More than eight million people have peripheral arterial disease or PAD, but relatively few know what it is. Ignoring the signs can have serious consequences.
Like coronary artery disease, PAD is caused by atherosclerosis, meaning a buildup of plaque that reduces blood flow in arteries throughout the body.
“In your legs, in your arms. You could have it in your carotid artery going up to the brain. Even your gut where you have arteries that feed the gut,” said Dr. James Park, an interventional cardiologist and Medical Director of the Heart and Vascular Program at Texas Health Dallas.
Park says it’s easy to mistake symptoms of PAD for other medical problems, but ignoring signs can result in decreased circulation leading to potential gangrene and loss of limbs.
Interview Highlights
How serious is PAD? Depending on where it is, it can cause strokes, it can cause amputation if untreated in the lower extremities. Some people get what’s called mesenteric eschemia, which means the blood flow to the gut is limited, so they’ll have weight loss or intractable pain whenever they eat. And there’s a lot of data that says if you have peripheral artery disease, those people are more likely to have a shorter life expectancy than others that don’t.
About low awareness of PAD.: It’s often not talked about. I also find primary care physicians and other physicians of specialty don’t recognize it very well. Part of the problem is it can mimic other things.
About diagnosing PAD: There’s a lot of non-invasive testing you can do. One is a simple thing called ankle brachial index where you can take a blood pressure on your arms and compare it to the legs. In addition to that, they can do an ultrasound of your arteries for plaque buildup, and you can also look at the speed of the blood going through the plaque, which demonstrates a tight blockage if the speed is high.
About treating PAD: First, modify the risk factors. If someone is a smoker – a big, big risk factor for PAD – they improve if they stop smoking. The second is exercise therapy. The more they exercise, the more the body recruits arteries to get bigger so that their symptoms improve.
But to get rid of the problem altogether, there are two types of treatment. One is called endovascular: You go through the skin and, as with coronary angioplasty or stent in the heart, you can do similar interventions of the lower extremities. If that’s not enough, sometimes you have to do bypasses in the legs with a prosthetic tube or your own vein to go around the blockage.
Texas Health's Vascular Rehab Program for PAD: We are equipping all our rehab centers where patients go for cardiac rehab and pulmonary rehab to be aware of the fact that now we can do vascular rehab in terms of exercise therapies. The beauty of the vascular rehab is that you do not need to under a procedure or surgery before you qualify, which is not the case on certain heart-related cardiac rehab.
Resources
- American Heart Association: About PAD
- Peripheral Arterial Disease (MedlinePlus.gov)
- Peripheral Arterial Disease – Symptoms and Causes
Interview responses have been lightly edited for length and clarity.
