Arterial health and care and treatment options for peripheral arterial disease
Q: What is PAD?
A: Peripheral arterial disease (PAD)
Is a disease in which plaque (atherosclerosis) builds up in the arteries that carry
Blood to your head organs and limbs
Plaque is made up of fat, cholesterol, calcium, fibrous tissue and other substances
In the blood over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.
PAD usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys and stomach. PAD affecting the legs is very common, and it is the most common cause of amputations in the United States. Therefore, it is a major cause for concern.
Q: What are the symptoms of PAD?
A: The classic symptom of PAD is pain in the legs with exertion such as walking, which is relieved by resting. However, up to 40 percent of individuals with PAD have no leg pain. Symptoms of pain, ache or cramping with walking (claudication) can occur in the buttock, hip, thigh or calf.
Physical signs in the leg that may indicate PAD include muscle atrophy, hair loss, smooth and shiny skin, skin that is cool to the touch (especially if accompanied by pain while walking that is relieved by stopping walking), decreased or absent pulses in the feet, non-healing ulcers or sores on the legs or feet and cold or numb toes.
Q: What are some causes of PAD?
A: The most common cause of PAD is atherosclerosis. Some rare causes include inflammation of the arteries to the legs, unusual anatomy of ligaments and muscles causing compression and radiation injury to the arteries.
Q: Are there risk factors for PAD?
A: The main risk factors for PAD include:
• Older age (65 years and older)
• High cholesterol
Q: Who needs to be screened for PAD?
A: The American College of Cardiology and the American Heart Association have given screening recommendations for PAD. Screening tests should be used to establish the lower-extremity PAD diagnosis in patients with suspected lower extremity PAD, defined as individuals with one or more of the following:
• Exertional leg symptoms
• Non-healing wounds
• Age 65 years and older
• Age 50 years and older with a history of smoking or diabetes
Q: What screening test is used to detect PAD?
A: A simple test called an ankle-brachial index (ABI) often is used to diagnose PAD. The ABI compares blood pressure in your ankle to blood pressure in your arm. This test shows how well blood is flowing in your limbs. ABI can show whether PAD is affecting your limbs, but it won’t show which blood vessels are narrowed or blocked.
A normal ABI result is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10 to 15 minutes to measure both arms and both ankles.
This test may be done yearly to see whether PAD is getting worse. A modified test where blood pressure cuffs are used at different levels in your legs can be done to perform ABI, and this can also localize which arteries are blocked.
Q: What lifestyle changes should a person with PAD make, or may be required to make?
A: The key to treating PAD is risk factor modification. Treatment often includes making long-lasting lifestyle changes such as:
Quitting smoking: Your risk of PAD increases four times if you smoke. Smoking also raises your risk for other diseases such as coronary heart disease (CHD).
Lowering blood pressure: This lifestyle change can help you avoid the risk of stroke, heart attack and heart failure.
Lowering cholesterol: Lowering cholesterol can delay or even reverse the buildup of plaque in your arteries.
Lowering blood glucose (sugar) levels if you have diabetes.
Being physically active: Talk with your doctor about taking part in
a supervised exercise program. This type of program has been shown to reduce PAD symptoms.
Following a healthy eating plan that’s low in total fat, saturated fat, Trans fat, cholesterol and sodium (salt): Include fruits, vegetables and low-fat dairy products in your diet. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.
Q: What happens if a patient is diagnosed with PAD?
A: Treatment primarily consists of aggressive control of blood pressure, diabetes and cholesterol. Complete cessation of smoking is essential, without which PAD will invariably get worse and can lead to amputations.
Further treatment options depend on patients’ symptoms. If a patient is asymptomatic, risk factor control is all that is needed. If a patient is symptomatic, a supervised exercise regimen, along with medical therapy with medications like Cilostazol, is recommended.
Patients with PAD and limb ischemia or non-healing ulcers need further studies like arterial Doppler’s, CT angiograms, MR angiograms and peripheral angiograms. Based on the extent of the disease, angioplasty with or without stenting or bypass surgery could be recommended.
All Fitness __ PAD10
Kiran K. Cheruku, M.D., is board certified in endovascular medicine and interventional cardiology. His office is at the Heart and Vascular Institute of Texas, with locations throughout San Antonio and South Texas. The main phone number is 210-804-6000.