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Peripheral Arterial Disease or PAD

Peripheral arterial disease, or PAD, is a condition in which the arteries that carry blood in the abdomen or the legs become narrowed or clogged, interfering with the normal flow of blood. The most common cause of PAD is atherosclerosis (often called hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol plaque builds up and clogs the blood vessels. PAD also may be caused by blood clots that lodge in the arteries and restrict blood flow.

How Common Is PAD?

PAD affects about one in 20 people over the age of 50, or 10 million people in the United States. More than half of those with PAD experience leg pain, numbness or other symptoms ? but many people dismiss these signs as "a normal part of aging" and don?t seek medical help. PAD affects both men and women.

What Are the Symptoms of PAD?

The most common symptom of PAD is called intermittent claudication, which is painful
cramping in the leg or hip, particularly when walking. Intermittent claudication occurs when there is not enough blood flowing to the leg muscles during exercise. The pain typically goes away when the muscles are rested.

Other symptoms may include numbness, tingling or weakness in the leg. In severe cases, you may experience a burning or aching pain in your foot or toes while resting, or develop a sore on your leg or foot that does not heal. People with PAD also may experience a cooling or color change in the skin of the legs or feet, or loss of hair on the legs. In extreme cases, untreated PAD can lead to gangrene a serious condition that may require amputation of a leg, foot or toes. If you have PAD, you are also at higher risk for heart disease and stroke.

PAD Symptoms:

• leg or hip pain while walking
• pain stops when you rest
• numbness
• tingling
• weakness in the legs
• 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 on legs
  

Who Is at Risk for PAD?

As many as 10 million people in the United States may have PAD. It is estimated that four million of them suffer leg pain symptoms. Those who are at highest risk are:

• over the age of 50
• smokers
• diabetic
• overweight
• people who do not exercise
• people who have high blood pressure or high cholesterol
• A family history of heart or vascular disease may also put you at higher risk for PAD.

How Is PAD Treated?

The best treatment for PAD depends on a number of factors, including your overall health and the severity of the disease. In some cases, lifestyle changes are enough to halt the progress of PAD and manage the disease. Your physician may prescribe medications when lifestyle changes are not enough. Procedures that open clogged blood vessels also are used to treat PAD.

• Lifestyle Changes. Most treatment plans will include a low fat diet and other cholesterol-lowering strategies, as well as a program of regular exercise. In study after study, patients who have taken part in a regular exercise program for at least three months have seen substantial increases in the distances they are able to walk without experiencing painful symptoms.
  
  If you are a smoker, it is absolutely essential that you stop the use of all types of tobacco. On average, smokers are diagnosed with PAD as much as 10 years earlier than non-smokers. Stopping smoking now is the single most important thing you can do to halt the progression of PAD or prevent it in the future. If decreased blood flow to the legs is causing injury to the feet and toes, a foot-care program to prevent sores or infection may be prescribed. This may include referral to a podiatrist.
  
• Medication. Medications that lower cholesterol or control high blood pressure may be prescribed. Medication also is available that has been shown to significantly increase pain-free walking distance and total walking distance in people with intermittent claudication. Other medications that help prevent blood clots or the build-up of plaque in the arteries are also available.

  What Can Be Done to Treat PAD When Lifestyle Changes and Medications Are Not Enough?
  There are a number of ways that physicians can open blood vessels at the site of blockages and restore normal blood flow. In many cases, these procedures can be performed without surgery using modern, interventional radiology techniques. Interventional radiologists are physicians who use tiny tubes called catheters and other miniaturized tools with X-ray guidance to do these procedures.

  Procedures performed by interventional radiologists include:

• Angioplasty - Medical procedure that opens up blocked or narrowed blood vessels without surgery. A tiny balloon is placed in the blood vessel at the site of the blockage. It is then inflated to open the blood vessel.

  An angioplasty has three major steps: placement of the angioplasty catheter into the blocked artery, inflation of the balloon to open the blocked artery, and removal of the catheter.

• Stents - A tiny metal cylinder, or stent, is inserted in the clogged vessel to act like a scaffolding and hold it open.
• Thrombolytic therapy - Clot-busting drugs are delivered to the site of blockages caused by blood clots.
• Stent-grafts - A stent covered with synthetic fabric is inserted into the blood vessels to bypass diseased arteries.