PAD is also associated with an increased risk for heart attack and stroke
By: Dr. Kenneth Goldman
Most of us are aware that arteriosclerosis, also known as hardening of the arteries, is a dangerous condition that can result in heart attacks and stroke. What many people don’t know, however, is that the same build up of plaque can also clog the arteries that circulate blood and oxygen to our extremities, abdominal organs and kidneys, causing a condition known as peripheral artery disease (PAD).
This little known, but common and often life threatening, disease can cause everything from difficulty walking in its earliest stages, to painful foot ulcers, infections, gangrene and even amputation, if it goes undiagnosed and untreated.
PAD is also associated with an increased risk for heart attack and stroke. In fact, according to the Society for Vascular Surgery, people with PAD are three times more likely to die from a heart attack or stroke than the general population.
Peripheral artery disease currently affects some 20 percent of people over the age of 70. Experts estimate that as the population ages, it may impact as many as 30 to 40 million Americans in the years to come. While everyone is susceptible to this disease, it is more common in men than in women. In addition, individuals with hypertension, diabetes, high cholesterol and smokers are at a greater risk as well.
PAD usually begins with mild leg or foot discomfort as plaque builds up on the walls of the arteries and circulation begins to diminish. Your leg muscles may feel tired or cramp up when walking or participating in other activities. This is known as claudication.
As PAD progresses, additional symptoms may include pain in the ball of the foot or toes; pain in your foot at night, that improves when you hang your foot off the bed; ulcers or sores on your feet, ankles or toes that won’t heal, and blue or black discoloration of your toes.
Since this condition occurs more often in older adults, the early stage symptoms are often dismissed as a natural part of the aging process and may go unreported during medical checkups. In addition, since the symptoms typically diminish when the individual stops exercising or rests, people with early-stage PAD may begin to reduce their activity and exercise level, which in turn can worsen the condition and further increase the risk of heart attack and other complications associated with atherosclerosis.
The good news is that peripheral artery disease is easily diagnosed, and with effective treatment, the risks of complications can be significantly reduced or eliminated. Be sure to tell your doctor if you have experienced problems walking or have any other painful symptoms in your legs or feet. Circulatory changes can be very subtle and your doctor may prescribe a detailed assessment of the circulation in your legs and feet.
Non-invasive vascular testing can be performed using a Doppler or duplex (a specialized ultrasound machine) device to determine whether arteriosclerosis is restricting your blood circulation.
If diagnosed with PAD, there are lifestyle changes that, if implemented, can help a patient to get a handle on this disease and reduce the risk for associated complications. Start a program of regular exercise, which can enhance overall circulation. Reduce the amount of salt, saturated fat and cholesterol in the diet to gain control over blood pressure and cholesterol levels. If diabetic, learn to manage the disease. Smokers or users of other tobacco products should quit.
In addition to these steps, a doctor may prescribe medications to help further reduce blood pressure or cholesterol levels, as well as medication to reduce the risk of blood clots associated with PAD.
If this disease goes undiagnosed, circulation, particularly to the legs and feet, is increasingly reduced, slowly cutting off the supply of blood and oxygen to the tissues. This can lead to a condition known as critical limb ischemia (CLI). CLI can result in severe infections, gangrene and ultimately the need for amputation.
If diagnosed with advanced peripheral artery disease, and CLI is suspected, a doctor may recommend an angiogram, a catheterization study where contrast is injected in the arteries of the legs, to identify the location and severity of the blockage and determine the best course of treatment.
Many people with CLI are helped through the use of angioplasty, with or without the placement of a stent. This procedure, more often associated with heart blockages, can be successful in opening blocked arteries within the legs and restoring circulation to the feet.
In some cases of CLI, angioplasty may not be sufficient to adequately restore circulation, and bypass surgery may be necessary. During this procedure, a section of vein is grafted from another part of the leg and used to reroute the blood flow around the blockage. In some cases, a prosthetic bypass graft may be used. This surgical procedure is very successful at restoring circulation to the leg and foot, and may reduce the incidence of amputation by as much as 85 percent.
Peripheral artery disease, and its associated complications, can be serious and life- threatening. If you experience leg pain, or any of the symptoms associated with PAD, be sure to tell your doctor and ask about your risk for peripheral artery disease.
To find a Princeton HealthCare System physician or vascular
surgeon near you, call (888) 742-7496 or visit www.princetonhcs.org.