Peripheral Artery Disease
Overview
Causes and Risks
“Plaque” is a sticky substance made up of fat and cholesterol. Peripheral Artery Disease (PAD) is a chronic condition where this plaque builds up in the arteries that carry blood to your legs. As you age, this plaque can narrow your arteries gradually. If this narrowing progresses, blood flow in that artery can become either partially blocked or blocked completely.
When this occurs, blood can’t provide oxygen, glucose, and other essential nutrients to your legs freely. Causing pain, cramps, or discomfort in your legs, especially when you walk or exercise. If left untreated, PAD can lead to serious complications, including amputation and death.
PAD affects more than 10 million people in the U.S. It is more common in people 65 years and older but can occur at almost any age. Smoking, diabetes, high cholesterol or triglycerides, high blood pressure, obesity, and kidney disease increase your risk of developing PAD.
Symptoms
Many people may not notice any symptoms in the early stages of PAD. It is important to know the risk factors for PAD and talk to your doctor about your possible risk.
Pain or Cramping While Walking (Claudication): Claudication is pain, discomfort, or cramping in the muscles in your legs (calves, thighs, or buttocks) or arms, that happens during physical activity like walking or exercising. The pain stops when you rest and returns when you start again.
Pain in Toes or Feet While Resting: When PAD worsens, you. might experience pain in your feet when resting (especially at night).
Sores on Toes or Feet that Won’t Heal: An open wound or ulcer on your toes or feet, often at a pressure point on the foot. An ulcer can progress to gangrene. These symptoms require immediate medical attention.
Leg Weakness or Numbness: You may experience numbness or weakness in the legs. This might make it harder to walk or stand for long durations of time.
Coldness in Your Lower Leg or Foot: One foot or leg may feel colder to the touch than the other due to restricted blood flow.
Change in Skin Color: The skin on your legs may turn pale, bluish, or have a shiny appearance.
Slow Nail or Hair Growth on Your Legs: Poor circulation can slow the rate of growth for your nails and hair on your legs and feet. This can lead to little to no hair on the toes, feet, or even lower legs.
Older Age
Males are more at risk than females
Smoking
Family History of PAD, heart disease, amputation, or stroke
High cholesterol
Diabetes
Lack of exercise
High blood pressure (Hypertension)
Obesity
Diagnosis
Talk to a Doctor
Leg pain does not always mean that you have PAD, however, if you are older or have other risk factors, you should ask your doctor if you should be assessed for PAD.
You should seek an urgent referral to a vascular surgeon if you experience pain when resting, especially at night, or foot sores that won’t heal.
Diagnosis
To diagnose PAD and determine how severe the diagnosis is, your doctor may recommend:
A non-invasive test called the ankle brachial index (ABI). This test checks your blood pressure at your ankle and compares it to the blood pressure in your arm.
An arterial Doppler which uses ultrasound to evaluate the blood vessels for plaque, flow, and blockage.
An X-ray called an angiogram. This procedure is used to find out the location of where the plaque has built up in your arteries. It can be done with a CT scan, an MRI, or by puncturing an artery in your groin or wrist and injecting contrast dye.
Role of a Vascular Surgeon
If you experience symptoms or have been diagnosed with PAD, ask your primary care provider to refer you to a vascular surgeon. Vascular surgeons can confirm your diagnosis and perform necessary treatments, including medication management, exercise therapy, minimally invasive “endovascular” procedures and open surgery.
Treatments
Treatment for PAD is important in the early and mid-stages to prevent the disease from progressing further and to avoid procedures that might otherwise become necessary. In advanced stages, treatment is critical to avoid amputation.
If you have PAD, treatments can include:
Daily exercise, like walking
Quitting smoking
Medication
If PAD is causing serious symptoms, treatment might also include:
Atherectomy
Balloon angioplasty
Stent placement
Surgical bypass
These treatments can be effective by improving blood flow to your affected leg.
What can I expect after treatment?
After treatment for PAD, most patients experience:
Better quality of life
Improved mobility
Lower risk of limb loss and cardiovascular events
But your journey doesn’t stop there. Think of treatment as the first step in a longer plan to stay healthy, active, and independent. You and your vascular team will continue working together to maintain good circulation and avoid future complications.
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