Peripheral arterial (vascular) disease is a chronic occlusive disease of the blood vessels that affects millions of Americans. This usually occurs in patients with underlying atherosclerotic disease—hardening of the arteries. Plaque that builds up inside the arteries limits or blocks blood flow to the legs and muscles. Especially with activity, this can cause problems. It is more common in men than women and increases in occurrence in people 60-70years of age. Leg pain, however is not a normal part of aging. If you are experiencing leg pain with walking or it is limiting your normal activities, you may be suffering from intermittent claudication.

What are the symptoms of PAD?
Blockages in the arteries are most common in the femoral and popliteal arteries in patients with symptomatic PAD but can also occur in the aorta and iliac vessels (about30% of the time) or in the tibial vessels (40-50% of the time). PAD can cause pain the the buttocks,thigh, leg, or calf usually with walking a certain distance. The pain is generally relieved by rest, but returns again with exertion. This is called intermittent claudication. If it progresses, PAD can also cause constant pain in the foot (rest pain), gangrene of the toes, nonhealing of wounds on the foot and leg, and even loss of the leg or toes because of lack of blood flow.

What are the risk factors for PAD?
The risk factors are the same as those for other types of cardiovascular disease:

• Smoking history
• High blood pressure
• High cholesterol
• Diabetes
• Family history of heart or vascular disease
• Obesity

Diabetes is more likely to be associated with problems with the blood vessels below the knee, while smoking is most likely to be associated with the blood vessels in the thigh and abdomen.

How is PAD diagnosed?
A physical exam is extremely important in diagnosing PAD. The legs are examined for presence of pulses at the groin, behind the knees, and on top of the foot. The blood vessels are also examined with a stethoscope for bruits, abnormal sound because of plaque build up inside the artery. The feet are examined for temperature, adequacy of hair growth, nail appearance, discoloration, and presence of any wounds. Once PAD is suspected, an ABI (ankle-brachial index)is often done. This is a measurement obtained by comparing the blood pressure at the arm with the blood pressure at the ankle. A machine called a Doppler is necessary for this. Further evaluation can be done with ultrasound, with the patient both at rest and after exercise. Finally, should information be needed to plan invasive treatment, angiogram may be ordered.

How is PAD treated?
Exercise Program: Many patients can be treated by embarking on an exercise program to help build collateral blood vessels in their legs and to get their muscles “used to” having less oxygen available. By walking until they develop pain twice a day, patients can double their pain-free walking distance in 6 weeks.

Risk factor control: Stopping smoking is essential to the treatment of PAD. It has been shown that simply stopping cigarettes for 6 weeks can also result in doubling of pain-free walking distances. Treatment of hypertension,high cholesterol, and control of diabetes are also helpful.

Medication: Two medications are available to help with intermittent Claudication. They must be used at least daily and only work in a relatively small percentage of patients who try them. However, in some patients they can dilate (widen) the leg arteries and allow better blood flow through narrowed arteries.

Angioplasty/stenting: Through a needle hole in the groin, a small tube (catheter) is introduced that may house either a balloon and/or stent (metal mesh tube). The balloon or stent is inflated inside the vessel compressing the plaque against the vessel wall. Often the stent is put in there as well to hold the plaque in place.

Surgery: Surgery is done in certain circumstances to clean out blocked arteries or to bring blood through a different path around arteries that are blocked. This is called “bypass surgery”. A plastic tube or the patients own vein can be used as the substitute blood vessel. This often requires multiple incisions on the leg and a several day hospitalization.

Risk Assessment

• Do you have high blood pressure or do you take medication for high blood pressure?
• Do you smoke or have a long history of smoking?
• Do you have an irregular heartbeat?
• Do you have have high cholesterol or do you take medication for high cholesterol?
• Is there an immediate family history of stroke or heart disease? (mother, father, siblings, children)
• Do you exercise less than three times per week for 20-30 minutes at a time?
• Do you eat a diet high in saturated and/or animal fat?
• Are you over 55 years of age?
• Are you male?

If you have checked Yes for two (2) or more of the above risk factors, you may be a candidate for a Stroke/Carotid Artery Screening and/or a Peripheral Arterial Disease Screening.