What is PAD?
Peripheral Arterial Disease (PAD) is a serious and common circulatory problem in which narrowed arteries reduce the blood flow to your limbs. It is often related to a number of other factors including obesity, smoking, high blood pressure, high cholesterol, inactivity and diabetes. With PAD, the arteries in the legs become narrowed or blocked with plaque or fatty deposits. This buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. The pain with PAD is in the muscles, not the joints as with arthritis. The pain usually goes away shortly after you stop walking, climbing stairs or exercising. Individuals with undiagnosed PAD can have a significantly reduced quality of life due to their restricted mobility. Too many people ignore their pain and think it's just a sign of getting older.
PAD often goes unrecognized and untreated and the consequences can be devistating. The disease can respond well to early detection and treatment. Unfortunately, many patients are not aware of the presence of the disease. PAD affects people of all ages. More than eight million people in the United States have PAD. The prevalence of the disease increased with age. Besides those over 50, individuals at highest risk are smokers, diabetics, and those who are overweight, do not exercise or have high blood pressure or high cholesterol. The combination of established PAD and diabetes seems to confer a worse prognosis.
Diagnostic Testing For PAD
- PADnet: This simple 20 minute, non-invasive exam uses special blood pressure cuffs and computer software to record blood pressure, calculate the Ankle-Brachial Index (ABI) and provide a Pulse Volume Recording (PVR) waveforms. The PADnet is usually the first test done when PAD symptoms appear or when a screening is prescribed because of risk factors.
- Ankle-Brachial Index (ABI): The ABI is an easy and reliable test for the diagnosis of peripheral arterial disease. This painless exam measures blood pressure at the ankle an in the arm. This test uses regular blood pressure cuffs and a special Doppler ultrasound stethoscope. By comparing the blood pressure in your ankle and in your arm, we can get a good idea of the level of blood flow to your legs. This test is the next step in determining the prevalence and severity of PAD. The American Diabetes Association recommends ABI screening in everyone with diabetes over age 50.
- Ultrasound Doppler: This non-invasive test uses sound waves to determine blood flow in the legs. With this test, we can diagnose if a specific artery has plaque buildup or blockage in a very precise manner.
Based on the results from any of the above tests, as well as symptoms and risk factors for PAD, your doctor will decide if additional testing is needed. These tests might include imaging diagnostic procedures such as Magnetic Resonance Angiography (MRA), angiography or a contrast-enhanced MRA.
Treatment Options For PAD
If the symptoms are mild, your doctor may only recommend periodic check-ups. However, if the sympoms are more severe, treatment may be required. Several options follow.
- Risk Factor Modification: Your doctor may recommend changes in your lifestyle to treat your PAD, including decreasing the amounts of fat and cholesterol in your diet, exercising regurarly, and, most importantly, smoking cessation. People with diabetes should strictly control their blood glucose (blood sugar) levels. Simple dedication to a daily walking program can make a big difference. Your doctor can advise you of a plan. When combined, these measures can help retard or reverse plaque buildup, relieve symptoms and improve quality of life.
- Medical Management: Your physician may also prescribe specific medicines to improve the blood flow in your arteries or to lower the cholesterol in your blood. Additionally, recent clinical trials using lipid-lowering drugs show promise for improving symptoms and reducing PAD-induced vascular events such as heart attacks or strokes.
- Angioplasty: Before your doctor can make a final diagnosis, you may be asked to undergo and angiogram. This test uses a special dye injected into the arteries to take X-rays, which show any narrowed or blocked arteries. During an angioplasty, the physician threads a balloon-tipped catheter (a thin, plastic tube) to the site of a narrow or blocked artery and then inflates a small balloon to open the vessel. To keep the artery open, often times a small mesh tube called a stent is placed in the newly opened artery. This may be necessary with the angioplasty procedure. The stent is a permanent device left in the artery to help it heal and remain open after the angioplasty.
- Atherectomy: This is a newer procedure that removes plaque from arteries. By various methods, arterial blockages, that are cutting off the circulation to the limbs are cleared away. Balloon angioplasty or stenting may be used after atherectomy.
To conduct a self assessment for PAD, click here.
