This is a guest post by Dr. Bhagat Reddy. Dr. Reddy is the Director of Vascular Medicine & Endovascular Interventions at Piedmont Heart Institute in Atlanta, Georgia.

Danger level: High

What is it?

Peripheral Arterial Disease (PAD) occurs when a patient’s blood vessels narrow over time as a result of several different factors pertaining to the build up of atherosclerotic or claudic materials. This can affect many major blood vessels supplying the organs and the limbs.

Who gets it?

Patients who have a history of high blood pressure, diabetes, high cholesterol, and smoking are particularly at risk. Also at risk are patients who have had blockages in other areas of the body or patients with a family history of conditions like heart disease or aneurysms. These are the most important risk factors patients should look for and physicians should screen for.

Of course, PAD is a disease with high correlations to advanced age. It does not matter if you are male or female, as you age you have an increased chance of developing it. The disease also appears to affect patients worldwide, including in Third World countries. In fact, it appears more quickly in patients in non-western regions due to high rates of smoking and diabetes in those countries, specifically India and China.

What causes it?

Over time, and for reasons we are continuing to understand today, PAD is caused by an accumulation and deposition of cholesterol in the lining of blood vessel walls. This can happen in any part of the body, whether the vessel is supplying a major organ like a kidney, the brain, the intestines or stomach, or even the upper and lower limbs. A lot of the risk factors mentioned above don’t just cause the problem but instigate and propagate the issue.

A normal artery and an artery with an accumulation of cholesterol in its lining.

How does it feel?

Symptoms usually depend on where the affected blood vessel is located.

Upper extremity – patients experience pain, fatigue, weakness, numbness, or difficulty using the arm. In some situations the patient may also notice instability in gait or difficulty walking in a straight line.

Lower extremity – If the blood vessel involved affects the lower limbs, the patient usually has pain in the buttocks, calf, or foot, depending upon the location and extent of the blockage. The patient might also experience fatigue, tiredness, weakness, or numbness either during exercise or at rest if the case is severe. Some important signs in patients with critical disease in the lower extremities, apart from severe pain, include non-healing sores, especially in patients with diabetes, and/or discoloration of their toes and foot (which would indicate gangrene).

Kidney – If the blood vessel to the kidney is involved, the disease is mostly silent and symptomless. However, patients may have early or late onset of hypertension and/or difficulty controlling blood pressure despite reasonable treatment with medications. Patients may also have an abnormal kidney function detected on routine blood tests.

Abdomen – If the blockage restricts blood flow to the belly, patients experience significant abdominal pain after eating and significant weight loss over time.

Neck/Brain – If the blockage restricts blood vessels supplying the neck or brain, patients usually exhibit stroke-like symptoms.

How is it discovered?

The best way to detect PAD, apart from asking questions about risk factors, is to examine the patient and feel pulses. Physicians should examine the patient with the stethoscope and listen for abnormal, “squishy” sounds that could indicate blockages in any part of the body. Next, an ABI, or Ankle Brachial Index, can be conducted to measure the blood pressure in the arms and the legs. Blood pressure is supposed to be equal in the arms and legs: if it’s lower in the legs, it means the patient could have reduced blood due to blockages. Clinical studies have shown that an abnormal ABI measurement, meaning lower blood pressure in the legs, is a sign of heart and vascular disease, and therefore also signifies a chance of early death due to these conditions.

How is it treated?

PAD is treated first and foremost by understanding, addressing and correcting risk factors for the disease, because if uncorrected, the disease continues to propagate in different areas of the body. So the treatment of hypertension, diabetes and smoking are important upfront. There are also certain medications designed to help reduce hypertension and cholesterol, such as aspirin and Plavix, that appear to significantly help these patients.

What is key is to not just recognize the problem, but to recognize the intensity and severity of the problem at the time. Based on a physician’s detailed examination, when severity is detected, the physician should focus on which part of the body needs priority in treatment by opening the blockages. Blockages are opened most of the time in a nonsurgical fashion using catheters or devices through a small needle stick.

Fortunately, we are able to provide most of the procedures on an outpatient basis without sedation. Patients do not need anesthesia and have a very quick recovery; plus, the chances of having major complications or infections is very low. The other significant advantage is that these procedures can be performed on a patient multiple times over a lifetime if additional blockages appear throughout the body.

What happens after treatment?

The outcome is fairly good for PAD patients, depending upon the extent and location of blockages. Outcome can also vary on a patient-to-patient basis. Most times, if the disease is treated effectively and the patient addresses and corrects risk factors with the help of a healthcare practitioner, the outcome appears to be very good. However, most patients will need to follow up with their vascular consultant for the rest of their lives, because this is a disease in progress. Even though the most serious problem has been fixed, a patient may develop a problem in another location in the body that could and should be treated before it proves serious. So – early detection and treatment should always be the priority.

The bottom line – How do I avoid it?

Most people, at least in the US, die of cardiovascular causes. It’s important to recognize this, because recognition and treatment of these patients is of significant value: if these patients are not treated, they will die much earlier than most people who do not have vascular disease.

People cannot necessarily avoid PAD, but they can be vigilant in early detection, treatment and managing risk factors. If a patient has already identified his/her risk factors, the next step is to aggressively continue toward improving or resolving the risk. Most importantly, patients need to be on the lookout for any vascular condition to get treated before it causes severe organ damage and/or death.

What next?

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