Peripheral Arterial Disease (PAD) is a commonly occurring disease that involves poor blood circulation from the heart to the body’s extremities, primarily the legs. While it can cause pain and discomfort, PAD can often persist undetected, increasing your risk of heart disease and other major health problems.
In recent years, there has been a sharp increase in the incidence of the most severe forms of PAD – critical limb ischemia or chronic limb-threatening ischemia (CLI/CLTI) – primarily due to rising rates of obesity, diabetes and chronic kidney disease. This is why it is important for patients experiencing symptoms (or those at high-risk for developing PAD) to be screened by a vascular specialist as early as possible.
Treatment for PAD includes diet and exercise, quitting smoking, if applicable, medications and/or minimally invasive surgical procedures.
PAD is a serious disorder resulting from the narrowing or blockage of the arteries that carry blood from the heart to the legs, ankles, and feet.
PAD is most commonly caused by atherosclerosis, a disease in which plaque (the buildup of fat, cholesterol, cellular waste, calcium and fibrin) develops on the inner walls of the arteries, causing them to narrow and harden. Narrowing of the arteries causes a decrease of blood flow from the heart to the body’s extremities. If the plaque ruptures, a blood clot may form that narrows the artery even further.
If this process continues unabated, the blood flow becomes so restricted that the organs and tissues below the site of the artery blockage can’t get enough oxygen and nutrients to flourish. Slowly they begin to injure and without the ability to heal, the tissue begins to die (in what’s called gangrene).
The following conditions and activities may put you at an advanced risk of developing PAD:
Approximately 6.5 million people over the age of 40 suffer from PAD. However, due to low awareness of PAD and its poor rate of detection the actual number is believed to be significantly higher.
As context, the National Heart, Lung, and Blood Institute at the National Institutes of Health (NIH) states that about half of Americans ages 45 to 84 have atherosclerosis without knowing it. This amounts to roughly 65 million people with the number one cause of PAD.
According to what’s known as the Fontaine Classification system, the stages of PAD are as follows:
Many people with PAD may not present with any symptoms, while others may have mild symptoms.
Some of the symptoms noted during PAD include:
Discover more symptoms of PAD.
PAD often goes undiagnosed because it either advances without showing symptoms, or the symptoms are mistaken for something else.
PAD researchers have also theorized that the up-to-50% of people with PAD who have been found to be “asymptomatic” (i.e. free from leg pain during and after a 6-minute walk test) may simply be restricting their physical activity to avoid painful symptoms.
It is critical for PAD to be treated as soon as possible. If left untreated, PAD can result in critical limb ischemia (CLI), which can cause constant leg pain, the need for amputation, or even lead to death.
If you experience any PAD symptoms, you should see a doctor immediately.
If you are not experiencing symptoms but fall into a high-risk group due to your age (65+) or poor health status (diabetes, smoking history, high cholesterol, high blood pressure) you should be seen by a doctor to screen for PAD. Early diagnosis and intervention is critical.
PAD’s poor detection rates are the result of a combination of factors. One factor is the nature of the disease, namely its ability to set in slowly, without warning signs that may go unrecognized or falsely attributed. A second (and larger) factor is a lack of awareness among the public of PAD and its dangers. Compared to other health risks such as cancer, PAD does not receive much public attention and surveys have shown that millions of Americans at risk for PAD have never even heard of it.
Complications of PAD can include:
PAD diagnosis begins with a medical history review and physical examination, then confirmed through additional, non-invasive testing.
Lifestyle Changes and Medication
Treatment begins with lifestyle changes including ceasing smoking, exercising, and reducing alcohol intake. Medications for cholesterol, blood pressure, vasodilators and/or antiplatelets may also be recommended.
If symptoms are not alleviated by the above, then medical intervention may be required to re-establish blood ﬂow and minimize tissue loss.
This is a minimally invasive process that includes one or up to three of the following:
No treatment exists to reverse PAD, but it can be treated to improve symptoms and prevent the condition from progressing. Lifestyle changes, exercise, diet (including a “reversal diet,”) and medication can slow the progression of PAD and help alleviate symptoms.
Conversely, failing to change your lifestyle habits increases your risk of recurring PAD symptoms even after medical treatment.
The outlook for people with PAD depends on their underlying risk factors, the severity of the condition, and the location of the narrowed or blocked artery, among other factors.
There is a high degree of overlap between PAD and coronary artery disease (CAD), and the extent of underlying CAD has a significant impact on the prognosis of patients with PAD.
According to the American College of Cardiology, patients with an ABI of 0.81-0.90 have a two-fold increase in mortality, and those with an ABI ≤0.70 have a four-fold increase in mortality, compared to patients with a normal ABI.
Diagnosing PAD as soon as possible is critically important to future outcomes, because although PAD increases the risk of heart disease, stroke, abdominal aortic aneurysm, amputation, and death, it can often be managed with medication or even simply lifestyle changes.
There are lifestyle changes that can not only reduce the risk of developing PAD but also can slow the progression of the disease. These include:
At VasCare, we treat PAD with the most minimally invasive methods possible to minimize your recovery time and get you back on the road to health as quickly as possible.