What is PAD?
Peripheral Artery Disease (PAD), also known as Peripheral Vascular Disease, is a very common medical condition in which a build-up of plaque due to atherosclerosis makes it difficult for blood to circulate through the arteries. PAD primarily affects the legs, but can also damage arteries in the kidneys, abdomen, feet, ankles, pelvis, hips, buttocks and arms.
Watch the video below for more information on Peripheral Artery Disease.
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What causes PAD?
Peripheral artery disease is caused by atherosclerosis, a build-up of plaque (fatty deposits and cholesterol) on the walls of the arteries. Over time, the arteries can become so narrow that it is difficult for blood to flow through to bring oxygen to the muscles, tissue and organs. Clots can form when plaque breaks off and enters the bloodstream.
What are the risk factors for PAD?
It’s important to be aware of the possible risks to better prepare for how to manage them. The risk for PAD increases with age, and diabetes is one of the most common risk factors for PAD, especially in patients over 50 years old.
Learn more about PAD and diabetes
Risk factors include:
- Diabetes Mellitus (DM)
- High blood pressure and high cholesterol levels
- Heart disease such as Coronary Artery Disease (CAD)
- Family history of heart or vascular disease
- Overweight (body mass index over 30)
- Lack of exercise and sedentary lifestyle
- Over 70 years old (or over 50 if you also smoke and/or have diabetes)
What are the symptoms of PAD?
Not everyone has symptoms in the early stages of PAD, this is known as Asymptomatic PAD. However, for patients who do have symptoms, called Symptomatic PAD, the most common ones are pain, cramping and discomfort in the legs, calves, thighs or buttocks. The pain occurs when walking, climbing stairs or exercising, but usually goes away during rest.
The legs may also feel cold or numb, tired, weak, achy or heavy. There might be a tingling that wakes you up at night. In addition, the skin on your legs may become discolored. If you have any sores or wounds on your feet, PAD will prevent them from being able to heal, so it’s important to check your feet daily for any cuts or swelling. If you notice that wounds are slow to heal or not healing at all, it’s important to talk to your doctor as soon as possible.
How is PAD diagnosed?
Your doctor will initially check the pulse in your feet and perform a non-invasive test called ankle-brachial pressure index (ABI).
ABI is used to compare the blood pressure in your arms with the blood pressure in your ankles. Based on test results, you may undergo an ultrasound to evaluate blood flow.
If further tests are required, an MRI (magnetic resonance imaging) or CT angiography may help identify the extent of narrowing in your blood vessels due to atherosclerosis.
Is PAD serious?
Severe PAD can lead to foot sores or wounds on feet that are not healing, which raises the risk for permanent tissue damage and leg amputation or foot amputation. PAD is also considered a risk factor for heart attack and stroke.
Learn more about amputation prevention
How is PAD treated?
Dr. Lam has a specific treatment algorithm depending on if the patient is asymptomatic or symptomatic. In most patient cases, lifestyle modification and medications are used as the first line of defense against PAD, unless the patient’s health is at risk.
Patients with asymptomatic PAD should receive a comprehensive program of guideline-directed management and therapy (GDMT), which includes a structured exercise and lifestyle modification program, to reduce cardiovascular events, such as stroke or heart attack, and improve function. Suggested lifestyle modifications would include lowering blood pressure and cholesterol, losing weight and stopping smoking. Medications are customized to each patient’s individual risk factors, such as diabetes, high blood pressure or hyperlipidemia.
Patients who have experienced symptoms of PAD and have an ABI of less than 0.90 are diagnosed with one of two conditions: Claudication or Critical Limb Ischemia (CLI).
Claudication is present when the patient experiences cramping and pain in the leg from exercising. This is caused by the lack of blood flow from the obstructed arteries. Once the patient stops exercising and is at rest, the pain and discomfort fade – this is known as intermittent claudication. If left untreated, the pain may become present at all times, which can limit your quality of life and ability to be active.
Each patient is given a customized care plan that includes a supervised exercise program as initial therapy to relieve symptoms of claudication and improve their quality of life.
Revascularization is recommended as a treatment option when the patient is experiencing lifestyle-limiting claudication with no improved response to GDMT.
Critical Limb Ischemia (CLI) occurs when there is severe obstruction of the arteries, which reduces blood flow to the extremities (hands, feet and legs) causing severe pain and development of ulcers or sores on the feet. Unlike intermittent claudication where the pain subsides while you rest, patients with CLI experience constant pain.
Chronic limb ischemia (CLI) is associated with an increased risk of major amputation and the symptoms include:
- Pain or numbness in the feet
- Shiny, smooth, dry skin of the legs or feet
- Thickening of the toenails
- Absent or diminished pulse in the legs or feet
- Open sores, skin infections or ulcers that will not heal
- Gangrene (dry, black skin) on the legs or feet
To avoid amputation, surgical or endovascular revascularization is recommended. The goal of revascularization is to provide blood flow back into the foot which will help decrease ischemic pain and allow healing of any wounds while preserving limb function. This will help minimize the loss of tissue.
If PAD progresses, it could develop into Acute Limb Ischemia (ALI) which is seen as a medical emergency. Patients with ALI must be treated rapidly because the longer the symptoms are present, the lower the chance of limb salvage.
Endovascular Revascularization Technology
Angioplasty and Stenting
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