What is PAD?
PAD is an acronym for peripheral artery disease. It involves atherosclerosis or hardening of the arteries in the peripheral circulation (legs, arms, neck etc). It is the result of cholesterol, lipid and cellular build up in the inner lining of the artery. This build up leads to stenosis or blockage that impedes blood flow. The arteries are conduits that carry blood from the heart to the rest of the body. Blockages in the arteries can limit blood flow or result in embolization.
Who gets PAD?
PAD is more common in individuals who smoke, have hypertension (high blood pressure), diabetes and or hyperlipidemia ( high cholesterol). As one ages the incidence of PAD increase.
How would I know I have PAD?
It is important to know your risk Factors. Risk factors for PAD include age over 50, Hypertension, Diabetes, High cholesterol and smoking. Any one of these or a combination of these risk factors increases your likelihood of having peripheral arterial disease. If you have more than one of these risk factors and have muscular pain with walking the likelihood of having peripheral arterial disease is high.
Why worry about PAD?
Peripheral arterial disease is a marker for systemic atherosclerosis. Atherosclerosis is the number one cause of death stroke and limb loss. Individuals with blockages in their peripheral arteries are more likely to have blockages in their carotid arteries and their coronary vessels. Thus individuals with PAD are at a higher risk for heart attack, stroke, death and limb loss. Individuals who are diagnosed with PAD can be treated to lessen the effects of atherosclerosis.
Individuals with blockages in their leg arteries usually have worse quality of life. They are usually only able to walk short distances before needing to stop secondary to pain in their legs. As a result these people usually become less active. This can lead to worse glucose control in diabetics, increase in bad cholesterol, and overall deconditioning.
If I have PAD what can I do?
If you think you have PAD you can ask your doctor. There are simple noninvasive studies that confirm the presence of PAD. The most common one is an ankle brachial index. In this study a blood pressure is taking at the arm and a blood pressure is taking at the ankle. The ankle pressure is then divided by the arm pressure. Generally the ankle pressure should be the same as the arm pressure. If for instance the arm pressure is 100 and the ankle is 50 the blood flow is 50% less than normal.
All individuals with PAD should be followed medically.
If I have PAD in my legs and I am having a hard time getting about can something be done?
Yes. If patients inability to walk has severely affected their quality of life or their PAD is so severe that they are at risk of losing the leg there are several treatment options available. Many patients can be treated with endovascular repair that involves stents, angioplasty or special devices that clean out the arteries ( ie atherectomy). These procedures are minimally invasive and are done on an outpatient basis. For patients that are not candidates for endovascular repair there are traditional bypass procedures that can be done.
Do all patients with PAD need surgery?
Not all individuals with PAD need to be treated surgically. Some patients with PAD only have mild leg pain with ambulation that does not affect their quality of life. These patients can often be treated with habit modification and exercise program.
However all patients diagnosed with PAD must be treated medically and followed closely clinically.. Smoke cessation, Blood pressure control, lipid therapy and exercise are fundamental in PAD management. Again individuals with PAD are at a higher risk for stroke and cardiac events.
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