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Peripheral Arterial Disease

What is Peripheral Arterial Disease (PAD)

  • PAD is a common circulatory problem in which narrowed or obstructed arteries reduce blood flow to your limbs. When you develop PAD, your limbs (usually your legs) do not receive enough blood and oxygen to keep up with demand. This causes symptoms, most notably pain in the legs when walking (termed intermittent claudication). It is most commonly caused by atherosclerosis – build up of plaque and fatty deposits in the walls of arteries in the body. This process can affect arteries throughout the body and PAD is often seen in combination with coronary artery disease and cerebrovascular disease. People with PAD are at risk for heart attacks and stroke!

Risk factors for PAD

  • Smoking
  • Diabetes
  • Obesity
  • High blood pressure
  • High cholesterol
  • Increasing age
  • Family history of heart disease, stroke, or PAD
  • People with diabetes and those who smoke are at highest risk for PAD and complications of PAD!

Complications of PAD

  • Critical Limb Ischemia – this usually begins as sores that don’t heal on the legs or feet. This can progress to tissue death (gangrene) due to severe lack of oxygen. This will result in amputation of the affected limb if not treated promptly.
  • Heart Attack and Stroke – the process of atherosclerosis that affects the limbs also occurs in other blood vessels in the body. Plaque also builds up in the arteries supplying your heart and brain and can lead to strokes or heart attacks.
  • Treatment for PAD
  • The first step for all patients with Peripheral Arterial Disease is lifestyle modification and addressing your risk factors for PAD. If you smoke – quitting smoking is the most important thing you can do to reduce your risk of PAD complications, heart attack, and stroke!
  • Exercise – This is the cornerstone of therapy for PAD. Try to walk up to 30 minutes daily. The more you walk, the easier it gets.
  • Medications – Medications to treat risk factors for PAD are important and include cholesterol-lowering medications, medications for high blood pressure, and medications to control blood sugar if you have diabetes. Medications to prevent blood clots, such as aspirin, are important to reduce the risk of blood clots in the legs, heart attack, and stroke. Cilostazol (Pletal) helps to reduce the symptoms of claudication, but may cause headache and diarrea and should not be taken if you have heart failure.
  • Angioplasty and Surgery – Often procedures are needed to improve the blood flow to your legs to reduce the symptoms of claudication. Angioplasty involves inserting a small hollow tube (catheter) into the arteries in the legs and using a balloon or other devices to expand the artery. Sometimes placement of a metal mesh called a stent is used to help keep the artery open. Some occluded arteries cannot be treated by angioplasty and will require surgery to create a bypass around the blocked arteries to restore blood flow.

How do I know if I have Peripheral Arterial Disease?

    • Pain in the legs when you walk is the most common symptom of PAD. Make an appointment with a doctor if you have these symptoms. Below is a questionnaire that will help identify if you have PAD:

Peripheral Arterial Disease Questionnaire

  • PAD can be diagnosed by simple, painless, noninvasive ultrasound tests. Further tests may be needed if the screening test is abnormal to evaluate the extent and severity, and to guide treatment, which may include CT scans, MRA, or angiography.