Peripheral Arterial Disease

You are probably familiar with the terms angina and heart attack, which are related to a blockage of blood flow to the heart. The same sort of blockage can occur elsewhere in the body, depriving the limbs of oxygen and nutrients. Left untreated, the disease can lead to amputation.

Healthy peripheral arteries are smooth and unobstructed, allowing blood to flow freely and to provide the legs with oxygen, glucose, and other nutrients. As we age, peripheral arteries build up plaque, a sticky substance made up of mostly fat and cholesterol. Plaque narrows the passageway within the arteries and causes them to become stiff.

A moderate blockage in one of the arteries in a major leg muscle, such as the calf or thigh, can cause pain when walking. This pain can temporarily decrease with rest but will act up again with more walking or activity.

Lower extremity pain, similar to angina, is called claudication by medical personnel. The pain itself is not limb-threatening but is a sign that you should make lifestyle changes and see your doctor.

If the disease becomes more severe, the affected limb can be starved of vital nutrients, and you may feel the pain at rest, especially at night. This is referred to as Critical Limb Ischemia. Sores may develop on the feet. This is a concerning sign for losing toes or an amputation. An urgent referral to a vascular surgeon is necessary to prevent limb loss in this situation.

Know your risk for PAD

Anyone can develop PAD, but there are certain risk factors that can increase the likelihood of developing this serious condition.

These conditions include:

• Smoking can damage the arteries and their ability to transport blood.
• Obesity or being overweight can also put pressure on your legs and restrict healthy blood flow.
• High cholesterol contributes to the buildup of plaque in your arteries.
• High blood pressure can increase the likelihood of developing disease.
• Diabetes can narrow vessels, making it more difficult for blood to flow to the limbs.
• Being older than 50 can increase the risk of PAD as blood vessels become damaged over time.
• A family history of cardiovascular problems increases the risk you too will have them.

The good news is that PAD can be managed effectively if detected early. Leg pain does not always indicate PAD, but older patients, especially those who are at higher risk, should see a physician. A simple non-invasive examination can diagnose peripheral arterial disease and determine its severity.

Your physician will evaluate your medical and family history, take blood tests, and conduct a physical examination. A combination of diagnostic tools may be used, such as:

• Ankle-brachial index (ABI) is a simple test that compares the blood pressure in the upper and lower limbs.
• Duplex ultrasound is a special ultrasound technique that can help detect areas of restricted blood flow through an artery.
• CT Angiography is used for identifying disease (PAD) with high accuracy.

Intravascular ultrasound enables healthcare providers to assess blood vessels from the inside. It uses sound waves to check for narrowing and blockages that can compromise blood flow.

If you are diagnosed with PAD, there are several treatment options available, including lifestyle changes.

Other treatments may include:

• Medication therapy to control symptoms and reduce plaque buildup.
• Angioplasty and stenting to open a blocked artery.
• Atherectomy may be used to reduce plaque buildup.
• Traditional lower extremity bypass grafting to redirect blood flow.