People who cannot walk short distances without pain may be suffering from peripheral arterial disease, shortened “PAD”, a potentially limb-threatening condition that puts them at greater risk for heart attack and stroke. About 1 in every 20 Americans over the age of 50 has peripheral arterial disease. This problem will only worsen as we get more people living into their 80s and 90s in America. The number of patients in the United States with PAD is growing rapidly, and it's going to continue as baby boomers get older. In DeKalb county, Alabama, we face near epidemic rates of heart and vascular disease, due to a high fat and cholesterol diet, and tobacco use.
How can you tell if you have PAD?
PAD is a serious but treatable blockage of arteries in the legs that occurs when cholesterol plaque builds up in the arteries, hardens and blocks blood flow. Treatment includes exercise, blood thinners, stent procedures to restore blood flow, and, in severe cases, bypass surgery. In the worst cases, lack of blood can cause tissue to die (a condition known as gangrene) and could lead to amputation.
Smokers are four times more likely to develop PAD. Other risk factors include high cholesterol, high blood pressure and diabetes. Smokers and people with diabetes are more likely to develop complications, like gangrene. African-Americans are at a greater risk for developing PAD than any other ethnic group.
“When There’s Smoke, There’s Fire”
Diagnosing PAD early is important because it is a strong marker for heart attack and stroke. Most people are aware of coronary artery disease. But fewer people know about vascular disease. People need to understand that it's not normal for their leg to hurt when they walk. It's not a sign of aging or of being out of shape. Patients with PAD are more likely to have coronary artery blockage, and vice versa.
The classic symptom in PAD is called "intermittent claudication", which occurs when pain develops in the calf, thigh or buttock muscles during climbing or walking, and improves after resting. In advanced cases, patients experience pain even at rest, which limits their ability to carry out their daily routines.
Ignoring the Warning Signs
Although PAD can be easily diagnosed by ultrasound and physical exam, the condition may go undetected for years because patients downplay the symptoms, don’t think anything can be done to help their pain, don't tell their doctors because they assume the pain will go away, or they think it is from arthritis. Many doctors do not routinely ask patients about leg pain with walking or climbing stairs, so the patient never has the discussion with their doctor. One of the first signs of PAD is hair loss on the lower legs. It is easy to detect, and can lead to a conversation with your doctor about leg pain, and what may be causing the leg pain – nerve loss, vein disease, or artery disease.
How do you Diagnose PAD?
Your cardiologist will examine your legs for hair loss, check for weak or absent pulses in the leg or feet, look for non-healing sores or wounds on the toes, feet or legs; thickened nail growth; pale or dusky color to the skin; and differences in warmth between limbs. Based on this exam and checking blood pressures between arms and ankles, called an Ankle-Brachial Index, your cardiologist may order an ultrasound.
Ultrasound is a painless, non-invasive procedure that converts sound waves into real-time images of blood flow in the arteries and veins. Ultrasound can tell who needs to have an arteriogram to look for, and in some cases, fix artery blockage. With an arteriogram, physicians can treat blocked arteries without sending the patient to a surgeon for an open procedure, which has a much longer recovery time compared to the arteriogram.
What Treatment is Available?
Treatment choices vary depending on the severity. Lifestyle changes such as eating nutritious food, quitting smoking and exercising are the first steps. Blood thinners and medications to improve blood flow, control blood pressure, cholesterol and blood sugar levels may also help. Exercise and weight loss can prevent PAD from getting worse. It also helps to take care of your diabetes, high blood pressure and high cholesterol."
Some patients with blocked arteries find relief with minimally invasive procedures that restore and maintain normal blood supply in the legs. For example, angioplasty and stenting – a procedure used to treat blocked vessels to the heart – can also restore blood flow to the legs. Physicians use a balloon on a catheter to open the blocked artery by pushing the plaque against the vessel's wall. They also may insert stents that work as scaffolds to keep the arteries open after the balloon is removed.
In another procedure known as atherectomy, physicians use a catheter to insert a small cutting device that shaves off the plaque in the blocked area, like a roto rooter or a dremel rotary sander. In severe cases, patients may need bypass surgery. Amputation is a last resort in extreme cases where gangrene has developed.
Increased Awareness of PAD
Experts advise people with leg pain to find a cardiologist who is associated with a comprehensive vascular center. Some interventional cardiologists perform PAD interventional procedures in an outpatient center where they can get their treatment performed in a convenient outpatient setting, and go home the same day. Outpatient heart and vascular centers are opening up around Alabama, including Appalachian Cardiovascular Associates in Fort Payne. Outpatient vascular centers offer convenience, and personal care, at a fraction of the cost associated with having the same procedure performed at a hospital. We need to increase awareness about peripheral arterial disease in rural Alabama. Legs don't get the same kind of medical attention that the heart and brain gets. And with knowledge about PAD, we can help people live better lives.
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