Peripheral Artery Disease (PAD)

Peripheral arterial disease, or PAD as it is often shortened, occurs when the arteries in the legs become narrowed or clogged with fatty deposits, otherwise known as plaque. The build-up of plaque causes the arteries to harden and narrow, a process called atherosclerosis. Atherosclerosis in the leg arteries reduces blood flow to the legs and feet, resulting in poor circulation.

PAD occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries inside the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.

Like other diseases related to the heart, PAD can be improved with lifestyle changes, medications or, if needed, endovascular or surgical procedures at our heart hospital in Dallas.

Lower-extremity PAD affects about 8 million Americans. The presence of hardened arteries in the legs makes it more likely these people will have hardened and narrowed arteries leading to the heart and brain. People who have received a peripheral artery disease diagnosis are at high risk of having a heart attack or a stroke.

When blood flow to the legs is severely reduced, people with PAD may experience pain when walking. PAD also can cause other complications that can lead to amputation.

Walking can greatly improve the quality of life for people with PAD. Research shows that a formal walking program as part of treatment for peripheral artery disease can effectively reduce leg pain or cramps (claudication). Over time, walking may be a more effective treatment than medication or surgery for reducing leg pain.

For people with peripheral arterial disease, a regular walking program will:

• Help you stay active
• Help control blood glucose, blood pressure, cholesterol and body weight
• Lower your chances of having a heart attack or stroke

People with diabetes are at higher risk for PAD. It is estimated that one out of three people with diabetes over age 50 has PAD. African Americans and Hispanics who have diabetes are at even higher risk for PAD.

People with both diseases are much more likely to have a heart attack or stroke than those who just have PAD, and they are more likely to die at a younger age. Because diabetes can decrease feeling or sensation in the feet or legs, many people also may have PAD but not know it or it goes undiagnosed. In addition, when blood flow to your feet and legs is narrowed or blocked due to PAD, cuts or wounds are more difficult to heal, increasing the potential risk for amputation.

Warning signs of PAD:

• Fatigue, tiredness or pain in the legs, thighs or buttocks that always happens with walking but goes away with rest
• Foot or toe pain at rest that often disturbs your sleep
• Skin sores or wounds on your feet or toes that are slow to heal

In addition to being a major cause of heart disease, cancer and lung disease, smoking also is the #1 cause of PAD. Smoking even half a pack of cigarettes per day may increase the risk of PAD by 30 to 50%.

Smoking speeds the build-up of plaque in the artery walls and increases the formation of leg artery blockages. Smoking constricts blood vessels and causes the blood to clot.

As a result, smoking causes PAD to get worse faster. PAD increases the chance of having leg pain or cramping even while at rest, losing a foot or a leg due to amputation, or having a heart attack or stroke. As many as one out of two people with PAD who continue to smoke will have a heart attack or stroke or die within five years.

Reasons to quit smoking

If you have peripheral artery disease, quitting smoking may save your life and lower the risk of heart attack, stroke or death. In addition:

• Your blood pressure will be lower in just a few days.
• If you have diabetes, the risk of foot ulcers, eye problems, nerve damage and kidney disease will be reduced.
• You will lower your risk of cancer of the mouth, throat, lungs and bladder.
• Within one year of quitting, your blood flow and breathing improve and your coughing and shortness of breath will reduce.

High blood pressure not only increases the risk of heart attack, stroke, eye problems and kidney disease, but also the risk of PAD Over time, high blood pressure makes blood vessel walls rougher and thicker. There also is a greater build-up of plaque, which causes arteries to harden and narrow, which in turn makes it harder for blood to flow through the vessels.

Controlling your blood pressure is an important part of controlling or preventing PAD. Have your blood pressure checked at least two to four times a year and take action to keep your blood pressure in control.

Too much cholesterol in your blood causes the walls of blood vessels to become narrowed or clogged with fatty deposits called plaque. Plaque builds up and causes hardening and narrowing of the arteries (atherosclerosis), which slows or blocks blood flow.

PAD occurs when the arteries in the legs are hardened and clogged. When arteries harden in one part of the body, it is likely they have hardened in other parts, such as the heart and brain. Therefore people with PAD are at much higher risk for a heart attack or stroke. Studies show that controlling cholesterol levels can help people with PAD lower their chances of a heart attack or stroke.

People with PAD are at high risk for a heart attack or stroke because of the build-up of plaque in their blood vessels. If a piece of plaque breaks off, red blood cells (platelets) clump together inside the blood vessel to form a clot on top of the plaque. This clot can limit or even block the flow of blood to your heart or brain, causing chest pain, a heart attack or stroke. Medications are available that can help prevent blood clots from forming, reducing the risk of heart attack or stroke.

Most people with PAD do not have any symptoms. People with diabetes over the age of 50 should be tested for PAD. Testing is also recommended for people with diabetes under the age of 50 who have other risk factors, such as smoking, high blood pressure or cholesterol problems.

Like other cardiovascular diseases, treatment for peripheral arterial disease can include lifestyle changes and medications that lower the risk heart attack or stroke.

These lifestyle changes include:

• Quitting smoking
• Taking medications to control blood pressure, cholesterol and blood glucose (if you have diabetes)
• Taking anti-platelet medications such as aspirin
• Getting regular physical activity such as walking for 30 minutes at least three or four times per week
• Following a heart-healthy diet that includes lots of fruits, vegetables and low-fat dairy products moderate in total fat and low in saturated fat and cholesterol
• Seeking a special PAD exercise program if you have pain or cramps in your legs

For most people with PAD, these tips may be enough to control the disease and even improve symptoms. When leg arteries are severely clogged or narrowed, endovascular procedures or bypass surgery may be needed to improve blood flow to the legs and feet.

Because of reduced blood flow, people with PAD are more likely to have foot problems. Minor problems such as cuts, sores or blisters may not heal quickly or heal at all.

Diabetes further increases the risk of people with PAD for foot problems. In addition to poor circulation to their feet and legs, they also may have nerve damage from high blood glucose levels. This nerve damage (or diabetic neuropathy) can cause loss of sensation in the feet. A person may not feel a small rock inside his or her sock that is causing a sore or a blister caused by poorly fitting shoes.

For people with peripheral artery disease and diabetes, minor foot injuries can turn into serious infections. If these sores are not treated right away, they may lead to amputation of a toe, foot or leg. With PAD, you can prevent serious foot problems by taking care of your feet every day.