Peripheral Arterial Disease (PAD)

Arteries carry the blood from the heart to all parts of the body. Healthy arteries have a smooth lining. Under certain conditions, fatty deposits, or plaques, build up in the arteries, interfering with the blood flow. This is known as atherosclerosis. Initially there may be no symptoms but with time the plaques thicken to a point where blood flow becomes seriously restricted and ultimately blocked. Symptoms occur first with exercise, when the working muscles require more blood and oxygen to function; with more advanced disease they also occur at rest.

Symptoms of PAD:

•Painful cramping of the leg or hip muscles during walking, that stops during rest; or a feeling of heaviness,  numbness or  weakness in the legs without pain.

•Burning or aching in the feet or toes at rest, particularly when lying flat. This is a sign of more advanced  disease

•Cold legs or feet

•Color changes in the skin, particularly in the legs or arms

•Sores on toes or feet that won't heal promptly

Risk Factors for PAD:

•Smoking is the most important risk factors. Even one or two cigarettes a day can constrict blood flow and  damage  blood vessels.

•Diabetes: it is very important to have your blood sugar well controlled. Blood vessel disease from diabetes is  the most  common cause of amputation due to gangrene.

•Older age. PAD occurs more frequently in patients over 60 years.

•Elevated cholesterol levels

•Uncontrolled high blood pressure damages artery walls

•Patients with a family history of early heart disease are at higher risk

You may notice that these are the same risk factors as for heart disease and strokes. Plaque build-up occurs not just in the blood vessel that feed the heart and the brain, but throughout all arteries of the body. In post mortem exams of young soldiers, who had died in the Vietnam War, it was found that even young people may already have some yellow plaque deposits in their arteries. With proper treatment this process can be prevented and reversed.

Treatments to reverse the disease:

If you smoke, quitting is the most important step, the one that by far outweighs than anything else that you might do. In addition to stopping smoking, regular exercise and a healthy diet, low in fat and salt, are the mainstay of conservative treatment. Other measures include control of blood pressure, preferably to equal to, or lower than, 120/80, lowering cholesterol levels with diet, and for diabetics normalizing blood sugars. In more serious cases, specific medications or surgery may be necessary.

How to diagnose PAD by measuring the Ankle/Brachial Index:

With increasing degrees of arterial narrowing there systolic blood pressure (the pressure measured when the heart pumps blood into the circulations) falls as you get further downstream. Normally the systolic blood pressure is higher in the ankles than in the arms. Obtaining the Ankle/Brachial Index, by comparing the blood pressures in the ankles to those in the arms, gives an indication of the extent of arterial narrowing and atherosclerotic disease. This assumes that the arteries are not calcified, a condition which is more common in diabetics (not the same as plaque build-up): calcified arteries are not compressible and a correct systolic blood pressure cannot be obtained.

We measure the systolic blood pressure by inflating a regular blood pressure cuff on both arms and ankles in turn and each time releasing the air slowly. A Doppler instrument that detects the sound of blood flow is held against the skin over the artery. The systolic BP is the point at which blood flow is first audible.

It is a quick, painless, non-invasive test and is done right in our office. Every patient over 50 years with hypertension, heart disease, or diabetes, and all older smokers, should have a baseline test to be repeated periodically to follow the success of therapy, or to detect progression of the disease.