Did you know that approximately one in five Americans over the age of 60 has peripheral arterial disease (PAD) – a condition caused by narrowing of the peripheral arteries that supply blood that is rich in oxygen and other essential nutrients to the legs, stomach, arms, and head?
PAD most commonly affects the arteries in the legs, which may result in cramping, pain, numbness, or fatigue in the leg or hip muscles when walking or climbing stairs. Pain in the toes and feet at night when lying down may also occur. A more severe symptom, especially in patients with diabetes, is a non-healing ulcer, which can be a sign of critically-insufficient blood supply to the limb and requires prompt evaluation and treatment. This lack of blood supply can result in loss of digits or limbs.
PAD Risk Factors and Diagnosis
Risk factors for PAD include age, diabetes, kidney disease, elevated cholesterol and other lipid disorders, high blood pressure (hypertension), and smoking. Men tend to develop PAD sooner than women, but the condition affects both men and women.
There are several ways that PAD can be diagnosed. Medical history and physical examination of the legs, including feeling the pulses and measuring the blood pressure in the legs and near the feet, serve as first steps in an evaluation. Imaging, including ultrasound, computed tomography (CT) and magnetic resonance angiography, can also be very useful.
Preventing and Treating PAD
People with PAD and other complex conditions benefit from a multidisciplinary team approach to their care, which may include vascular medicine specialists, cardiologists, endocrinologists, vascular surgeons, and cardiac surgeons who can address the underlying causes of PAD.
“One of the most important interventions for PAD is lifestyle modifications to prevent the acceleration of atherosclerosis – the process which causes the build-up of plaque in the arteries that limits blood flow,” explains Dr. C. Keith Ozaki, a vascular surgeon in the Heart & Vascular Center at Brigham and Women’s Hospital. “Healthy diet, moderate exercise, and smoking cessation are all examples of modifications that can help prevent worsening of the condition.”
Supervised exercise programs can help alleviate symptoms and improve blood flow to the legs. Medications are also available to control blood pressure, lower cholesterol, and help manage blood sugar and other risk factors that contribute to the development of PAD. Catheter-based treatments include balloon angioplasty and stenting to open the blood vessel, as well as bypass procedures using grafts to redirect blood flow.
“It is important for patients with PAD to partner with a care team that specializes in evaluation and management of this condition to achieve the best results,” says Dr. Ozaki.