Peripheral Arterial Disease

What is P.A.D.?

P.A.D. is short for Peripheral Arterial Disease . People have P.A.D. when the arteries in their legs become narrowed or clogged with fatty deposits, or plaque. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. Some people call this poor circulation.

P.A.D. occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

The good news is that like other diseases related to the arteries, P.A.D. can be treated by making lifestyle changes, by taking medicines, or by having endovascular or surgical procedures, if needed.

Is P.A.D. serious? Lower-extremity P.A.D. is a serious disease that affects over 10 million Americans. The hardened arteries found in people with P.A.D. are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain. That is why people with P.A.D. are at high risk for having a heart attack or a stroke.

When the blood flow to the legs and feet is greatly (or severely) reduced, people with P.A.D. may experience pain when walking. P.A.D. may cause other problems, such as a wound that won't heal. P.A.D. is a leading cause of lower extemity amputation . People with P.A.D. may become disabled and not be able to go to work. As time goes on, they may have a very poor quality of life.

Risk Factors:

Who is at risk for P.A.D.? The chance of having P.A.D. increases as you get older. People over age 50 have a higher risk for P.A.D., but the risk is increased if you:

  • Smoke, or used to smoke
  • Have diabetes
  • Have high blood pressure
  • Have abnormal blood cholesterol levels
  • Are of African American ethnicity
  • Have had heart disease, a heart attack or a stroke

Symptoms:

What are the warning signs or symptoms of P.A.D.? P.A.D. develops slowly over many years. In the early stages, most people with P.A.D. have no symptoms. Only about one out of three people with P.A.D. actually feel there is something wrong with their feet or legs. By that time, their arteries may be so clogged or hardened that they are not getting enough oxygen to supply their leg muscles.

The most common signs of P.A.D. include one or more of these problems:

  • Cramps, tiredness or pain in your legs, thighs or buttocks that always happens when you walk but that goes away when you rest. This is called claudication (pronounced as ‘klo´di-ka´shen’).
  • Foot or toe pain at rest that often disturbs your sleep.
  • Skin wounds or ulcers on your feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks).

Sometimes, people ignore their leg pain and think it is just a sign that they are getting older. As a result, many people with P.A.D. do not know they have it and do not get treatment. It is important to discuss any leg or thigh pain you may be having with your doctor since it may be a warning sign of a serious disease such as P.A.D.

Diagnosis:

How do I find out if I have P.A.D.? If you think you may have P.A.D., print and answer this questionnaire. If you answer 'yes' to any of these questions, call to schedule an appointment with a podiatrist to discuss any symptoms you may be having as well as review your medical history and your risk factors for P.A.D. Dr Talarico will conduct a thorough examination including the pulses in your feet and legs. If he finds those pulses to be weak and thinks you may have P.A.D., he may order a simple test called an Ankle Brachial Index (ABI). This test is painless, non-invasive and performed in our Neuro-Vascular Testing Lab where we offer the latest in computerized vascular testing technology.

The ABI is the best test for finding out if you have P.A.D. It uses sound waves to find out if there is reduced blood flow in the arteries. It also compares the blood pressure in your ankles with the blood pressure in your arms. P.A.D. also can be diagnosed by other tests that measure blood pressures in the leg (segmental pressure), toe pressures (toe-brachial index or TBI) or artery blood flow (with ultrasound).

Treatment:

How is P.A.D. treated? P.A.D. can be treated with lifestyle changes, medicines and endovascular or surgical procedures, if needed. Since people with P.A.D. are at high risk for heart attacks and stroke, they must take charge of controlling their risk factors related to cardiovascular disease.

These life saving steps will help to prevent and control P.A.D.:

  • Get help to quit smoking and set a quit date now.
  • Lower your blood pressure to less than 140/90 mmHg or less than 130/80 mmHg if you have diabetes or chronic kidney disease.
  • Lower your LDL (bad) cholesterol to less than 100 mg/dl. If you are at very high risk for a heart attack or stroke, your health care provider may recommend an LDL goal of less than 70 mg/dl.
  • Manage your blood glucose to reach an A1C level of less than 7 and practice proper foot care if you have diabetes.
  • Talk to your doctor about taking anti-platelet medicines such as aspirin or clopidogrel to prevent clotting.
  • Follow a healthy eating plan to control your blood pressure, cholesterol and blood glucose (for diabetes).
  • Get regular exercise such as walking for 30 minutes at least 3 or 4 times per week. If you have pain or cramps in your legs, ask your health care provider to refer you to a special PAD exercise program. Also, talk with your doctor about using medicines such as cilostazol to improve your walking ability.

For most people with P.A.D., these life saving steps may be enough to slow down the disease and even improve any symptoms. If needed, your health care provider can refer you to a specialist for procedures or surgery to treat arteries that are severely blocked and reduce symptoms.

Finding and treating P.A.D. early can help keep your legs healthy, lower your risk for heart attack or stroke, and save your life and limbs.

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