What You Need to Know About Peripheral Artery Disease

If you don’t know much about peripheral artery disease, you’re far from alone. A recent survey found that 70 percent of people are unaware of this vascular condition — including many of the people most at risk.

Peripheral artery disease (PAD) is a serious, progressive cardiovascular disease that increases the risk of amputation, heart attack, stroke and death. In the United States, it leads to an estimated 150,000 leg amputations a year. It is primarily caused by a buildup of fatty plaque in the blood vessels, a condition known as atherosclerosis. The plaque narrows blood vessels and reduces blood flow from the heart to the rest of the body.

While not all PAD patients experience noticeable symptoms, PAD often affects the legs and feet, causing weakness, fatigue, aching, pain or cramping while walking. Some people dismiss these warning signs and fail to mention them to their doctor, attributing them instead to old age, being out of shape or overweight. But that’s a mistake. At least 8 million adults ages 40 and older in the U.S. have PAD, according to the National Institutes of Health, but many go undiagnosed in the early stages when treatment is most successful.

“It’s important to recognize the signs and symptoms of PAD and move quickly to initiate treatment in order to improve outcomes and reduce risks,” says Constantino Peña, M.D., an interventional radiologist and medical director of vascular imaging at Baptist Health Miami Cardiac & Vascular Institute. He noted that many cases likely go undetected because roughly half of the people with PAD have no obvious symptoms. “There are probably more than 10 million Americans with PAD,” says Dr. Pena, adding that the condition is now considered a leading indicator for coronary artery disease, heart attack and stroke.

Constantino Peña, M.D., an interventional radiologist and medical director of vascular imaging at Baptist Health Miami Cardiac & Vascular Institute

Because PAD can have dire consequences, medical organizations throughout the country have banded together to raise awareness. September has been designated Peripheral Arterial Disease Awareness Month to bring focus to this vascular disease.

Who Is at Risk?

The top three risk factors for PAD are diabetes, high blood pressure and the use of tobacco products. People with diabetes are three to four times more likely to suffer from PAD, while 35% to 55% of people with PAD also have high blood pressure. Approximately 80% of patients with PAD are smokers or former smokers.

A report earlier this year noted widespread health disparities when it comes to diagnosing and treating PAD. Black people are twice as likely to suffer from the condition and up to four times more likely to undergo an amputation compared to white people, according to the American Heart Association and other medical groups. Hispanics also have more advanced PAD by the time they consult a doctor, leading to worse outcomes, the report said.

Joint treatment guidelines released earlier this year by the medical groups noted that timely diagnosis and proper management of the condition, including coordinated care with a multispecialty team, are essential to reducing the risk of amputation, heart attack, stroke and death.

The report stressed the importance of screening patients with risk factors even if they have no symptoms, particularly if they have diabetes, high blood pressure, obesity, cardiovascular disease or chronic kidney disease. 

“The degree of PAD varies in severity and can range from people who have no symptoms, to people with ulcers or non-healing wounds, and to those who come in with limb-threatening emergencies that have to be treated immediately,” says Brian Schiro, M.D., vascular/interventional radiologist at Miami Cardiac & Vascular Institute and medical director of the Baptist Hospital Peripheral Vascular Lab.

Brian Schiro, M.D., vascular/interventional radiologist at Baptist Health Miami Cardiac & Vascular Institute and medical director of the Baptist Hospital Peripheral Vascular Lab

Watching for the signs of vascular disease can be very important. Symptoms like leg pain, numbness in the limbs, wounds that don’t heal, or changes in skin color should be checked by a doctor. Other symptoms include lack of leg hair or toenail growth, and decreased skin temperature, or thin, brittle and shiny skin on the legs and feet. As with most conditions, the sooner vascular issues are addressed, the more successful treatment will be, he adds.

“Many patients experience calf or buttock claudication, or pain with walking, that improves with rest. If you have symptoms that are unusual or abnormal, go see you doctor and get checked out,” Dr. Schiro says. “Remember to listen to your body.”

How Is PAD Treated?

PAD is a very treatable diagnosis that, when identified early, rarely requires surgical intervention and generally can be stabilized by lifestyle modification and medical therapy. That’s why it is important to be aware of the risk factors, symptoms and management options, Dr. Schiro says.

Detection occurs by measuring the blood pressure at the ankle and comparing it to the upper arm. Patients may also be referred for an ultrasound, computed tomography angiography (CTA), magnetic resonance angiography (MRA) or catheter-based angiography that allows physicians to see inside the arteries of the legs.

If you are diagnosed with PAD, your treatment will depend on its severity, location and your general health, Dr. Schiro says. Physicians first want to ensure that your disease does not progress, so patients are often put on medications to lower blood pressure and cholesterol. You may also be given medications to prevent the formation of a blood clot, which can occur when a blood vessel narrows.

In more-advanced cases, interventions include a minimally invasive angioplasty, in which a small catheter is threaded through an artery in the wrist or groin and a balloon is inflated, pushing the plaque against the artery walls. Some patients may need an atherectomy, in which plaque is removed from the artery. Others may undergo a bypass procedure, using a blood vessel from another part of the body or a synthetic vessel.

Once PAD is diagnosed, it’s important to implement a plan of care that includes management of PAD-related risk amplifiers to reduce the likelihood of progression, amputation, heart attack and stroke. For patients with diabetes, for example, care should be coordinated to address diet, exercise, weight management, blood sugar control and the management of other cardiovascular risk factors.  

“The overall goal is to eliminate pain with walking and improve blood flow to the affected leg in order to preserve the limb [in advanced cases],” explains Dr. Schiro. “Improving mobility and giving patients the ability to return to their normal lives and activities is something we really strive for. Mobility and exercise are important not only for the blood vessels but also for good heart health.”

What You Can Do

Since the hardened arteries that cause problems in your legs can also affect the blood vessels in your heart and brain, it’s important to discuss your risk with your physician. Regular checkups are key. People with PAD often have other cardiovascular conditions, Dr. Peña says.  

“Patients with PAD are at an increased risk for developing serious problems with their legs, but they also have a much higher incidence of heart attack and stroke. As a result, they require intensive and aggressive management over time,” Dr. Peña says. “Symptoms of vascular disease can be treated and even reversed, but patients need to be followed by a specialist.”

An unobstructed flow of nutrient-rich blood is necessary for preventing both heart and vascular diseases, but vascular diseases usually gets less attention. That’s why September also marks National Vascular Disease Awareness Month. Vascular disease covers any condition that affects the circulatory system, including arterial disease, venous disease and blood clots.

“At Miami Cardiac & Vascular Institute, we take a multidisciplinary approach to treat our patients,” Dr. Peña says. “We focus on the complete patient, from making the diagnosis to understanding the disease and managing the patient’s condition over the long term. When treating vascular disease, the goal is not just to improve the patient’s symptoms, but also to prevent adverse events such as limb amputation, heart attack or stroke.”