foot, when either standing or lying down. Also tell your doctor about any abdominal pain after eating, especially if it’s associated with weight loss; any family history of abdominal aortic aneurism, or drug-resistant high blood pressure or abrupt changes in kidney function.
Your doctor should take your blood pressure in both legs and notice any differences. Your doctor should also check your pulse in multiple locations.
Most people with Peripheral Arterial Disease do not require any type of invasive procedure. Treatment begins with lifestyle changes—eating a heart-healthy diet and doing appropriate exercise. These changes reduce the risk of heart attack, stroke, and limb loss and improve your capacity to function.
The most important change is to stop smoking.
“People who smoke will develop PAD 10-15 years before the normal population,” Dr. Sherman says. “If they continue smoking, it is very difficult to treat them, and other interventions are less effective.” Smokers are at higher risk for losing a limb through amputation.
Dr. Sherman typically puts patients who smoke on Chantix, a non-nicotine prescription medication, for three months.
Therapy for PAD also includes aggressively treating high blood fats, high blood pressure, and diabetes. Medications such as Pletal may be prescribed to help you walk farther.
Proper foot care is important. That includes washing and moisturizing, wearing well-fitting shoes and socks, treating infections, taking care with nail trimming, and avoiding barefoot walking, and seeing your doctor at the first sign of a sore or injury.
Supervised exercise can improve walking distance by training muscles to use oxygen more efficiently and may reduce incidence of complications associated with PAD, including heart attack and stroke.
In advanced cases, surgery or stenting may be necessary to reduce symptoms, avoid limb loss, or help wounds heal.