Microsoft word - peripheral arterial disease 2.docx

By Christopher J. Bosarge, MD Peripheral arterial disease (PAD) affects over 10 to 12 million people. PAD occurs when the arteries that deliver blood from the heart to the body become narrowed from the accumulation of fatty deposits on the artery wall known as plaque. The process is called atherosclerosis. PAD most commonly affects the legs but can affect blood flow to other organs such as the arms, kidneys and stomach. The process is the same as that which narrows the blood vessels in the heart causing a heart attack or to the brain which can cause a stroke. There is a good chance that someone with PAD will go undiagnosed because almost half the time there is no symptoms. If this is the case, why should one care? Well. anyone with PAD has at least a five times greater risk of having a heart attack or stroke! It has also been shown that if a person has PAD their life expectancy is substantially reduced as compared to someone without PAD ~ mostly due to the adverse cardiovascular events. Another issue worth mentioning is that the most common symptom, leg pain when walking, is often dismissed by the patient or even the doctor as just a sign of getting old or related to joint or muscle aches. In this situation, the patient may go months or years without being correctly diagnosed and once again miss out on timely treatment. There is good news. Diagnosing PAD is quite simple with a test called the ankle brachial index. This test measures the blood pressure in the legs and compares it to the arm. It literally takes a few minutes to perform and is completely painless. The challenge, however, is to get those individuals considered at risk tested. As a result, extensive efforts are being made to promote public awareness of PAD. If you are ⇒ over 50 years old, smoke and/or diabetic -or- ⇒ 65 years and older You should get tested! There is at least 12% chance or higher that you have PAD in these situations. What do you do for PAD if there are no symptoms? If diagnosed with PAD, it becomes extremely important to identify which risk factors are present and modify them. This is done with lifestyle changes like smoking cessation, blood sugar control in diabetics, diet and exercise. Medications such as statins maybe prescribed to control high cholesterol and others to manage high blood pressure if present. A patient should also take an antiplatelet medication, typically aspirin, every day. If leg pain is present, it is treated the same way but a supervised walking program will be encouraged and a medication called cilostazol may be given. These measures alone may improve the leg pain if not too severe. The most common symptom of PAD is leg pain described as cramping either in the calf, thigh or even buttock when walking and goes away with rest. Sometimes the pain becomes quite severe and can significantly interfere with lifestyle. If conservative treatment fails to improve the symptoms, then non surgical procedures may be attempted to increase blood flow to the leg. These procedures include angioplasty, stent placement, and /or atherectomy. Angioplasty involves using a balloon to dilate the vessel. A stent is a metallic tube that is used to dilate the vessel and push the plaque out of the way if angioplasty fails. Atherectomy is a process where some of the plaque is removed from the artery wall by shaving it with a small cutter. The shavings are collected in a chamber and removed from the body. Anyone of these procedures can be used and which one would depend on the location, extent and type of plaque. Are there other leg symptoms that can occur with PAD? Absolutely. Some patients can have leg pain even at rest if PAD is severe. The worst thing that can occur is ulceration. This indicates PAD is quite severe and if left untreated can result in amputation. This is particularly important for anyone who is diabetic where the risk of amputation can be as high as 25%. This is why it is imperative that all diabetics undergo routine foot inspections checking for ulcers or open sores. Less typical symptoms include things like numbness, tingling or coldness in the leg. PAD is a systemic disease that will become more common as the population ages. Fortunately, diagnosing PAD is easy, but, there is a continuous challenge in making the public aware of the disease so that testing can be initiated in those high risk individuals. With the medications and technologies that are now available to treat the risk factors and symptoms, getting diagnosed can literally be a life saving event.

Source: http://weartv.com/health/features/health_watch/microsite/coastal_vascular_pad.pdf