Peripheral Artery Disease (PAD): What Are the Symptoms and Treatment Options?

As the number of seniors in America continues to rise, so has the frequency of vascular, or blood vessel, issues. According to the Cardiovascular Coalition, peripheral artery disease (PAD) affects nearly 33 million U.S. citizens. Roughly 200,000 of these patients are estimated to undergo avoidable limb amputations every year.

Peripheral artery disease is a circulatory condition that occurs when narrowed arteries decrease the amount of blood flow to your limbs. When your arteries narrow, your limbs may not get enough blood to perform the activities you are used to. Decreased circulation can lead to common symptoms such as pain during walking, pain at rest and lower extremity wounds. Muscle pain or cramping can be prevalent, with pain often experienced in the calves of the legs.

Without treatment, peripheral artery disease can result in heart attack, stroke, amputation, and early death if left untreated. It’s important to see a doctor, particularly a vascular surgeon if you’re experiencing PAD symptoms.

Vascular surgeons are doctors who specialize in arteries and veins. Each person will have symptoms that are unique to them, so everyone who sees a vascular surgeon for PAD will receive an individualized approach and treatment plan. Treatment options may include medical therapy or a surgical procedure. Vascular surgeons will determine each patient's best opportunity to give them the most significant benefit with the least amount of risk. Our goal is to improve your circulation to keep you active.

Risk Factors for PAD

One of the most important risk factors for PAD is smoking. According to the American College of Cardiology, approximately 80% of patients with PAD are former or current smokers. A few other risk factors include:

1. Using tobacco products
2. Diabetes
3. Age – those over the age of 50 are at an increased risk
4. Family history
5. High blood pressure (hypertension)
6. High cholesterol (hyperlipidemia)
7. Obesity
8. Blood clotting disorder
9. Having kidney disease

PAD affects both men and women. If you have one or more of these risk factors, you are at an increased risk of developing peripheral artery disease.

Though PAD is not related to coronary artery disease, patients that suffer from PAD also have coronary artery disease. According to the American College of Cardiology a person with PAD as a six or seven times higher risk of coronary artery disease, stroke, heart attack or transient ischemic attack (TIA).

Symptoms of PAD

The most common symptoms of Peripheral Artery Disease is pain or cramp that comes on with physical activity and subsides when the activity is stopped. Other signs and symptoms of PAD are:

• Painful cramping in one or both of your hips, thighs or calf muscles after walking, running or climbing stairs.
• Numbness or loss of sensation in foot.
• Coldness in your lower leg or foot, especially when compared with the other side.
• No pulse or weak pulse in the feet or legs.
• Sores (ulcer) in the legs or feet that heal slowly or fail to heal.
• The skin on your legs is smooth and shiny.
• A change in the color of your legs.

Medical Management of PAD

There are many ways to treat peripheral artery disease with non-surgical methods. Medical management options include:

1. Adopt a heart-healthy lifestyle
2. Eat a balanced diet
3. If you are a smoker, quitting smoking
4. Taking certain medications
5. Doing supervised exercise therapy
6. Performing good foot and skincare.

Some medications used to treat pain during walking have contributed to patient’s doubling their walking distance. These medications work by providing more blood flow to your legs and feet. They also lower your cholesterol and decrease your chance of a heart attack, stroke or blood clot. Supervised exercise therapy has led to longer pain-free walking distances when compared to specific procedures.

Surgery Options for PAD

When medical management does not improve symptoms or if the patient's symptoms are severe, surgery is often recommended. If surgery is best for the patient, minimally invasive procedures are an option and can get people back on their feet and at home on the same day as the procedure. Minimally invasive surgical options include:

• Balloon angioplasty using balloons to open the area of narrowing. This allows more blood flow to reach your legs and feet.
• Stent placement allows for permanent scaffolding of the artery so it can remain open longer.
• A CO2 (carbon dioxide) angiogram. For patients with kidney problems, CO2 may be recommended to reduce injury to the kidney during angiograms. The patient can obtain an improvement in their pain without damage to their kidney function.
• Atherectomy, which removes plaque buildup (atherosclerosis) from the blood vessels.

Occasionally, PAD is severe enough to need open surgery. These surgeries include:

1. Endarterectomy removes the plaque from the artery and bypass surgery gives the blood a different path around the blocked artery, improving your blood flow and pain.
2. Hybrid surgeries can also be performed by vascular surgeons where both open and endovascular procedures are performed simultaneously ensuring that you received the best possible treatment and outcome.

Peripheral artery disease can be serious, but it can be treated. Reach out to your doctor in order to understand which treatment option is best for you. Don't let PAD change your way of life!

Our goal is to increase the general public’s awareness of peripheral artery disease in order to improve access to screenings and early treatments and prevent otherwise avoidable amputations. Please help us spread the word by sharing this article with your friends and family via email or through social media, and let’s get the word out about PAD.