An introduction to understanding PAD and its treatment
Cardiovascular disease refers to conditions that affect the heart and blood vessels.
Peripheral artery disease or PAD is narrowing or blockage of the arteries that carry blood from the heart to other parts of the body. It is a type of cardiovascular disease. PAD usually restricts blood flow to the legs and feet. It is also referred to as peripheral vascular disease (PVD).
What causes PAD? The inner lining of the arteries is normally smooth enough for blood to flow through freely.
With PAD, a substance called plaque forms over time, coating the lining of the arteries and preventing oxygen-carrying blood from flowing.
Why do some people develop PAD? The risk factors for developing PAD include:
- Smoking
- Diabetes
- Age 50 or older
- Excess weight
- Family history of blood vessel or heart disease
You may also be at risk if you have high blood pressure, high cholesterol, kidney disease or a clotting disorder. Men are at higher risk than women, as are those who have suffered a stroke.
What are the symptoms of PAD?
Fortunately, PAD is not difficult to diagnose. Numbness, leg pain or discomfort are common symptoms. The pain my affect your upper legs and buttocks. Later, you may notice, pain with activity that goes away with rest and comes back. Your muscles may start to feel weak and tired, or numb. However, PAD may have no symptoms at all.
Advanced symptoms of PAD are often described as:
- Aching or burning pain in the feet when you’re resting.
- The skin may redden or darken.
- The skin on your feet may feel cool.
- There may be infections of the skin and soft tissue, or sores on the feet that don’t heal.
How is PAD diagnosed? Your physician will perform an ankle brachial index (ABI) exam using ultrasound images to calculate blood pressure in the feet and arms. The two measures are compared, and if they differ, that could be a sign of PAD. Other tests may be ordered to identify the blockage.
The stages of PAD
You may have heard your physician refer to the Rutherford Chronic Limb Ischemia Classification system. This system categorizes the risk for patients for medical and surgical care.
Please discuss with your doctor the risk factors associated with PAD.
Rutherford Classifications
| Grade | Category | Clinical description |
|---|---|---|
| 0 | 0 | Asymptomatic |
| I | 1 | Mild or intermittent claudication* |
| I | 2 | Moderate claudication |
| I | 3 | Severe claudication |
| II | 4 | Rest pain |
| III | 5 | Nonhealing ulcer of the toes |
| III | 6 | Severe ischemic ulcers or frank gangrene |
*Claudication is pain in the thigh, calf, or buttocks that happens when you walk. https://www.hopkinsmedicine.org/health/conditions-and-diseases/claudication
How is PAD treated?
Early treatment includes regular exercise, quitting smoking, controlling diabetes, and maintaining healthy blood-pressure and cholesterol levels.
Patients with critical limb ischemia—an advanced form PAD where blood flow to the legs and feet is blocked—require prompt treatment. Beyond medications, your physician may recommend minimally invasive endovascular treatments. These are called revascularization therapies, and include stents, balloons or bypass surgery.
Endovascular treatments are done by doctors who specialize in interventional cardiology, interventional radiology or vascular surgery. These physicians have received advanced training in diagnosing and treating patients using the least invasive techniques available to improve health outcomes with minimal risk to the patient.
DEFINITIONS
Critical Limb Ischemia (CLI) is a serious form of PAD in which the arteries are so obstructed that blood flow to the extremities (hands, legs, and feet) is greatly reduced. The result can be painful, even when you’re resting. It can also cause skin ulcers or sores.
Coronary artery disease occurs when the blood flow to the heart’s muscle is limited by plaque, a fatty material that can build up in the walls of the coronary arteries. The plaque deposits, also known as calcifications, can harden the arteries or even block the flow of oxygen-rich blood.
The severely decreased flow of blood and oxygen to the heart muscle is called cardiac ischemia. If it becomes chronic, it may narrow the coronary artery and restrict the blood supply to part of the muscle. Acute ischemia can be the result of sudden rupture in the plaque which creates a blood clot.
Both PAD and coronary disease are caused by atherosclerosis. This is a buildup of fatty plaque in the arteries that narrows and blocks them. It can occur in the heart, arms, legs, brain, pelvis, and kidneys.