Peripheral arterial disease, commonly referred to as P.A.D., is a clogging of the arteries with fatty deposits. These fatty deposits, or plaques, can build up over time, slowly narrowing the arteries in the body. When the arteries become hardened and narrowed, it may also be referred to as atherosclerosis. P.A.D. is most common in the lower extremities, but can also occur in the upper extremities and in vessels supplying major organs like the kidneys or stomach. When the vessels of the legs are affected, it can lead to significant changes, which some people may attribute to “poor circulation”.
Peripheral arterial disease can often indicate a problem in not just the vessels of the legs, but in all the vessels in the entire body. For this reason, people with P.A.D. are at an increased risk for heart disease and stroke. When atherosclerosis occurs in the vessels supplying blood to the heart, it is called coronary artery disease (C.A.D.)
About 8 million Americans are affected by P.A.D., and the numbers are on the rise. This is partly due to a greater effort to screen for peripheral arterial disease, but may also be attributed to a greater incidence of the disease and an increase in risk factors across the American population. Risk factors for P.A.D. include diabetes, smoking, high blood pressure, high cholesterol, and a history of heart disease or stroke. African Americans are also at an increased risk for developing P.A.D.
Peripheral arterial disease is a slowly-developing process in the body, and as such, the signs and symptoms of the disease can be slow to develop too. In fact, they can often go unrecognized. Most commonly, the symptoms will include pain and cramping in the legs, thighs, buttocks, or feet that occurs while walking and is relieved with rest. This is referred to as claudication, and is a reproducible pain. This means that the pain will appear with a consistent amount of activity, such as walking two blocks before the pain begins. This pain is attributed to a lack of oxygen to the muscles, most commonly in the leg, due to the narrowing of the arteries supplying the muscles. Other symptoms may include pain at night in the toes or feet that disturbs sleep, or slow healing wounds in the legs and feet.
In the podiatrist’s office, screening for P.A.D. becomes routine, particularly when patients are at an elevated risk for developing the disease. Screening involves checking for pulses in the feet, and monitoring the time it takes for the skin to return to a normal color after the blood is pressed from it (capillary fill time). The pulses in the feet can also be listened to with a hand-held Doppler device. This allows your podiatrist to listen to the blood flow into your feet, and have an idea of the condition of your vessels.
Common tests for diagnosing peripheral vascular disease include the use of segmental pressure measurements, ankle-brachial indices, measurement of toe pressures, and measurement of transcutaneous oxygen pressures. These tests can give a comprehensive analysis of the blood flow to the feet. If it is necessary, an arteriogram can also be performed. This test involves injecting a dye into the arteries, then taking x-rays to visualize the vessels. This is generally only done for surgical planning, when it is determined that there is a total or nearly complete occlusion of a vessel, and it must be visualized pre-operatively.
Treatment for P.A.D may involve surgery by a vascular surgeon to stent the vessels, or to create a bypass in the arteries. There are also medical treatments that can be used to bust up the clots in the arteries. The P.A.D. Coalition, a non-profit organization that promotes screening and education about peripheral vascular disease, recommends the following lifestyle changes that can help prevent or treat mild to moderate peripheral vascular disease:
- Quitting smoking
- Lowering blood pressure to 140/90 mmHg, or 130/80 mmHg for people with diabetes or chronic kidney disease
- Lowering LDL (“bad) cholesterol to less than 100 mg/dL. For people at an increased risk of heart disease or stroke, the target number may be less than 70 mg/dL.
- Lowering HgbA1c (glycosylated hemoglobin) to less than 7% for diabetic patients
- Using anti-platelet medications such as aspiring or clopidogrel under the supervision of a doctor
- Eating healthy
- Regular exercise, such as walking at least 30 minutes per day, 3-4 days per week.
Peripheral arterial disease has become a serious problem, and can lead to poor wound healing, gangrene, infection, and amputation. For this reason, it is commonly screened for in the podiatrist’s office. If you have any questions, or feel that you or someone you know may be affected by P.A.D., talk to your doctor today. Catching it early can make a huge difference in the outcome of the disease.
