What is Peripheral Arterial Disease (P.A.D.)
P.A.D is a common, yet serious disease that raises the risk of heart attack and stroke. P.A.D develops when arteries in your legs become clogged with plaque – fatty deposits that limit blood flow to your legs. Just like clogged arteries in the heart, clogged arteries in the legs raise your risk for heart attack or stroke.
P.A.D affect 8 to 12 million people in the United States, especially those over age 50. It does not always cause symptoms, so many people may have PAD and not know it. People who do experience symptoms, such as pain, or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.
Some conditions and habits raise your chance of developing P.A.D. Your risk increases if you:
- Are over the age of 50
- Smoke or used to smoke
- Have diabetes
- Have high blood pressure
- Have a personal history of vascular disease, heart attack, or stroke
- Are African American
Physical Exam – during the physical exam your pulse in both legs and feet will be examined to determine if there is enough blood flowing to these areas as well as the color, temperature, and appearance of your legs and feet and for signs of poor wound healing on the legs and feet. A review of your medical and family history including: your current diet and medications; any symptoms you may be experiencing in your legs while sitting, standing, walking, climbing, or participating in other physical activities; your status as a current or former smoker; presence of diabetes, high blood pressure, high cholesterol and other important factors are all crucial to an accurate diagnosis.
Non-Invasive Vascular Testing:
Ankle-brachial index (ABI) – ABI compares the blood pressure in your ankle with the blood pressure in your arm by using a regular B/P cuff and a special ultrasound device to evaluate blood pressure and flow.
Duplex doppler – this test uses standard ultrasound methods to produce a picture of a blood vessel and surrounding organs. Also, a computer converts the doppler sounds into a graph that gives information about the speed and direction of blood flow through the blood vessel being examined.
Magnetic Resonance Angiogram (MRA) – it is a type of MRI scan that uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body. It can see the blood flow as well as the condition of the blood vessel walls.
CT Angiogram – is an imaging test for various types of heart disease. It relies on a powerful X-ray machine to produce images of your heart and heart vessels. This is used primarily to check for narrowed arteries in your heart that can put you at risk for a heart attack.
Vascular Testing -The “Gold Standard”
Angiography with Contrast
By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your
arteries as it happens. Your doctor is able to trace the flow of the dye using imaging techniques such as X-ray imaging or MRA or CT angiography.
Timely detection and treatment can help reduce your symptoms, improve the quality of your life; help you keep your independence and mobility; and can reduce your risk of heart attack, stroke, leg amputation and even death. There are three main approaches to treating P.A.D.
- Making lifestyle changes
- Taking medication
- In some cases, having a special procedure or surgery
- Quit smoking – Don’t smoke, and if you do quit!!
- Lower your numbers – Work with your health care provider to correct any high blood pressure, cholesterol and blood glucose levels.
- Follow a health eating plan – Choose foods that are low in saturated fat, transfat, and cholesterol. Be sure to include whole grains, vegetables, and fruits.
- Get moving – Make a commitment to be more physically active, Aim for 30 minutes of moderate-intensity activity on most, preferably all, days of the week.
- Aim for a healthy weight – If you are overweight or obese, work with your health care provider to develop a supervised weight loss plan.
In addition to lifestyle changes, your health care provider may prescribe one or more medications. The medications are used to:
- Lower high blood pressure and cholesterol levels and treat diabetes.
- Prevent the formation of blood clots that could cause a heart attack or stroke.
- Help reduce leg pain while walking or climbing stairs.
Special Procedures and Surgeries
If the blood flow in one of your limbs is completely or almost completely blocked, you may benefit from having a procedure of surgery in addition to medications and lifestyle changes. Procedures such as angioplasty and bypass graft surgery will not cure P.A.D., but they can improve the blood circulation to your legs and your ability to walk.
Questions to ask your health care provider:
- Will P.A.D. increase my risk for other conditions?
- Which screening tests or exams are right for me?
- What are my cholesterol numbers? (LDL, HDL, and triglycerides.)
- What is my blood pressure?
- What is my blood sugar level?
- What can I do to quit smoking?