Peripheral Artery Disease (PAD) Awareness is Growing, But It's Still Underdiagnosed

Lower extremity peripheral artery disease, or PAD, is underdiagnosed, undertreated and “underappreciated” in the U.S., despite its prevalence with an estimated 8.5 million Americans, primarily over the age of 40, having this condition, says the American Heart Association in a new scientific statement.

PAD is a narrowing of the peripheral arteries that carry blood away from the heart to other parts of the body. The most common type is lower-extremity PAD, in which blood flow is reduced to the legs and feet. (September is PAD Awareness Month).

“The magnitude and significance of functional impairment in PAD is underappreciated,” states the AHA’s scientific statement. “Despite difficulty walking long distances, individuals with PAD frequently have atypical leg symptoms that can be mistaken for comorbidities, such as hip or knee arthritis or spinal stenosis. Some clinicians may attribute difficulty walking to normal aging.”

Both PAD and coronary artery disease are caused by atherosclerosis, the buildup of fatty plaque in the arteries that narrows and blocks them throughout the body, including in the heart, brain, arms, legs, pelvis and kidneys.

PAD Carries Many Increased Health Risks

Ian Del Conde, M.D., a cardiologist and vascular medicine specialist who treats PAD patients at Miami Cardiac & Vascular Institute.

Miami Cardiac & Vascular Institute leads and participates in numerous clinical trials involving PAD and other cardiovascular problems. Ian Del Conde, M.D., a cardiologist and vascular medicine specialist who treats PAD patients at Miami Cardiac & Vascular Institute, agrees with the AHA’s position.

“Because peripheral arterial disease produces textbook symptoms of claudication in only a minority of patients, physicians and care providers must have an increased awareness for this diagnosis, which carries increased risk of heart attacks, stroke, and also limb complications, such as amputation,” explains Dr. Del Conde.

Physicians need to be thorough when examining patients with lower-extremity issues. The most common symptoms of lower-extremity PAD are cramping, fatigue, aching, pain or discomfort in the leg or hip muscles while walking or climbing stairs, says the AHA. This pain will likely diminish with rest, but returns when walking again. 

“A focused vascular exam is critical, including an inspection of the patient’s feet, taking the patient’s socks and shoes off, and carefully palpating the ankle pulses,” said Dr. Del Conde. “There are a number of relatively simple diagnostic tests that are readily available that can help confirm the diagnosis of PAD.”

Miami Cardiac & Vascular Institute provides a range of treatments to prevent PAD from worsening, and offers the newest technologies to restore blood flow, if intervention is needed. It also hosts one of the premier annual medical conferences that brings together the world’s best specialists to discuss cutting-edge PAD treatments and other breakthroughs.

“If the diagnosis of PAD is established, patients are typically started on appropriate therapies that help reduce her cardiovascular risk,” said Dr. Del Conde

Who is At Risk?

Anyone can get peripheral artery disease. But there are some risk factors that can make you more prone to PAD, including smoking, high blood pressure and cholesterol, atherosclerosis and being 60 or older. Diabetics and Blacks also have a higher rate of PAD than others.

“Everyone should be having a conversation with their primary care provider about PAD,” Dr. Conde says. “We should be looking at patients’ feet and taking ankle-brachial pulses.” Testing the pulse in the ankles allows a physician to determine if blood is flowing normally down the legs. If blood pressure in the ankles is weak, further testing may be suggested.”

How is PAD Treated?

If you are diagnosed with PAD, your treatment will depend on its severity, location and your general health. Physicians first want to ensure that your disease does not progress, so patients are often put on steroids, as well as medications to lower blood pressure and cholesterol. You may also be given medications to prevent the formation of a blood clot, which can occur when a blood vessel narrows. Finally, you may be asked to make lifestyle changes, such as quitting smoking, losing weight if you are overweight, exercising more and drinking more water.

Options for interventions include a minimally invasive procedure called angioplasty, where a small catheter is threaded through an artery in the groin to the blockage and a balloon is inflated, pushing the plaque against the artery walls. Some patients may need an atherectomy, where plaque is removed from the artery. In either case, a tiny mesh and metal tube, or stent, may be left in place so that the vessel remains open. Others may undergo a bypass procedure, using a blood vessel from another part of the body or a synthetic vessel.

“PAD awareness has been increasing,” Dr. Del Conde says. “But more needs to be done.”