Peripheral Arterial Disease Q&A

Do you have leg pain with walking? There are many causes for leg pain, but difficulty with walking due to pain in the thigh or calf area is suggestive of Peripheral Arterial Disease (PAD).

What is PAD?

PAD is a form of artery blockage, or narrowing referred to as atherosclerosis. Blocked arteries cannot supply sufficient blood flow to the muscles of the legs and with walking, symptoms develop that force patients to stop or sit down.

Why does atherosclerosis develop?

A natural part of aging; as we grow older all of us will develop some narrowing in the blood vessels throughout the body. In this circumstance, the blockage is usually not severe and problems rarely occur. Add to aging the risk factors of high blood pressure, tobacco use, diabetes mellitus, and high blood cholesterol levels, and the likelihood of having a symptom goes up dramatically.

What are some examples of PAD?

PAD refers to blood vessel blockage in all the blood vessels outside of the heart. Poor blood flow to the brain can lead to a stroke, to the kidneys, renal failure, and to the legs, difficulty walking.

How do I know if I have poor blood flow to my legs?

The symptoms are located in a muscle group, not a joint like the knee or the hip. With walking, patients will report pain, fatigue, cramping, tingling or other unusual sensations. The amount of walking needed to produce these symptoms varies, with some reporting symptoms only at long distances while others complain after walking to the mailbox. Typically, the symptoms will go away within minutes after stopping walking and sitting down only to recur when walking is resumed.

How common is PAD?

Well, if 65 or older and risk factors (high blood pressure, tobacco use, etc.) exist, the likelihood of developing PAD could be as high as 25-30%. This translates into about 12 million people in the US today. For every person who has symptoms from PAD there are three others who are unaware of their disease. Stately differently, most patients are not even aware these artery blockages exist.

Is PAD a marker of a more serious problem?

The short answer is yes. As atherosclerosis affects the entire body, the heart likewise is involved. With time, patients have the potential to become less active which can result in loss of muscle mass and balance which can contribute further to limited activity. Weight gain is common placing more stress on joints leading to arthritis. What may follow is poorer control of blood pressure, blood sugars, and cholesterol. This loss of independence has a psychological effect that can lead to depression or anxiety. Patients can be so limited they cannot complete their daily chores necessary for work or even independently care for themselves. Ultimately, patients have trouble maintaining a healthy lifestyle important for a healthy heart and the risk of heart problems increases.

If I have artery blockages but don’t have symptoms, does it matter?

Yes. As the artery blockages are a marker of blood vessel disease elsewhere in the body, avoidance of treatment allows the cycle of poor cardiovascular health to continue. With education and treatment we can change the outcome.

How is PAD diagnosed?

The patient can be one of the first to recognize PAD. With increased age, some of the risk factors (high blood pressure, diabetes mellitus, etc.) and symptoms with walking, patients should be alerted to the possibility of PAD. Follow this up with an evaluation by a vascular specialist and the question can be answered usually in a single visit. In most cases, a vascular ultrasound is performed during that visit to identify the severity and location of the blockage.

OK, now what do I do to treat the problem?

First and foremost, risk factor modification is started. This means stopping smoking, control of blood pressure, sugars, and cholesterol. Usually this is managed by your primary care physician. Vascular specialists step in to pinpoint the severity and location of the disease and educate you on what the outcome may be. First line treatment usually consists of the use of certain medications that can improve the blood flow to the legs and initiating and monitoring an exercise program. With these measures many patients can maintain good cardiovascular health and an active lifestyle.

How good is exercise for PAD?

Exercise is safe, cheap, and very effective. In the Journal of the American Medical Association, 1995 patients complying with an exercise program increased their pain-free walking distance 180% compared to those not involved in a structured program. Add to this the potential benefit of medication and the possibilities for improvement are great.

Why do I need a vascular specialist?

The field of vascular medicine and surgery has advanced dramatically over the past decade with an explosion of technological advances and new information. Couple this with our aging population; a “general” approach to vascular diseases is not enough. At the Endovascular Surgery Center, vascular specialists are surgeons fellowship trained in the diagnosis and treatment of vascular diseases. We have at our disposal all the tools – medical management, structured exercise program, endovascular techniques such and angioplasty and stent placement, and when necessary, traditional bypass operations.

What does the future hold?

Treatments will focus more on prevention and risk factor modification and less on traditional bypass operations. Even today vascular specialists are offering more to our patients with less surgery to keep them healthy and active.