Peripheral Artery Disease (PAD)

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Peripheral arterial disease (PAD) is narrowing (stenosis) in the arteries of the legs caused by atherosclerosis.

The earliest sign of PAD is leg pain with walking that is improved immediately upon rest (claudication). Typically, the pain is described as a deep muscular ache or weakness that involves the muscle of the back of the calf, or less commonly, the thigh. The pain arises only after walking a certain distance, and dissipates after standing still a few minutes. It comes on more readily when walking at a fast pace or when walking uphill. Most people do not develop the same pain with other forms of exercise, such as climbing stairs, riding a bike, or swimming. Other conditions can cause leg pain that should not be confused with claudication. Sciatica (a pinched nerve in the back) causes a stinging or burning pain that shoots down the back of the leg from the back or buttock area. Sciatica pain, unlike claudication, can arise from standing or sitting too long and usually takes a long time to dissipate. Arthritis pain can also be mistaken for claudication, but arthritis involves the joints, not the muscle of the leg—and arthritis pain typically is worst when you first start an exercise and seems to improve as you continue that exercise.

About a third of people who have PAD develop such severe limitation in blood flow to the leg that they are likely to loose the leg if blood flow is not restored. We call this limb-threatening ischemia, and it may be associated with chronic non-healing wounds, gangrene (dead tissue), or rest pain (pain in the foot or lower leg that wakes you from sleep).

PAD is a manifestation of atherosclerosis, so being diagnosed with PAD increases the likelihood of your having heart disease or carotid stenosis. Frequently, you doctor will recommend screening for these other problems if you are found to have PAD. Treating PAD begins with controlling risk factors for atherosclerosis.

PAD is fairly common. In random screening, 10-20 percent of people over the age of 65 have PAD. An estimated 12 million people in the U.S have PAD—that’s more than the number of people with cancer or Alzheimer’s disease. Yet over 75 percent of adults don’t know what PAD is. This disease is underdiagnosed—almost 30 percent of people with PAD are unaware they have it.

Screening is performed by checking pulses in the legs and performing an ankle-brachial index (ABI). The ABI is a ratio of the blood pressure in the leg to the blood pressure in the arm. It is normal when the pressures are equal. If the blood pressure in the leg is lower than in the arm, the ABI is abnormal. Ultrasound or CT can be used to locate the region of stenosis or occlusion. We offer two treatment options for PAD: Angioplasty and Bypass Surgery.