PAD is both common and commonly misunderstood. In the Q&A below, Dr. Lam clears up a few things.
What is PAD?
Lam: PAD stands for Peripheral Arterial Disease which and in short, it is blockage of the arteries going to an extremity. While, technically, it could exist in the arm or hand, it’s most common in the legs and feet.
How common is PAD?
Lam: PAD is pretty common – millions have it – especially those with diabetes over age 50 or who are over 70. However, while it affects many, very few understand or know how to treat it, especially complex cases.
What are the symptoms of PAD?
Lam: There are millions of people who have decreased circulation in their lower extremities, but because they are older and/or less mobile, they don’t really have any symptoms, so they don’t come see me.
The patients that I most commonly see are those who are experiencing pain in their lower legs when they walk or exercise. This pain is called intermittent claudication and for many with PAD, it greatly decreases their quality of life.
A totally different group of patients are those with diabetes. Diabetes very often causes severe PAD, and it not only affects the lower extremity arteries, but that poor circulation also affects the nerves in the legs and feet. Since diabetics do not have “normal” sensation in their feet, they will often get a simple sore like a blister and not feel it so they will continue to agitate it until it turns into an ulcer.
These ulcers will then get infected and threaten the whole foot – thus, leading to the threat of amputation. I see many patients that are told by another doctor that their toes or whole foot will need to be amputated. I specialize in this kind of care – limb salvage – and have been able to save many patients’ limbs using a variety of endovascular and vascular procedures.
What are the risk factors for PAD?
Lam: The risk factors for peripheral arterial disease include smoking, diabetes, high cholesterol, and one that we can’t really do much about – getting older. As we age, our blood vessels often “wear out,” and that is why regular physical exams are increasingly important as we get older. Because PAD can increase your risk of heart attack and stroke, it’s good to catch it as early as possible.
How is PAD diagnosed?
Lam: The challenge of PAD is again, many people don’t present with symptoms. So, what happens is they will go see their doctor for a routine exam, and the doctor can’t feel a pulse. So, they begin digging deeper into the cause.
The reason for lack of symptoms is that Americans just don’t exercise enough or walk very much. So, if there is not a large amount of blood flow needed in the legs, symptoms often won’t present. Therefore, you could have PAD, be at risk and simply not know it.
However, when people do have symptoms, PAD is fairly easy to diagnose. If symptoms are present, they’re present every day when you walk or move a certain distance or amount of time. It’s not like one day you have pain and then the next you can walk a mile without any problem. It’s either there or it isn’t.
How is PAD treated?
Lam: In the past, we didn’t treat mild PAD very aggressively because in most cases, it wasn’t a direct threat to the patient’s life or to their limbs. So patients were left to endure the pain or undergo invasive surgeries that often presented more risk than benefit.
But fortunately, today, we have a variety of minimally invasive techniques such as angioplasty (insertion of a tiny balloon into the artery to open it up) and stenting (placing a cylindrical structure in the artery to keep blood flowing effectively) that successfully treat PAD. These procedures are performed in our state-of-the-art endovascular suite, require only a small incision and treat the issue with very little downtime. There is no need for a hospital stay; in most cases, patients can go home the same day.
Complex cases – those that are at risk for losing their limb due to severe ulceration, discoloration and/or decreased function of their feet or legs – often times call for a more aggressive treatment option known as lower extremity bypass surgery.
The bypass surgery is pretty true to its name. In its simplest of descriptions, it involves “bypassing” the blockage by connecting the areas above and below it where circulation is still normal to enable normal blood flow again. While this procedure is more invasive, technology has enabled it to be very successful in preventing amputation and giving patients back their desired quality of life.
More often than not, I can save a patient’s limb and effectively treat their PAD using either or both endovascular and vascular procedures. I love what I do and am passionate about staying ahead of technology, continuous education, making patient care my priority and being able to give people back their lives each and every day.
Think you may have PAD, are facing amputation or know and love someone who is? Make an appointment with Dr. Lam today. Click here or call Lam Vascular & Associates at 214.345.4160.
The information contained in this article is not intended to be used as a substitute for medical advice. Patient results will vary based on risk factors, age, disease and medical history and are not guaranteed in any way.