Associate Staff, Clinical Cardiology and Vascular Medicine
Tomsich Family Department of Cardiovascular Medicine
Specialties: general cardiology, vascular medicine, claudication and peripheral arterial disease, vascular ultrasound, Raynaud's Phenomenon, secondary hypertension, atherosclerosis, fibromuscular dysplasia
Hi, I’m Dr. Heather Gornik in the Tomsich Family Department of Cardiovascular Medicine at the Cleveland Clinic. Today I would like to speak with you about Peripheral Arterial Disease.
Peripheral arterial disease—or PAD—may be one of the deadliest diseases you’ve never heard of.
PAD is a disorder of blocked or clogged blood vessels in the arms and the legs. As you know, the heart is a pump, and blood vessels known as arteries are like pipes that carry blood through the body. When a pipe or artery gets blocked, there can be serious problems.
PAD causes leg pain with walking, leg sores, and reduced quality of life. PAD can also lead to poor function and ability to participate in activities you enjoy, such as golfing or chasing after grand children. It is the leading reason for amputation in the United States, and puts you at risk for heart attack, stroke, and death.
Heart attacks are caused by blocked artery in the heart. PAD is the same kind of blockage, only it takes place in the arm, leg, or other part of the body.
Up to 12 million Americans may have PAD. Nearly one in 20 Americans above the age of 50, and up to one in five above the age of 70 have it. African Americans, people with diabetes, and people who smoke are particularly at risk.
Many people with PAD don’t know they have it, but some people may have leg pain due to PAD. Just as a blockage in the blood vessels of the heart causes angina, or chest pain, blockages in the legs cause muscle pain. This is pain that comes on with walking and goes away with rest.
Symptoms of peripheral arterial disease
Symptoms of PAD include fatigue, heaviness or cramping in the calf, thigh or buttocks that occurs when you walk or move, but usually goes away when you’re at rest. They also include skin wounds or ulcers that don’t heal after more than a few weeks. Also, changes in the color or temperature of the feet may occur.
But fully half of people who have PAD experience no symptoms at all. That’s one of the reasons it’s so dangerous.
A blocked artery is rarely an isolated condition. If you have a blockage in your arm or leg, others may be forming in your heart or brain. That’s why PAD is considered a warning sign that you may be at high risk for a heart attack or stroke.
Diagnosis of peripheral arterial disease
There are a number of ways we diagnose PAD. They begin with a medical history and physical examination by your doctor. The most reliable and inexpensive test is called the ankle-brachial index, or A.B.I Test. This simple test can detect the presence and severity of PAD by measuring blood pressure in the arms and legs. There are also imaging tests to diagnose PAD. All of these tests are non-invasive.
Treatment of peripheral arterial disease
PAD is often treated with the same medications and therapies that are used to treat coronary artery disease. These include blood-pressure and cholesterol-lowering drugs and drugs that prevent blood clot formation, such as aspirin or clopidogrel. Patients with very severe leg symptoms may be eligible for angioplasty and stenting. In some cases, a kind of surgical bypass can be performed.
As always the most important treatment is prevention. You can lower your risk of getting PAD. If you smoke, quit smoking. Eat a low-fat diet. Exercise at least 30 minutes a day on most days of the week. Even simple walking is great for your heart and vascular health. Ask your doctor about controlling high blood pressure and high cholesterol, and getting treatment for diabetes. Take blood thinners like aspirin or clopidogrel if your doctor prescribes them.
By following these steps, you not only lower your risk for PAD, but you lower your risk for heart attack and stroke as well.
If you have PAD, you need to protect your feet. Wear comfortable and properly fitting shoes. Avoid high heels. Keep your skin clean and soft and take good care of your toenails. Check your feet regularly for ulcers or discoloring, and tell your doctor if you see anything that concerns you.
It’s never too late to quit smoking and begin exercising. Exercise is a wonder treatment for PAD. It increases your walking stamina, improves your function and quality of life, it helps with weight loss, blood pressure and cholesterol. Best of all, it makes you feel good.
Remember, everyone over 50 is at risk for PAD. But you need to be particularly vigilant if you smoke, or ever smoked, if you have diabetes, high blood pressure, abnormal cholesterol, or a personal history of coronary artery disease or stroke. At your next check-up, ask your doctor if you are at risk for PAD.
For more information on PAD, I encourage you to visit www.aboutpad.org which is the national website for this condition.
I’m Dr. Heather Gornik. It’s been my pleasure to talk to you about PAD. I look forward to your continuing good health.
For More Information