Peripheral Artery Disease (PAD)

It is a somewhat shocking statistic that more people have Peripheral Artery Disease (PAD) than all types of cancer combined; yet 75 percent of adults in the U.S. don’t know what it is. PAD is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs (usually the legs). Essentially, the legs don't receive enough blood flow to keep up with demand. The earliest sign of PAD is a type of leg pain called claudication. The pain arises only after walking a certain distance, and dissipates after a few minutes of resting or standing still. Typically, the pain is described as a deep muscular ache or weakness that involves the muscle of the back of the calf and less commonly, the thigh. It comes on more readily when walking rapidly or uphill. Most people with claudication don’t experience the same pain with other forms of exercise, such as climbing stairs, riding a bike, or swimming.

PAD is fairly common. In random screening, 10-20 percent of people over the age of 65 have PAD. An estimated 12 million people in the U.S. have PAD—that’s more than the number of people with cancer or Alzheimer’s disease. Yet this disease is under diagnosed—almost 30 percent of people with PAD are unaware they have it.

PAD can be treated by either a Vascular Surgeon or an Interventional Cardiologist.

Screening for PAD

PAD is a manifestation of atherosclerosis, so being diagnosed with PAD increases the likelihood of your having heart disease or carotid stenosis. Frequently, your doctor will recommend screening for these other problems if you are found to have PAD. Treating PAD begins with controlling risk factors for atherosclerosis.

Screening for PAD involves checking pulses in the legs and performing a simple blood pressure measurement called an ankle-brachial index (ABI). The ABI is a ratio of the blood pressure in the leg to the blood pressure in the arm. It is normal when the pressures are equal. If the blood pressure in the leg is lower than in the arm, the ABI is abnormal. If the screening is abnormal, an ultrasound can be used to locate the narrowing in the artery. Sometimes a walking program or medication is all that is needed to improve symptoms. Other times, bypass surgery or angioplasty is advised. Our award-winning vascular team excels at both.

PAD and Atherosclerosis

PAD is a symptom of atherosclerosis, often called “hardening of the arteries.” In this condition, excess cholesterol is deposited on the inside walls of the arteries, causing them to get progressively harder and more narrow. This condition can eventually reduce blood flow to the heart and brain as well as the legs. Being diagnosed with PAD increases the likelihood that a person also has heart disease and/or carotid stenosis. That’s why we often recommend that PAD patients be screened for these other problems.

In about a third of people with PAD blood flow to the leg is eventually reduced to such an extent that that they are likely to loose the leg if blood flow is not restored. We call this limb-threatening ischemia, and it may be associated with chronic non-healing wounds, gangrene, or pain in the foot or lower leg that wakes you from sleep.

Treating PAD begins with controlling risk factors for atherosclerosis.