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Peripheral artery disease (PAD) affects about 10 million Americans, although many of those people may not be aware they have this common circulation problem. That’s because peripheral artery symptoms include pain and weakness in the leg, as well as sores on the legs and feet that don’t heal. The symptoms are often subtle at first, and easy to ignore, especially if you are dealing with other, more intrusive health challenges.
“Generally, PAD is under-diagnosed because people think their symptoms are part of the normal process of getting older,” says Ghulam Awan, MD, director of interventional cardiology and endovascular interventions at the University of South Alabama College of Medicine. “If proper medical history is taken, the disease can be easily diagnosed.”
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Peripheral artery disease is a narrowing of the arteries in the limbs, abdomen, neck or head, though blood vessels in one or both legs are most commonly affected. PAD occurs as a result of atherosclerosis, which is the formation of fatty plaques on the inner walls of your arteries. The plaques are made up of cholesterol, fatty substances, waste products, calcium and fibrin—a material that helps blood clot.
High LDL (“bad”) cholesterol levels are associated with atherosclerosis, but it’s not always clear why some people are afflicted with narrowed arteries and others aren’t, even if their LDL levels are similar. There is some evidence that atherosclerosis may be an inherited trait. Also, high blood pressure and high blood sugar levels may also harm artery walls, making them more susceptible to plaque formation. Smoking can also damage your blood vessels.
Diagnosing Peripheral Artery Disease
PAD is usually diagnosed after you notice symptoms. One of the most common symptoms is called intermittent claudication. It’s a pain in the leg that develops when you walk or climb stairs. If the pain goes away when you rest, you should see a doctor about screening for peripheral artery disease.
“Often, the first sign is calf cramping that requires rest to relieve after walking a certain distance,” says Kelley Gillroy, DPM, a podiatrist at the Midwestern University Multispecialty Clinic in Glendale, Arizona. “There can also be pain or cramps in the thigh, hip, or buttock area with exercise.”
Your doctor should get a complete medical history and a review of your symptoms. Be ready to discuss your symptoms in detail. If you have intermittent claudication, know how long you walk before symptoms begin and how long it takes for the pain and cramping to end when you rest.
Diagnosing PAD also involves a physical examination. Your doctor will look at your leg to check for slow-healing wounds or discoloration that suggest poor circulation. Slow-growing toenails may also indicate PAD. Your doctor or other healthcare provider will also check your pulse and listen to the leg (or other areas suspected of having PAD) with a stethoscope. A whooshing sound, or bruit, may suggest peripheral artery disease.
One of the may screening tests used to diagnose PAD is called an ankle-brachial index (ABI). During this test, your arm and ankle will each be fitted with a blood pressure cuff. The blood pressure in both limbs will be taken and compared. This can help identify if a limb is experiencing an unhealthy change in blood pressure, though it can’t identify the specific artery that is affected. An ABI may be done before and after a treadmill workout to see how exercise affects blood flow in your limbs.
A Doppler ultrasound is another painless, non-invasive test to check for abnormal blood flow. Blood tests that include a cholesterol check may also be ordered to see if you have certain PAD risk factors.
Even if you don’t have traditional PAD symptoms, you should probably seek an evaluation anyway, if you are over age 70 or are over age 50 and have a history of smoking and/or diabetes. You may be advised to seek a PAD screening if you’re under 50 and have risk factors for atherosclerosis, including smoking, diabetes, high blood pressure and high LDL cholesterol.
Getting an accurate PAD diagnosis is important because people who have peripheral artery disease are also at greater risk of developing coronary artery disease (heart disease), heart attack, and stroke.
If PAD Is Diagnosed
A diagnosis of peripheral artery disease may require an intervention if your symptoms are severe.
Treatment options include:
- Angioplasty and stenting: A tiny balloon at the end of a catheter is guided to the area of blockage in the artery. The balloon is expanded, pushing plaque against the walls and opening up the artery for better blood flow. In some cases, a flexible tube called a stent is left in the artery to help keep it open for continued healthy blood flow. “If a patient needs peripheral artery disease intervention, we usually treat those arteries with balloon angioplasty and stents,” Dr. Awan says. “Once we perform intervention, most patients normally feel a 100 percent improvement in their quality of life, ability to walk distances, and relief of symptoms.”
- Bypass grafting: If the blockage can’t be properly treated with a stent, you may need surgery to treat your PAD. With bypass grafting, a blood vessel is taken from somewhere else in the body and grafted (sewn) onto the affected artery. Blood flow is routed through the graft and around the blockage, where it returns to the artery on the other side of the narrowed section.
- Atherectomy: Another surgical procedure is called an atherectomy. It involves opening up a blocked artery and removing the plaque.
Increasingly, cardiologists are recommending structured walking programs to help people deal with their PAD symptoms. While walking may hurt, by walking every day and trying to extend the time you spend on your feet, you may be able to better manage your symptoms. You may be able to delay when symptoms begin, allowing your more pain-free time walking, playing golf, shopping and any other activities that require you to be up and moving about.
Individuals with peripheral artery disease should also make lifestyle changes that include a heart-healthy diet, no smoking, more exercise, and the use of medications (if necessary) to manage blood pressure, cholesterol, and blood sugar levels.
Your doctor should be able to guide you to experts who can help you make these important transitions.
Peripheral artery disease is fairly easy to diagnose and is often treatable to the point where your symptoms can improve dramatically. But it all starts with managing your risk factors and seeking out a diagnosis as soon as you notice signs of PAD. “If you have leg pain, numbness, or other symptoms, don’t dismiss them as a normal part of aging,” says Dr. Awan. “Call your doctor and make an appointment.”