What is PAD? Am I at Risk? What do I do next?

  • Dr. Beheshtian
  • April 5, 2020
Peripheral Arterial Disease

What is Peripheral Arterial Disease (PAD)?

Peripheral arterial disease, more commonly referred to as PAD, “is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.” An individual with this condition typically experiences blockages of blood vessels outside of the heart and brain, primarily in the lower extremities — specifically the legs.  As a result of this lack of blood flow, a patient may begin to experience a variety of symptoms.

What symptoms are associated with PAD?

Several symptoms are associated with PAD, but the most common is claudication, or “leg pain when walking.” A patient expressing signs of claudication may endure “muscle pain or cramping in their legs or arms that’s triggered by activity, such as walking, but that disappears after a few minutes of rest.” Although the severity of pain can vary from person to person, severe leg pain can make a difficult task out something as simple as walking. In addition, those with PAD may also experience “painful cramping in one or both hips, thighs or calf muscles after certain activities such as walking or climbing stairs.”

Moreover, PAD patients may show the following symptoms:

It is also imperative to note that an individual can have PAD and not present any outward symptoms for several years. “Only 10% of patients with PAD have classic claudication; others have atypical leg pain (50%) or show now symptoms (40%),” making regular screening vital. Many PAD patients may not even experience symptoms until it’s too late to salvage the affected limb.

Risk factors for PAD can be screened with a simple non-invasive test — called an ankle-brachial index (ABI) — that takes just 10 minutes to perform. The ABI compares blood pressure in your ankle to blood pressure in your arm,” and “shows how well blood is flowing in your limbs.”

What happens if PAD is left untreated?

Left untreated PAD can result in leg pain, lower extremity infections, gangrene, amputation, and death. With a vast number of PAD cases being asymptomatic, many PAD patients are often left untreated. In addition, PAD raises an individual’s “risk of chest pain, heart attack, stroke, and even death.” 

How do I know if I’m at risk?

An individual may be at risk of developing PAD if they are over 50 years of age, smoke, overweight or obese, or if they have diabetes mellitus, hypertension, hyperlipidemia, heart disease, bad cholesterol, renal insufficiency. A family history of “peripheral artery disease, heart disease, or stroke” also has the potential of putting a patient at risk for PAD. It is important to note that “smoking and diabetes are associated with the highest relative risk for developing lower-extremity PAD.”

How is PAD diagnosed?

At-risk patients are screened with a non-invasive test called an ABI (Ankle Brachial Index) that measures blood pressure at all 4 extremities and compares them together using a widely tested algorithm. “A normal ABI result is 1.0 or greater (with a range of 0.90 to 1.30)” and an ABI “takes about 10 to 15 minutes to measure both arms and both ankles” and can be performed annually for regular monitoring of PAD symptoms. Those with positive ABI test results will then undergo an ultrasound or CT scan to confirm the presence and nature of the disease. 

What is the treatment for PAD?

Mild cases of PAD can be treated or managed through a combination of the following:

If a patient’s case of PAD is severe enough, blockages can generally be treated through a minimally invasive procedure that includes requires a small balloon to disrupt plaque and alleviate or eliminate issues at the point of disease.

In extreme cases in which PAD is not addressed or treated in a timely fashion, bypass surgery may be required. Unfortunately, if left untreated and undiagnosed, some PAD patients may have no choice but to proceed with amputation.

What to do next?

If you have any of the risk factors mentioned, it is advised that you make an appointment for a screening.  The investment of a few minutes of your time could be both lifesaving and improve your quality of life.