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The Hidden Dangers of PAD often Start with Smoking

Perhaps you’ve been walking all day at a theme park or sight-seeing on a family trip when you experience muscle fatigue and cramping in your calves. The pain forces you to stop and rest, then it subsides. But when you hurry to catch up with your group, the searing muscle cramps return, forcing you to stop once again after just a few minutes. What’s going on? 

These are classic symptoms of peripheral arterial disease, or PAD, a widespread chronic circulatory condition caused by plaque gradually building up in the leg arteries. Between 10 million and 20 million Americans are affected by PAD, but many experience no symptoms, according to the Society of Vascular Surgery. Still, they are in danger of the condition silently progressing to the point where blood flow in the affected artery is limited or blocked altogether, and the limb must be amputated. Early detection and treatment are crucial to preventing unnecessary limb loss and catching other blockages in the body. 

Who Is Most At-Risk of PAD? 

PAD is more common in those who are over 55, but can occur at nearly any age. It is caused by a combination of factors — high blood pressure, high cholesterol or triglycerides, diabetes, kidney failure and obesity. But the greatest risk factor by far is smoking. Given that these same risk factors apply to coronary artery disease and stroke, there also is overlap between the three conditions. For example, a patient with coronary artery disease is more likely to have PAD than someone in the general population. 

Keep in mind that this condition often builds up and quietly “hides,” so it is important to recognize symptoms before any significant events occur. If identified early on, lifestyle modification and medical management are often enough to prevent further progression. Men and minorities are considered to be at higher risk of PAD, according to the Cardiovascular Coalition, and are especially in need of improved access to screening and treatments.

Symptoms include:

  • Muscle fatigue or cramping in the calf, thigh, hip or buttock while walking 

  • Pain that becomes progressively worse with distance, increased speed, uphill trajectory and carrying a heavy object

  • Pain in the toes or feet while resting

  • Decreased temperature in limb

  • Hair loss or thinning of skin 

  • Open wounds or ulcers in the toe or foot, often at a pressure point

If you are having difficulty healing lower extremity wounds, you must be evaluated as soon as possible by a vascular surgeon who can help identify blockages and formulate a treatment plan to prevent worsening symptoms or amputation. In more severe cases, patients can experience pain while at rest or develop gangrene of their toes or feet.

Quitting Smoking May Prevent Limb Loss

The management of PAD also includes measures that effectively reduce the overall risk of heart attack and stroke, such as:

  • Quitting smoking.

  • Eating a nutritious, balanced diet.

  • Exercising regularly.

  • Taking prescribed medications to control high blood pressure, high cholesterol or triglycerides, diabetes and kidney disease.

  • Losing weight.

Treatment Options

For patients who are not having problems with wound healing, adopting a “if it isn’t broken, don’t fix it” mentality may apply, as the risk of undergoing a procedure may outweigh the benefits. However, once symptoms become significant and affect quality of life, PAD should be addressed. 

Treatment depends upon blockage location and severity. Often, a minimally invasive intervention is adequate. Vascular surgeons can perform open repairs such as bypass surgeries and cleaning out of blood vessels. Treatment is tailored to your needs for the best possible outcome.


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