PAD is a narrowing of the peripheral arteries, most common in the arteries of the pelvis and legs. PAD is similar to coronary artery disease (CAD) and carotid artery disease. All three of these conditions are caused by narrowed and blocked arteries in various critical regions of the body. Hardened arteries (or atherosclerosis) in the coronary artery region, restricts the blood supply to the heart muscle. Carotid artery disease refers to atherosclerosis in the arteries that supply blood to the brain.

Quick Facts about PAD:

  • The most common symptoms of PAD are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.
  • Many people mistake the symptoms of PAD for something else.
  • PAD often goes undiagnosed by healthcare professionals.
  • People with peripheral arterial disease have four to five times more risk of heart attack or stroke.
  • Left untreated, PAD can lead to gangrene and amputation.

Atherosclerosis and PAD:

Added risks for PAD:

  • If you smoke, you have an especially high risk for PAD.
  • If you have diabetes, you have an especially high risk for PAD. 
  • People with high blood pressure or high cholesterol are at risk for PAD. 

The good news for PAD patients:

  • PAD is easily diagnosed in a simple, painless way.
  • You can take control by leading a heart-healthy lifestyle and following the recommendations of your healthcare professional.
  • Most cases of PAD can be managed with lifestyle changes and medication.

Atherosclerosis is a disease in which plaque builds up in the wall of an artery. PAD is usually caused by atherosclerosis in the peripheral arteries (or outer regions away from the heart). Plaque is made up of deposits of fats, cholesterol and other substances. Plaque formations can grow large enough to significantly reduce the blood's flow through an artery. When a plaque formation becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot may either further narrow the artery, or completely block it.

If the blockage remains in the peripheral arteries, it can cause pain, changes in skin color, sores or ulcers and difficulty walking. Total loss of circulation to the legs and feet can cause gangrene and loss of a limb.

If the blockage occurs in a coronary artery, it can cause a heart attack. Heart attacks happen when an area of the heart tissue dies from lack of blood flow. When it occurs in a carotid artery, it can cause a stroke.

*Information from the American Heart Association

Why PAD Matters

Why does peripheral artery disease matter?

Peripheral artery disease happens when fatty deposits build up in arteries outside the heart, usually the arteries supplying fresh oxygen and blood to the arms, legs and feet.

Is PAD dangerous or life threatening?

Yes, PAD is dangerous because these blockages can restrict circulation to the limbs and organs. Without adequate blood flow, the kidneys, legs, arms and feet suffer damage. Left untreated, the tissue can die or harbor infection such as gangrene.

Does PAD cause additional health problems?

PAD may be the first warning sign of atherosclerosis- chronic fatty deposit build-ups throughout your arteries. The whole circulatory system, including your heart and brain, are at risk when arteries are blocked and narrowed. Fatty deposits also increase the risk for vascular inflammation and blood clots that can block the blood supply and cause tissue death.

PAD is a life-threatening condition that can be managed or even reversed with proper care.

*Information from the American Heart Association

Symptoms of PAD

The most common symptom of PAD is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising.

The pain of PAD usually goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow. Resting muscles can get by with less. If there's a blood-flow blockage due to plaque buildup, the muscles won't get enough blood during exercise to meet the needs. The "crampy" pain (called "intermittent claudication"), when caused by PAD, is the muscles' way of warning the body that it isn't receiving enough blood during exercise to meet the increased demand.

Many people with PAD have no symptoms or mistake their symptoms for something else.

Symptoms of severe PAD include:

  • Leg pain that does not go away when you stop exercising
  • Foot or toe wounds that won't heal or heal very slowly
  • Gangrene

A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body

Understanding leg pain:

Many people dismiss leg pain as a normal sign of aging. You may think its arthritis, sciatica or just "stiffness" from getting older. For an accurate diagnosis, consider the source of your pain. PAD leg pain occurs in the muscles, not the joints.

Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that is a burning or painful discomfort of the feet or thighs. If you're having any kind of recurring pain, talk to your healthcare professional and describe the pain as accurately as you can. If you have any of the risk factors for PAD, you should ask your healthcare professional about PAD even if you aren't having symptoms.

*Information from the American Heart Association

Risk Factors for PAD

People who smoke and/or have diabetes are at especially high risk. If you have risk factors, get screened for PAD, even if you're not having symptoms.

PAD risk factors you can control:

Certain risk factors for PAD can't be controlled, such as aging or having a personal or family history of PAD, cardiovascular disease or stroke. However, you can control many risk factors including:

  • Cigarette smoking - You can stop smoking. Smoking is a major risk factor for PAD. Smokers may have four times the risk of PAD than nonsmokers. Our guide to quitting smoking can help you.
  • Obesity - You can reduce your weight. People with a Body Mass Index (BMI) of 25 or higher are more likely to develop heart disease and stroke even if they have no other risk factors. Calculate your BMI and learn healthy ways to manage your weight.
  • Diabetes mellitus - You can manage diabetes and blood sugar levels. Having diabetes puts you at greater risk of developing PAD as well as other cardiovascular diseases. Learn more about the risks and how to manage diabetes.
  • Physical inactivity - You can get moving. Physical activity increases the distance that people with PAD can walk without pain and also helps decrease the risk of heart attack or stroke. Supervised exercise programs are one of the treatments for PAD patients. 
  • High blood cholesterol - You can manage your cholesterol levels. High cholesterol contributes to the build-up of plaque in the arteries, which can significantly reduce the blood's flow. This condition is known as atherosclerosis. Managing your cholesterol levels is essential to prevent or treat PAD.
  • High blood pressure - You can manage your blood pressure. It's sometimes called "the silent killer" because it has no symptoms. Work with your healthcare professionals to monitor and control your blood pressure.

You can choose more than one target to improve! Taking care of only one risk factor is not as effective as taking care of all those that you can control. Learn the facts. Develop a heart-healthy lifestyle and cooperate with your healthcare professionals. Your heart will thank you by functioning better and lasting longer.

*Information from the American Heart Association

Prevention of PAD

Treatment for PAD focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow the progression or even reverse the symptoms of PAD.

The most effective treatment for PAD is regular physical activity. Your doctor may recommend a program of supervised exercise training for you. You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs three times a week can result in decreased symptoms in just four to eight weeks. Exercise for intermittent claudication takes into account the fact that walking causes pain. The program consists of alternating activity and rest in intervals to build up the amount of time you can walk before the pain sets in. It's best if this exercise program is undertaken in a rehabilitation center on a treadmill and monitored. If it isn't possible to go to a rehabilitation center, ask your healthcare professional to help you plan a program that's best suited to your situation.

Many PAD patients have elevated cholesterol levels. A diet low in saturated fat, trans fat and cholesterol can help lower blood cholesterol levels, but medication may be necessary to maintain the proper cholesterol levels.

Tobacco smoke greatly increases your risk for PAD and your risk for heart attack and stroke. Smokers may have four times the risk of developing PAD than nonsmokers. Stop smoking. It will help to slow the progression of PAD and other heart-related diseases.

Medication:

  • You may be prescribed high blood pressure and/or cholesterol-lowering medications. It's important to make sure that you take the medication as recommended by your healthcare professional. Not following directions increases your risk for PAD, as well as heart attack and stroke.
  • Medications that your doctor may prescribe to help improve the distance you can walk include cilostazol and pentoxifylline.
  • In addition, you may be prescribed antiplatelet medications (aspirin and clopidogrel) to help prevent blood clots.

*Information from the American Heart Association

Diagnosing PAD

PAD diagnosis begins with a physical examination.  Your healthcare provider will check for weak pulses in the legs. Your physical examination may include the following an ABI.

Ankle-brachial index (ABI)

Ankle-brachial index is a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.

If an ABI reveals an abnormal ratio between the blood pressure of the ankle and arm, you may need more testing. Your doctor may recommend one of these other tests.

  • Doppler and Ultrasound (Duplex) imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage. View an illustration of Doppler ultrasound imaging. 
  • Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents. View an illustration of CT imaging. 
  • Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays. 
  • Angiography: (generally reserved for use in conjunction with vascular treatment procedures) During an angiogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present. View an illustration of a peripheral angiogram.

As stated earlier, PAD often goes undiagnosed. Untreated PAD can be dangerous because it can lead to painful symptoms, loss of a leg, increased risk of coronary artery disease and carotid atherosclerosis. Because people with PAD have this increased risk for heart attack and stroke, the American Heart Association encourages people at risk to discuss

PAD with their healthcare professional to ensure early diagnosis and treatment.

*Information from the American Heart Association

Treatment for PAD at Lourdes Hospital

The specialists at Lourdes Hospital can detect PAD with a quick, simple, painless test.

These experienced, regional leaders are at the cutting edge of minimally invasive treatments and breakthrough techniques. In fact, they have performed thousands of procedures with such excellent results that other doctors come to them for training.

Is your chronic leg pain a warning sign? Ask Lourdes Hospital experts and be sure.