Peripheral Arterial Disease
PAD is a disease of the arteries that carry blood from the heart down to the leg and foot.
What is Peripheral Arterial Disease?
PAD is a disease of the arteries in the lower extremities—the blood vessels that carry blood from the heart down to the leg and foot. When you develop PAD, your extremities don’t receive enough blood to keep up with demand. Just like when you go for a run and you get a cramp in your side because of lack of oxygen, if you’re walking you can get a cramp in your legs.
However, it’s important to note that the symptoms of blockages depend on the location and the severities of them. The blockages can be located anywhere along the blood supply to the legs, from the start of the aorta near the belly button, down to the legs, and everything distal to that.
These blockages are primarily caused by plaque or LCD (Bad) Cholesterol buildup—also known 33as Atherosclerosis.
PAD is considered to be one of the major signs of major heart disease, and thus, it is important that it be dealt with appropriately.
Who is affected by PAD?
PAD is estimated to affect from 12%-20% of Americans age 65 or older, with as many as 70% of them being asymptomatic (Rogers et al, 2011).
- High Cholesterol
- High Blood Pressure
- Poor dietary habits
The two most self-evident risk factors seem to be smoking and diabetes. Age certainly plays an important role; as well do high cholesterol and blood pressure.
For reasons unknown, the African American minority of America seems to disproportionately contract PAD more often. However, PAD is considered to be both under-diagnosed and under-treated by the AHA and NIH.
The progression of PAD
PAD progresses the same way coronary and other arterial diseases do.
Classically an injury occurs to the epithelial tissues in the blood vessels. These can be mechanical injuries or smoke/tar related injuries. Ultimately, the causes vary but as soon as the injury occurs plaque builds up and things worsen. Ultimately, the blood vessels narrow and may even become completely blocked. This is obviously very dangerous in situations where the PAD has deteriorated significantly.
Who should be tested for PAD?
- If you’re concerned because you have leg symptoms and you fit any of the risk categories.
- If you are of an appropriate age and have one or more of these risk factors,
- If you’ve have previous evidence of previous major cardiovascular disease or procedure, like bypass, stenting, etc. or advanced atherosclerosis you should get a complete vaster exam (checking the pulses in your legs and feet) and an ABI test.
Testing for PAD
The Ankle Brachial Index (ABI) procedure is a way of measuring the blood pressure in the ankle and comparing it to the blood pressure in the arm. By taking both blood pressures one can get a ratio of blood flow. The ratio should always be over .9 (90%) for normal indication, and any less suggests a problem to the blood flow to the lower extremities.
In some situations, which the arteries are too calcified, cuffs can be placed around the toe instead. This is called a TPI, or toe pressure index.
If someone exhibits the classic symptoms only when they walk, the ABI will be done on a treadmill. If they do have PAD, or their pain is related to PAD, then the blood pressure in the leg will drop and the symptoms will arise. For this very reason, PAD is sometimes referred to as “Window-Shoppers disease”.
So you have PAD… now what?
Treatment for PAD traditionally consists of reducing and preventing symptoms. This approach is usually taken in a bevy of different ways. There are several levels of treatments. First, come lifestyle changes. If necessary, your doctor may also prescribe high cholesterol or blood pressure medications. And, should your PAD continue to progress, there are several non-invasive procedures that can alleviate symptoms as well.
Very often, PAD is targeted with several lifestyle changes and an exercise regimen. However, if you currently smoke or use tobacco, then you should cease and consider smoking cessation counseling. This will also help any co-morbid diseases that come with PAD, such has Coronary Heart Disease, Hypertension, Hypercholesterolemia, etc.
More than this, making the right food choices and walking or other forms of cardiovascular exercise will go a long way in controlling PAD.
Taking an aspirin or other anti-platelet medications will also ease any ongoing symptoms of PAD and help prevent any complications from arising.