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What is Peripheral Arterial Disease (PAD)?
Peripheral arterial disease, also known as PAD, is a narrowing of the arteries in the legs, stomach, arms and head. It is caused by atherosclerosis, which also causes coronary artery disease. Atherosclerosis is commonly called “hardening of the arteries.” This condition is caused by fatty buildup (plaque) in the inner walls of the arteries and causes the arteries to become narrowed or blocked. PAD affects an estimated 18 million people in the United States, including up to 20 percent of people over age 60. Men and women are affected equally. PAD can occur in any blood vessel but is most common in the legs.
Signs and Symptoms of PAD
- Intermittent claudication. This is the classic symptom of PAD and includes leg discomfort, pain, or cramping that occurs with activity, is relieved with rest, and recurs upon resuming activity. The discomfort is often felt in the calves but may also be felt in the buttocks or thighs.
- Redness or discoloration of the skin in the lower extremities.
- Burning or aching in the feet and toes at rest, especially at night while lying flat.
- Cold or numb toes.
- Foot or toe sores or ulcers that do not heal.
Risk Factors for PAD
- Age (50 or older)
- Current or past smoker
- High blood pressure
- High cholesterol
- Coronary artery disease
- Family history of stroke or vascular disease
- Inactive lifestyle
If two or more of the risk factors above apply to you, your doctor may order tests to determine if you have PAD.
Diagnosis of PAD
PAD is diagnosed with a test called the ankle-brachial index, or ABI, which compares the blood pressure in the ankle and the arm at rest and after exercise. In most healthy adults, the ratio is between 1.0 and 1.4. If PAD is present, the ratio is less than 0.9. When the ABI test indicates PAD, one or more of the following tests may be performed.
- Doppler ultrasound. A transducer uses sound waves to image blood vessels to evaluate for blockages.
- CT angiogram. A CT scan is taken after administering an X-ray dye to produce detailed pictures of the arteries.
Treatment of PAD
- Lifestyle and medical treatments
A diagnosis of PAD indicates that you are at risk not only for mobility problems but also for heart attack and stroke. Here is what you need to do to reduce your risk:
-Exercise. If intermittent claudication makes it hard to walk or bike, you can increase your leg strength and walking speed with a targeted, preferably supervised exercise program.
-Don’t smoke. Quitting smoking can reduce the risk for PAD by 60 percent within 10 years.
-Manage chronic conditions. Manage the conditions that contribute to PAD such as diabetes, high cholesterol and high blood pressure.
-Take medications to prevent blood clots. Low-dose aspirin is strongly recommended. Your doctor may also prescribe clopidogrel (Plavix).
- Restoring blood flow (Revascularization)
In some cases where PAD is causing severe symptoms, restoring blood flow is needed. This is done by opening up narrowed or blocked arteries with angioplasty, or creating a bypass around the blockage.
Our interventional cardiologists provide comprehensive specialty care in an outpatient setting for patients with PAD. In one convenient location, we offer a full array of diagnostic tests as well as advanced vascular procedures in our state-of-the-art Cath Lab, including:
- Angiography, an X-ray based test that produces images of the inside of your arteries to determine if there are blockages.
- Angioplasty, where a balloon catheter is used to open blocked arteries.
- Stent implantation, where a metal mesh tube is used to support or help keep the artery open.
- Atherectomy, where a catheter is used to remove plaque from diseased arteries.