The ABCs of PAD

Did you know that pain in your leg could be a symptom of a serious vascular condition? David J. Paolini, MD, a vascular surgeon with ProMedica Heart and Vascular Institutes, shares his insight on peripheral arterial disease or PAD.

“This disease is a vascular condition caused by plaque buildup in the arteries located in the extremities of the body, as well as the brain, abdomen and chest,” Dr. Paolini explains.

Like most conditions associated with the cardiovascular system, PAD poses many serious risks. Because the arteries are less capable of transporting blood, the flow of oxygen is restricted to the extremities, warns Dr. Paolini. If left untreated, PAD may cause severe nerve, organ or tissue damage, as well as gangrene or amputation of limbs. Also, according to the American Heart Association, an individual with PAD is four to five times more likely to suffer from a heart attack or stroke.

Recognizing the Sneaky Symptoms and Risk Factors
Affecting about 8 million Americans with up to 20% of those 65 and older, PAD can be a life-threatening condition. Unfortunately, the disease can go undiagnosed when patients don’t connect their symptoms to a vascular problem. That’s why it is important to be aware of your body and understand the warning signs that accompany the disease.

Dr. Paolini lists the most common symptoms of PAD as:

  • Pain in your calf and thigh muscles that fades with rest. This pain, caused by a lack of oxygen flow to your muscles, is called claudication.
  • Pain in the front of the foot, even when at rest.
  • Sores on your toes, feet or legs that won’t heal. These ulcers or gangrene are caused by lack of oxygen to the tissue cells.

Although the symptoms occur most commonly in the legs and feet, Dr. Paolini stresses that this does not necessarily mean the disease is isolated to these areas. “It’s a systematic problem that is usually not just in one location of the body,” he says. And, even more challenging, many people never have symptoms.

So how do you prevent PAD?

First, take care of your overall heart and vascular health by seeing your physician for regular physicals and screens of your blood pressure and cholesterol levels. For more information about knowing the numbers that are important to your heart health, download this handy chart.

And, if you have risk factors for PAD, proactively manage them. These include:

  • Cigarette and tobacco product use
  • Uncontrolled diabetes
  • High blood pressure or cholesterol
  • Family history of PAD

Smoking poses the greatest risk for PAD. It is imperative to immediately quit using tobacco products. In addition, you can lower your risk for PAD by managing your diabetes, high blood pressure and/or high cholesterol levels. That leaves family history as the only risk factor you can’t control.

Treating PAD
To diagnose PAD, your physician will conduct a physical exam to check for abnormalities in the pulses of the leg. An ankle-brachial index (ABI) may also be used to measure the blood pressure in the legs, as well as a duplex ultrasound to get an image of the arteries.

When the diagnosis is PAD, you and your physician will develop a plan for treating the disease. This may include managing your risk factors with changes to your lifestyle, quitting smoking, exercising, and taking medication.

In some cases, treatment may also include a surgical procedure to clean out the buildup or bypass the arteries. Dr. Paolini explains that surgical treatment includes either endovascular (minimally-invasive surgery) or open repair.

“Endovascular options require access to the arterial system with a sheath placed remotely, with subsequent wire negotiation of the plaque,” he says. “Then, balloon angioplasty, atherectomy (plaque removal) and/or stenting can be applied. Alternatively, the open surgical options include endarterectomy (complete plaque removal) or bypass procedures. Finally, a hybrid procedure involving both open and endovascular techniques can be employed.”

“Unfortunately, PAD can’t be cured,” Dr. Paolini says. “But with cooperation from the patient, it can be treated resulting in good outcomes for the patient and their health.”

Talk to your doctor to see if you are at risk for Peripheral Arterial Disease.