Peripheral artery disease (PAD) affects millions of people in the United States. It is a circulatory problem caused by hardening of the arteries (called atherosclerosis). With PAD, plaque (comprised of fat, cholesterol, calcium and other substances in the blood) builds up and narrows the arteries, reducing blood flow to the limbs or internal organs. Sometimes the plaque breaks off and travels with the blood, which can cause mini-strokes or strokes. People with PAD are also at an increased risk for heart attacks. The good news is that PAD is easy to diagnose and treatment is available.
The risk of PAD increases with age and is more common in smokers, diabetics and people with high blood pressure and high cholesterol levels. African Americans and people with kidney disease are also at increased risk.
A common symptom is pain or cramping (charlie horse), numbness, aching or a "heavy" feeling in the legs when exercising or going up and down the stairs. Many mistake this symptom as a sign of aging or arthritis. Additional symptoms of PAD include:
- Weakness in the leg
- Cold feeling in lower leg or foot
- Sores on your toes, feet or legs that won't heal
- Color change/shiny skin on legs
- Slower growth of toenails
- Slower growth of hair on legs and feet
- No pulse or a weak pulse in your legs or feet
- Erectile dysfunction in men
Report any of these symptoms to your doctor. Generally, sedentary people or people over age 70 should be tested for PAD especially if they experience pain in their feet at night or have a sore that won't heal.
PAD should be diagnosed and treated not only to eliminate associated pain, which can interfere with getting appropriate exercise, but also because it is a major marker for cardiovascular disease. Without medical management, the condition can lead to heart attack, stroke, tissue death and even amputation.
The ankle-brachial index is a simple test that compares the blood pressure at your ankle to the one in your arm and is used to diagnose and monitor PAD. For diabetics, the Doppler ultrasound, along with great toe pressure, is a more reliable test. Other tests include treadmill test, magnetic resonance angiogram, arteriogram and blood tests.
If you smoke, the number one thing you can do to prevent PAD is quit now. You can also lower your risk for PAD and improve your cardiovascular health by maintaining a healthy lifestyle, eating a balanced diet, exercising regularly and keeping your weight under control. Taking steps to manage your cholesterol, diabetes and high blood pressure with the help of your primary care provider are also very important.
PAD can often be treated with a comprehensive approach that involves lifestyle modifications, medical management and when appropriate, procedures to increase blood flow. Many times minimally invasive endovascular techniques are used before bypass surgery to improve circulation.
Dr. Sai Sajja, of Susquehanna Health Vascular Surgery, is a specialist in endovascular and vascular surgery. He is board certified in vascular surgery. A graduate of Guntur Medical College, Dr. Sajja completed his residency at Bronx-Lebanon Hospital Center and a fellowship at Hershey Medical Center.