The human vascular system—also called the circulatory system—carries blood and delivers nutrients and oxygen to all parts of the body. With the heart as the pump, blood travels through thousands of miles of blood vessels—arteries, capillaries and veins. And, just like the rest of the body, sometimes things can go wrong.
Peripheral vascular disease (PVD) is a condition that affects blood vessels away from the heart and brain. One type of PVD is peripheral artery disease (PAD), which affects the arteries supplying oxygen-rich blood to your body. To better understand PAD, Cecil Vaughn, MD, a vascular surgeon who treats patients at Banner Thunderbird Medical Center, explains what the disease is.
What is PAD?
Dr. Vaughn says PAD is a condition caused by the buildup of plaque in the arteries, called atherosclerosis, which narrows the artery and causes a partial or complete blockage. This plaque buildup can affect the arteries of the heart, brain, abdomen, arms and legs. However, the legs are most commonly affected, according to the American Heart Association.
With PAD, patients may have a variety of symptoms, or they may have no symptoms at all.
“It is estimated that there are 3 times as many patients with PAD who are asymptomatic as opposed to symptomatic,” Dr. Vaughn said.
When symptoms do show up, patients will often complain of pain in their legs when walking or exercising. Dr. Vaughn explains this is called claudication, which is caused by not enough blood flowing to the affected muscles. This pain gets better with rest and can be mild to severe, which depends on how many obstructions you have and how much you use the leg.
Another sign of PAD is called critical limb ischemia. Dr. Vaughn explains this is when the blood flow is so restricted by obstructions that the tissue is at risk. In some cases, ulcers or gangrene can develop and, if left untreated, can lead to amputation.
So, who gets PAD? Dr. Vaughn says that 2010 census data suggests women are more likely to develop PAD than men. It also typically affects people over the age of 50, and Dr. Vaughn estimates 10% of the population over the age of 55 are affected with PAD.
“PAD can and does, however, affect younger people,” Dr. Vaughn said. “Most commonly those with significant medical comorbidities such as diabetes, cardiac disease or hypertension.”
Common risk factors for PAD include tobacco use, hypertension, high cholesterol, diabetes and hereditary factors.
For a doctor to determine if you have PAD, you’ll need to have a physical exam and give a detailed health history. Additionally, you will likely have an ankle-brachial index (ABI test), which measures the difference between blood pressure in the arm and in the leg. You doctor may also order an ultrasound to find obstructions and determine their severity.
More invasive tests, such as the CT angiography, MR angiography and catheter-based angiography, are usually only used when the doctor is planning interventional procedures. The good news is not all patients will need an invasive procedure to help with PAD.
“First line treatment includes risk factor modification, smoking cessation, weight reduction and pharmacologic therapy,” Dr. Vaughn said. “Medications are geared towards slowing disease progression and possibly some regression.”
Dr. Vaughn says medications typically prescribed to help with PAD include antiplatelet therapy, lipid lowering medication, glycemic control and hypertensive control.
There are some cases where a doctor would recommend surgery. Typically, this would be for patients with pain while resting, ulcers forming on the skin or pain that is unmanageable with non-invasive treatments.
So, what surgical treatments are available? Dr. Vaughn says treatments could include a surgical procedure, such as a bypass surgery, or a minimally invasive procedure—angioplasty, stents and atherectomy, for example.
To help prevent PAD, Dr. Vaughn says managing associated risk factors should be a priority. This means keeping blood pressure and cholesterol in a healthy range and managing diabetes. However, Dr. Vaughn’s final suggestion should not be overlooked.
“Smoking cessation is the single most important thing that patients can do to help themselves,” Dr. Vaughn said.
Read our post, No Butts About It: Quit Smoking Now, for advice on kicking your habit.