March 16, 2018 by John Fernandez and Tanya Racoobian
Peripheral Artery Disease -PAD: Risk Factors, Symptoms and Treatment (Video)
When Jerry Lewis passed away from heart failure, it was also revealed the iconic comedian suffered from peripheral artery disease, commonly referred to as PAD. Often occurring in people who have heart problems, PAD is a disease that affects a person’s arteries – most of the time the vessels that bring blood to the legs. It’s typically caused by cholesterol that builds up in the arteries and creates an obstruction.
(Video: The Baptist Health South Florida News Team hears from Ian Del Conde, M.D., a cardiovascular specialist at Miami Cardiac & Vascular Institute, about peripheral artery disease, commonly referred to as PAD. Video by George Carvalho)
About 18 million people in the United States have PAD, according to the U.S. Centers for Disease Control and Prevention (CDC). It’s the same type of disease that causes heart attacks when the arteries that supply blood to the heart become blocked.
“Most people with PAD will not have any significant symptoms, but it’s still a very important diagnosis to make,” said Ian Del Conde, M.D., a cardiovascular specialist at Miami Cardiac & Vascular Institute. “PAD is a marker for cardiovascular risk. Every person diagnosed with PAD must be managed with the proper medical care to prevent heart attacks and stroke.”
Diagnosing Peripheral Artery Disease (PAD)
When it comes to diagnosing PAD, Dr. Del Conde says he usually sees two types of patients.
“A small group of patients will have symptoms related to their legs which they usually describe as a tiredness or discomfort, typically when they walk,” he said. “We also see patients who have had significant pain in their legs along with other symptoms. After proper screening, we make the diagnosis of PAD. PAD that causes leg discomfort can cause a significant decrease in a person’s ability to walk and function normally. This has a significant impact on their quality of life.”
PAD is initially diagnosed with a physical exam done by a cardiovascular specialist. A relatively simple test, called an ankle-brachial index (ABI), checks blood flow by comparing blood pressure in the ankles and the arms, explains Dr. Del Conde.
“If we detect any significant difference in the two pressure readings, the diagnosis is usually PAD,” he says. “Normally, the ankle and brachial pressures should be the same in a person without PAD. In a person with PAD, there are blockages in the arteries going to the legs, so you see a difference in the two pressures.”
Symptoms of PAD
The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs, according to the American Heart Association. Typically, the pain goes away with rest and returns when walking again. Because many people mistake the symptoms of PAD for something else, it often goes undetected or misdiagnosed, Dr. Del Conde says. This can be dangerous because PAD that goes undetected and untreated can lead to heart failure or amputation from complete loss of blood flow to the legs or feet.
Other signs and symptoms of PAD include:
- Sores on toes feet or legs that won’t heal
- Weakness, especially while moving around
- Swollen feet or ankles
- Shiny skin on the legs or feet
Peripheral Artery Disease Risk Factors
Dr. Del Conde explains that PAD is caused by the same risk factors that cause heart disease. Smoking and diabetes are perhaps two of the most powerful risk factors, he says. High cholesterol, high blood pressure, an existing heart condition and male gender are also high risk factors.
The disease tends to affect men more than women, typically men in their 60s and 70s or older. Estimates suggest that anywhere from 12 to 20 percent of people older than age 60 in the U.S. are living with PAD, says the CDC.
Dr. Del Conde says the more people are aware of PAD, a lesser number of people will suffer from it. The American Heart Association highlights the disease this month, marking September as Peripheral Arterial Disease month.
In the early stages, PAD can often be treated with simple lifestyle changes that include regular exercise, healthier eating and stopping smoking.
Dr. Del Conde says patients with PAD benefit most when being treated by a team of doctors who each specialize in a specific aspect of the disease, referred to by healthcare professionals as a “multidisciplinary” approach.
“The first line of treatment is modifying or optimizing cardiovascular risk for these patients. We prescribe three medications for all PAD patients: aspirin, a statin and an ACE inhibitor,” Dr. Del Conde said. “Then the medical team focuses on alleviating patients’ leg symptoms so their ability to walk improves and normalizes.”
If the disease progresses, doctors are more aggressive in restoring blood flow, according to Dr. Del Conde. This is done through catheter-based therapies by an interventional radiologist or surgical bypass in the legs by a vascular surgeon.
Endovascular therapy for PAD is a minimally invasive procedure in which a catheter is inserted into one of the arteries – typically in the groin – and sometimes the wrist. The catheter is advanced to the site where there’s narrowing in the artery. At that point, Dr. Del Conde says there are many different options to open the blocked artery to allow a normal amount of blood to flow, such as angioplasty and stenting.
Occasionally, the medical team sees patients with such decrease in circulation that their legs are in jeopardy. For these patients, whose PAD is not treatable with catheter therapies, doctors resort to surgical bypass. In this procedure, a vascular surgeon reroutes the blood vessels of the legs or arms around blockages to restore blood flow. The goal of this treatment – also called peripheral bypass surgery – is to avoid limb amputation.
“At Miami Cardiac & Vascular Institute, we have a collection of top-notch physicians focused on endovascular and surgical therapies and the medical aspects of PAD,” he said. “The interventional radiologists, vascular surgeons and medical specialists work hand-in-hand to deliver the best possible care and management for patients with PAD.”
Living with Peripheral Artery Disease
After an endovascular procedure, almost every single patient with PAD is asked to maintain a very active lifestyle. Doctors often prescribe a walking program, according to Dr. Del Conde. It includes specific written instructions on how to walk and how much to walk and exert themselves to maintain good, healthy vessels. Patients are asked to walk every day for a minimum of 30 minutes. If he or she has pain in leg, we ask them to walk to the point that they feel those symptoms and then rest. Then we ask them to walk again, and rest again and continue doing so, Dr. Del Conde says.
“The improvements we see are quite dramatic,” he said. “These patients improve their ability to walk within just a few weeks of exercise.”
Dr. Del Conde adds that the interventions and treatments that restore blood flow to the leg do not alter a person’s inherent history of PAD.
“These patients are still at increased risk of cardiovascular events such as heart attack or stroke, so they usually stay on medication for a long time,” he said. “In addition to not smoking, controlling weight and glucose levels, and staying active, this is the best way to ensure the best outcomes.”
Dr. Del Conde also advises otherwise healthy people on how to avoid PAD.
“It’s critical to maintain an active lifestyle, and if you have any symptoms in your legs that are primarily present when walking or exerting, see you doctor,” he said. “Also, your doctor should be feeling ankle pulses during routine physical exams.”