PAD is Bad: What You Need to Know About Peripheral Arterial Disease

Have you noticed a pain in your legs or feet when walking that goes away with rest? Does the skin on your ankles appear shiny or brittle and feel cool to the touch? If so, experts advise you to see your physician or cardiovascular specialist. Peripheral arterial disease (PAD) is now considered a leading indicator for coronary artery disease, heart attack and stroke. And that, doctors say, is reason enough to familiarize yourself with PAD’s symptoms – especially if you have any risk factors for the disease.

“PAD is a slow and progressive disorder in which the blood vessels – particularly in the legs – become narrow or blocked due to atherosclerosis, or the build-up of cholesterol plaques,” says Ian Del Conde, M.D., a cardiologist and vascular medicine specialist with Miami Cardiac & Vascular Institute. “When this occurs, organs and limbs supplied by those vessels may not get enough blood flow for healthy function.”

According to the U.S. Centers for Disease Control and Prevention (CDC), PAD affects more than 8.5 million U.S. adults over the age of 40. Doctors suspect the actual number is much higher, because roughly half of the people diagnosed with PAD have no obvious symptoms and many cases likely go undiagnosed.

PAD most often affects the legs, Dr. Del Conde says, and one of its more common symptoms is leg discomfort or tiredness that occurs with exercise and is relieved by rest. “This is known as intermittent claudication, which can occur in one or both legs,” he says. “During rest, the muscles need less blood flow, so the pain disappears.

With advanced PAD, though, the discomfort can be severe enough to limit the patient’s ability to lead a normal life, says Dr. Del Conde. “If left untreated, PAD can lead to poor wound healing, gangrene and possible amputation of the affected limb,” he adds.

Other PAD symptoms to watch for

Aside from unexplained leg pain, which occurs in only a small number of patients diagnosed with PAD, Dr. Del Conde says that symptoms for PAD can also include:

• Changes in the skin, including decreased skin temperature, or thin, brittle, shiny skin on the legs, ankles and feet
• Weak pulses in the legs, ankles and feet
• Gangrene (dead tissue due to lack of blood flow)
• Hair loss on the legs
• Impotence
• Wounds that won’t heal over pressure points, such as heels or ankles
• Numbness, weakness, or heaviness in muscles
• Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
• Paleness when the legs are elevated
• Reddish-blue discoloration of the extremities
• Restricted mobility
• Severe pain when the artery is very narrow or blocked
• Thickened, opaque toenails

“If you have a healthy 18-year-old with leg aches, that’s one thing,” Dr. Del Conde says. “If you have an elderly patient with diabetes and pain in their legs while walking, be aware that PAD is a possibility and have the doctor check their ankle pulse.”

Foot wounds or ulcers that don’t heal within three to four weeks at the most are also a sign that you could have PAD, Dr. Del Conde says, because your body’s natural healing processes are being inhibited by reduced blood flow to the limb and foot. “Any person with a slow- or non-healing wound should be evaluated for PAD, particularly if they have typical risk factors such as smoking or diabetes,” he advises.

There are a variety of tests a doctor can order to confirm a PAD diagnosis, including relatively simple non-invasive studies that look at blood flow in the legs, doppler ultrasound, , magnetic resonance angiography (MRA) and computed tomography angiography (CTA), and others, Dr. Del Conde says.

Know your risk factors; control the ones you can

Risk factors for PAD range from those that can be controlled or treated to those that can’t. According to Dr. Del Conde, risk factors you can’t control include:

• Age (higher risk over age 50)
• History of heart disease
• Male gender
• Postmenopausal women
• Family history of high cholesterol, high blood pressure or PAD
• Ethnicity (African-Americans have an increased risk)

There are a number of risk factors for PAD that can be controlled, however, Dr. Del Conde says. These include:

• Coronary artery disease
• Diabetes
• High cholesterol
• High blood pressure
• Overweight
• Physical inactivity
• Smoking or use of tobacco products

“People who smoke or have diabetes have the highest risk of complications from PAD because each of those has the effect of restricting blood flow to vital organs and limbs,” Dr. Del Conde notes. People with advanced kidney disease are also at risk for PAD, he says. “If you’re on dialysis, your kidneys aren’t doing their job clearing compounds from your body, which can accelerate damage to your arteries.”

A high risk of heart attack or stroke

According to Dr. Del Conde, it has become increasingly obvious that PAD is not just a leg issue but an important marker of cardiovascular health. “If you have the atherosclerotic process in your leg arteries, we know you’re at high risk for having a heart attack or stroke, and you need to be aggressively treated for cardiovascular disease,” he warns.

Dr. Del Conde says that patients with the disease historically have been neglected, simply because there wasn’t the awareness there is today of PAD’s effect on cardiovascular health, and also because of a lack of effective therapies. “The only option for many years was a surgical bypass of the leg artery, but only a small number of patients were actually candidates for that procedure,” he notes.

With new therapies available today and more on the horizon, things are looking brighter for patients with PAD, according to Dr. Del Conde. “PAD treatment protocols are constantly evolving and have improved dramatically in recent years,” he says. “With new technologies and new classes of medications, we can treat patients now who previously had no other options.”

Better outcomes with multi-disciplinary approach

Where you get treated for PAD can also make a difference, says Dr. Del Conde. “There’s no one single specialist who can treat PAD,” he says. “It requires comprehensive management and close collaboration across all vascular specialties. And that’s exactly what Miami Cardiac & Vascular Institute has been known for over the past 35 years.”

Miami Cardiac & Vascular Institute was founded in 1987 by Dr. Barry Katzen, who Dr. Del Conde says is recognized globally as one of the pioneers of interventional radiology and a leader in advancing cardiovascular medicine. Dr. Katzen, who also serves as chief medical innovation officer for Baptist Health, has always emphasized the benefits of a multi-disciplinary approach in caring for cardiovascular patients. That approach always provides the best outcomes for patients, according to Dr. Del Conde, and has been a hallmark of the Institute since its founding.

In addition, Dr. Del Conde says, Miami Cardiac & Vascular Institute is one of the highest-volume centers for vascular care in the region. “We have the leading vascular specialists in their fields – interventional neurology, interventional vascular radiology, vascular surgery and vascular medicine – all working together to determine your precise diagnosis and best possible treatment plan,” he says.