Peripheral Arterial Disease
Vascular Diseases Causing Leg Pain
Peripheral Arterial Disease (PAD) is the most common peripheral vascular disease (PVD) affecting 8 to 12 million Americans or in other words 12 - 20 percent of Americans over the age of 65. PAD is usually the result of atherosclerosis or "hardening of the arteries" due to cholesterol build up that eventually narrows and clogs up the artery.PAD generally affects the arteries of the pelvis and the legs in a manner similar to that affecting the heart (causing a heart attack) or the brain (causing a stroke). Research indicates that most patients (about 70 percent) will not experience any symptoms; however, in patients with progressive disease, this could become a serious condition leading to gangrene and amputation if left untreated. Research also suggests that PAD may be an independent risk factor for heart attack and stroke, underscoring the importance of early diagnosis.
Symptoms
The commonest symptoms of PAD are cramping, pain or tiredness in the leg and hip muscles while walking or climbing stairs. The clogged artery is unable to meet the demands of the exercising muscle and hence results in the cramping pain felt by PAD patients. Typically the pain is relieved with rest and reappears on resuming physical activity.Symptoms of severe PAD include foot pain that does not go away when you stop exerting, pain at rest, foot or toe wounds that are not healing, a marked decrease in the temperature of your foot and/or leg compared to the other foot or the rest of the body, significant loss of leg hair and gangrene.
Most people dismiss leg pain as a sign of growing old or arthritis. Pain from PAD differs from arthritic pain in two ways:
1. Compared to arthritic pain that is felt in the joints, PAD pain is felt in the muscles, particularly the lower leg muscles.
2. Arthritic pain and stiffness is usually worst in the morning and often relieved by movement or light exercise.
On the other hand, PAD is exacerbated with exercise. Diabetics can experience leg pain from two reasons, PAD or diabetic neuropathy, a conditioned caused by diabetes that presents as a burning sensation in the thighs or the feet. These different symptoms can be easily differentiated by the history and by simple tests. If you are experiencing any kind of recurring pain that worsens with exercise you should talk to your doctor or a specialist.
If you have any of the risk factors for PAD, you should ask your healthcare professional about PAD even if you are not experiencing symptoms.
Risk factors
The following risk factors are associated with an increased incidence of PAD, heart attack and stroke.Factors that cannot be changed include advancing age and heredity. Factors that can be modified by lifestyle changes include:1. Smoking
2. High cholesterol levelsa. Risk of heart attack twice that of non-smokers
b. Biggest risk for sudden cardiac death
c. Smokers who have a heart attack are more likely to die and die suddenly (within 1 hour) than non-smokers
d. Smokers are more likely to have strokes
e. Smokers are more likely to develop PAD at an earlier age than non-smokers
a. The risk of heart disease and PAD increases with an increase in the cholesterol level.
b. This risk is even greater in patients who also have high blood pressure and smoke
c. Talk to your doctor or a specialist to understand the effects of cholesterol and the impact of "good" cholesterol and "bad" cholesterol
3. High blood pressure
High blood pressure increases your risk of heart attacks, strokes, PAD, kidney failure and heart failure. When combined with obesity, smoking high cholesterol levels and diabetes, this could prove to be deadly.
4. Diabetes
a. Increases the risk of heart attack
b. Frequently causes PAD and non-healing of small wounds
c. Even with controlled blood glucose levels, there is a significant risk of heart disease and other associated diseases such as PAD and strokes
d. If you have diabetes, it's critically important for you to monitor and control your blood sugar closely as well as control any other risk factors you can.
5. Obesity and lack of physical activity
a. Independent risk factor for heart disease and stroke
b. More likely to develop diabetes
c. Risks significantly reduced with even a 10 o 20 pound weigh loss
Diagnosis
PAD can often be diagnosed by a detailed history and a physical examination of the pulses in your legs. A simple screening exam called the ABI (Arterial-Brachial Index) can be performed by your doctor or by a specialist. This simple exam is non-invasive, painless and only takes a few minutes. If this screening test is abnormal, ultrasound, CTscan or an MRI can be done for a more detailed evaluation.Treatment
Most patients with early or mild PAD can be easily treated with a few small lifestyle changes. These include1. Regular exercise. This is the most effective way of treating PAD. Suggested exercise plan for claudicants.2. Diet: PAD patients often have elevated cholesterol levels. A diet low in saturated fat and cholesterol can help lower blood cholesterol levels, but cholesterol medication may be necessary.3. Smoking cessation.4. Medicationsa. Your doctor may prescribe high blood pressure medicines as well as cholesterol lowering medications.b. Medications to improve the distance you can walk include cilostazol and pentoxifylline.c. In addition, you may be prescribed antiplatelet medications (aspirin and clopidogrel) to help to prevent blood clots.d. These medications are all prescription medications and should only be started and stopped under a doctors supervision
5. Procedures
In a minority of patients the above recommendations are not enough. In these cases, minimally invasive treatment can be performed to open up the clogged artery and restore blood flow. These procedures do not involve surgery and are performed via small (2mm) nick in the skin of your leg. Using advanced technology and X-ray guidance the narrowed or clogged artery can be re-opened by either inflating a tiny balloon inside the artery or by placing a stent, a metal tube to help hold the artery open. Occasionally a clot busting medicine can be given through the catheter or a special device can be inserted through it to remove a clot that is blocking the artery. These procedures are done in an outpatient setting but may occasionally require an overnight stay.
