The Rundown: Peripheral Artery Disease

Peripheral Artery Disease (PAD), a narrowing of the arteries in legs and arms, affects more than 200 million people worldwide. In fact, it is the most common type of vascular disease. More than 20 percent of women over the age of 80 and over 25 percent of men that age have the disease. The disease makes it so limbs receive less blood than they need. The consequences can be severe, including losing a limb.

Risk Factors
People are at greater risk for PAD if they are over 60 years old, black or Hispanic, if they smoke, or if they have obesity, high blood pressure, high cholesterol, or diabetes. Having PAD puts people at greater risk for heart disease, heart attack, and stroke.

Causes
The most common cause of PAD is atherosclerosis, where fatty deposits in the arteries cause the arteries to harden and narrow. This makes it more difficult for your limbs to get the amount of blood they need. Other causes include blood vessel inflammation or others.

Symptoms
Some people with PAD experience no symptoms, but as many as 6 in 10 will experience cramps. Most commonly, the cramp is felt in the calf, but it can also affect the buttock, hip, and thigh. Initially, cramps come on while walking and subside with rest. In some cases, one foot feels colder than the other. People may feel that their legs feel numb, weak, heavy, or tired.

If you have these early symptoms, call your doctor to make an appointment.

As the disease progresses, people can experience cramps even when resting or cramps that disrupt their sleep. Skin becomes shiny and discolored. Hair on the legs grows more slowly or falls out. Toenails grow slower. In severe cases, patients experience constant foot pain. They can get gangrene, open sores that don’t heal, which may necessitate having a limb amputated.

Detection
Your doctor will conduct an examination, including taking your pulse at the ankles. They may order an ankle brachial index (ABI), a simple non-invasive test that can be used for screening for PAD. SVMC Cardiology conducts ABI tests conveniently in the office. They may also recommend imaging tests to help identify the problem.

Treatment
Healthy lifestyle changes are a big part of managing PAD. Quitting smoking, eating a healthful diet, and getting active are important parts of the plan. Your doctor might also prescribe medications; recommend a supervised exercise program, like cardiac rehabilitation; or refer you for a stent or bypass procedure to allow blood to get to the areas in which it needs to go.

You can prevent PAD with a healthy lifestyle. If you smoke, quit; get plenty of physical activity; and keep a healthy diet of whole grains, fruits, vegetables, and lean proteins. Managing other conditions—like high blood pressure, high cholesterol, and diabetes—helps, too.

Scott Rogge, MD, FACC, is a cardiologist with SVMC Cardiology, part of Southwestern Vermont Medical Center and Southwestern Vermont Health Care, in Bennington.