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Peripheral Arterial Disease (PAD): The Tip of the Iceberg

September 23, 2016

What is PAD?

PAD, or peripheral arterial disease, is a fairly common medical condition that is caused by reduced blood flow to the legs and feet. This reduced blood flow is a result of partial or complete blockages of the arteries that act as "pipes" carrying oxygen and other nutrients to the legs and feet. The legs and feet need this oxygen to stay alive and to function (for ex: walking). Because these blocked "pipes" cannot carry oxygen efficiently, the legs don’t function as well, which causes pain while walking. If the blockages are severe and numerous enough, this reduction of blood flow may result in tissue death (gangrene).

The condition affects one in every 20 Americans over age 50, amounting to between 8 and 12 million people in the U.S.

What are the symptoms of PAD?

Symptoms of PAD include pain in the legs and feet, color changes in the skin, fatigue, heaviness or cramping in the lower part of the body, especially during movement. In most cases, this pain goes away once the person with PAD stops the activity and gets some rest. Other symptoms include sores or wounds on the lower extremities that heal slowly or don’t heal well at all.

Who is at risk for PAD?

People who have a family or personal history of heart attack, stroke and/or amputations may be at increased risk of developing PAD. Other risk factors include high cholesterol, high blood pressure and certain kidney diseases. Two of the most significant risk factors are diabetes and smoking. One in every three people over age 50 with diabetes is likely to have PAD and those who smoke have a four times greater risk of the condition. If you have a history of cardiovascular disease or stroke, there’s a one in three chance you’ll have PAD.

Can PAD put me at risk for other conditions?

Many other conditions may occur in patients with PAD. This often makes PAD the "tip of the iceberg," with other, more serious conditions lurking below the surface.

The narrowing and blockages that plug our arteries is known as atherosclerotic plaque. This plaque builds up in the arteries over years and even decades, eventually causing them to narrow or block off completely. Because this comes from smoking, the foods we eat and conditions that affect the body as a whole, these blockages can occur in other organs — the heart and brain, in particular. Because of this, patients with PAD have an increased risk of a heart attack or stroke. With this in mind, it’s crucial to control factors that lead to plaque formation in people with PAD.

What can I do about my PAD?

If you’re a smoker, the most beneficial thing you can do is to stop smoking. This is a very difficult, but potentially lifesaving step. Many resources are available to help you quit. You can find a list of them on Controlling blood sugar, cholesterol levels and blood pressure also can help people with PAD.

Your doctor should refer you to a peripheral vascular specialist who can discuss additional options. A peripheral vascular specialist typically will prescribe medication and an exercise program to improve the symptoms of PAD in mild to moderate cases. In severe cases where blood flow is so limited that the ability of the tissue to stay alive (or heal itself of sores) is compromised, more blood flow may have to be brought to the tissue. This is accomplished with procedures that range from minimally invasive to major open surgery. Minimally invasive procedures include opening up the artery from the inside using wires, balloons, atherectomy devices (think Roto-Rooters), and even stents. Major surgery will entail cleaning out the artery directly and bypassing the entire blockage. Each category of procedures has inherent benefits over the other. A visit with your vascular specialist can help you decide which treatment is right for you.