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Peripheral Arterial Disease (PAD)

Peripheral arterial disease, also known as PAD, is a chronic disease of the arteries of the legs which is caused by atherosclerosis (the same hardening of the arteries that can lead to heart attacks and strokes).

What are common symptoms of PAD?

Claudication, or pain or in the calf muscles brought on by walking and relieved by rest, may indicate that you have PAD. In some instances, the pain may involve the buttocks, hips, thighs or lower back muscles in addition to the calves. While PAD is more common in the legs, atherosclerosis can occur in any part of the body, thus PAD can also occur in the arms. When this occurs, you may have unequal blood pressure measurements in each arm, so be sure to ask the nurse or medical assistant checking your blood pressure to check both arms. [A small variation in blood pressures is normal, however.]

However, less than one-half of elderly people with PAD have symptoms. This may be in part related to the fact that as we grow older we are less likely to walk fast or exercise often. Therefore, the classic finding of pain in the calves with exercise may be masked simply due to lack of sufficient physical activity to bring on the symptoms.

Other signs of PAD include reduced or absent pulses in the feet, muscle atrophy (shrinkage of leg muscles), loss of leg hair, cool legs and feet, foot ulcers or gangrene, and pale or bluish skin.

Who gets PAD?

Like most diseases, the prevalence of PAD increases with age. One recent scientific study examined over 1,000 men and women who averaged 80 years of age. It revealed that PAD was present in 32% of men and 26% of women studied.

How can I decrease my risk of developing PAD?

The following risk factors predispose you to PAD:
Cigarette smoking
Diabetes mellitus
High cholesterol
Elevated plasma homocysteine (a naturally occurring amino acid, or building block of protein)

How is PAD diagnosed?

A common test used to diagnose PAD is called the ABI (ankle-brachial index). This noninvasive test is simply an ultrasound study which compares the blood flow in the ankles to the blood flow in the brachial arteries of the arms. A normal ABI is 0.9 to 1.2. The lower the value the more severe the blockage of blood flow. For instance, an ABI of 0.4 is much more severe than an ABI of 0.8.

How is PAD treated?

Lifestyle changes are important to reduce your risk. If you smoke and are unable to stop on your own, ask your doctor for assistance. If you have high blood pressure, diabetes, or high cholesterol, work with your doctor to keep these conditions controlled. Stick to the prescribed regimen laid out for you and if you have side effects of any of the medications, tell your doctor so you can be changed to another drug that is more tolerable.

There are also medications which can be used to treat PAD, such as aspirin, ramipril, or a cilostazol, or clopidogrel. Exercise rehabilitation is also useful in PAD. When PAD is very severe, more invasive approaches to treatment, including surgery, must be considered.

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Content copyright © 2013 by A. Maria Hester, M.D.. All rights reserved.
This content was written by A. Maria Hester, M.D.. If you wish to use this content in any manner, you need written permission. Contact Patricia Villani, MPA, PhD for details.

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