September is Peripheral Arterial Disease (PAD) Awareness Month

Peripheral arterial disease (PAD) simply is blockage in the arteries of your legs. This is normally due to cholesterol particles and fats that form plaque. This plaque buildup in-turn narrows the artery walls causing poor circulation throughout the legs. When plaque obstructs nutrient and oxygen rich blood from transport to leg arteries and on to muscles and tissues, limb cells can die. In these severe cases, PAD can cause pain in the legs with or without walking and can even lead to a more serious condition called critical limb ischemia (CLI). Inadequate treatment or delay in care for CLI can result in amputation and leg loss. According to the national Institutes of Health (NIH), PAD affects between 8-12 Million people in the U.S. and up to 2 Million suffer from CLI.

  • Among adults age 65 and older, 12 to 20 percent may have PAD
  • Up to 85 percent of all amputations occur in people over the age of 60
  • One in three people over the age of 50 with Diabetes is likely to have PAD

Common Risk Factors for PAD

PAD cases range from mild symptoms consisting of leg or calf pain while walking or immediately thereafter to serious CLI ailments including sores on the foot or leg that just will not heal, gangrene and pain when at rest. Four Main Risk Factors for PAD:

  • Hypertension
  • Smoking
  • Diabetes
  • High Cholesterol

If left to progress, CLI can result in foot or leg amputation. Up to 650,000 amputations due to CLI occur yearly in the U.S. More than half of these patients had not been re-vascularized meaning they did not have blood flow to their limbs improved prior to amputation. Prompt recognition of CLI and aggressive treatment by optimizing blood flow, leads to amputation prevention. This type of vascular care called limb salvage is a procedure performed by vascular surgeons to improve the blood circulation to a limb in an effort to save the leg. This re-supply of blood can help the leg and any wounds on the affected area heal from the limb down to the toes.

  • Up to 650,000 lower-limb amputations are performed each year in the U.S. for critical limb ischemia (CLI)
  • Of all lower-limb amputation, more than 60 percent occur among people with Diabetes
  • Up to 50 percent of people who have had an amputation, have never had a diagnostic angiogram to determine if blood flow could be restored

Early Screening of Patients for PAD

Non-invasive diagnostic testing can be completed as an outpatient in the office such as ankle-brachial index, segmental pressures, pulse volume recordings and arterial duplex. Computer tomography angiography (CTA) and angiography are also tools used to diagnose PAD in the hospital setting. Common factors of PAD and CLI include:

  • Over 50-Years Old
  • Current or Past Smoker
  • Kidney Disease
  • High Blood Pressure
  • High Cholesterol
  • Leg Fatigue, Heaviness or Cramping
  • Toes of Feet that Look Pale, Discolored or Bluish
  • Pain in the Legs and or Feet that Disturbs Sleep
  • Sores/Wounds on Toes, Feet or Legs that Heal Slowly or Not at All
  • One Leg or Foot that Feels Colder than the other
  • Poor Nail Growth and Decreased Hair Growth Over Time on Toes and Legs

Endovascular and Surgical Treatment

Patients who have non-healing wounds are more likely to require future hospital care. In fact, more people die each year from CLI/PAD then stroke, cancer or heart attacks. Throughout our U.S. communities, PAD Awareness is very low. Patients who undergo amputation have a very high mortality rate. Preventing amputation saves lives and decreases mortality. Before a decision on amputation, each patient should undergo a thorough evaluation for best medical therapy, which can include lifestyle changes, medication, or open surgical or endovascular revascularization. Endovascular treatment is a minimally invasive procedure that is performed using a small needle puncture through which the blockage in the arteries can be removed using balloons and/or stents.  Over the past decade, as endovascular treatment and technologies have become more widely available and implemented, amputation rates have decreased.

Treatment Options for PAD include:

Lifestyle Changes – Quit Smoking, Lowering Blood Pressure, Lower LDL Cholesterol, Managing Diabetes to Lower Blood Glucose levels, Healthy Diet and Regular Exercise.

Medications – Lower High Cholesterol and High Blood Pressure, Manage Diabetes, Prevent Formation of Blood Clots and Help Improve Walking Ability and Increase Circulation.

Revascularization – Angioplasty, Stenting, Atherectomy and Bypass Surgery. *Endovascular Treatments (Fixing the Problem from the Inside with Balloons and Stents) has Reduced the Amputation Rate.