HEALTH MATTERS 12/17: Seek Treatment for P.A.D. to Avoid Future Complications

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By Elliot Sambol, MD, FACS

More than 8.5 million U.S. adults over age 40 suffer from peripheral artery disease (P.A.D.) and many are unaware they have it, according to the American Heart Association.

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Peripheral artery disease is a narrowing or blockage of the blood vessels that carry blood from the heart to the extremities. The disease is primarily caused by a buildup of fatty plague in the arteries, which is called atherosclerosis, and it most often occurs in the legs.

A complex disease process, P.A.D. can lead to other health complications, including limb loss, and can also be an indication of other blockages in arteries in other parts of the body, such as the heart, brain, and stomach.

The Center for Vascular Care at Penn Medicine Princeton Medical Center offers screening, diagnosis and treatment for a wide range of vascular diseases, including P.A.D.

Understanding Your Risk

P.A.D. is most often diagnosed in older adults. However, in most cases it starts developing much earlier in life through a slow process that takes place over years or decades.

In general, people who smoke or have diabetes are at greatest risk of developing the disease, due to damage to and narrowing of the blood vessels.

Other common risk factors include:

• Obesity or a BMI of over 30
• High blood pressure
• High cholesterol
• A family history of vascular or cardiovascular disease

Family history is an important factor. Individuals with multiple family members who have had P.A.D., are almost twice as likely to develop the disease as someone without a family history. This risk is even higher if P.A.D. develops in family members when they are younger than 68.

Recognizing the Symptoms

The reduced blood flow caused by P.A.D. can lead to painful cramping in one or both of your hips, thighs, or calf muscles after certain activities, such as walking or climbing stairs.

Once you feel this type of pain, it may mean that the disease has already progressed to the point where it can compromise your daily functioning.
Other signs and symptoms that can be indicators of P.A.D., include:

• Leg numbness or weakness
• Coldness in your lower leg or foot
• Sores that won’t heal on your toes, feet, or legs
• Change in the color of the skin on your legs
• Shiny skin on your legs
• Hair loss or slower hair growth on your legs and feet
• Slower growth of your toenails
• No pulse or a weak pulse in your legs or feet
• Erectile dysfunction in men

Diagnosing and Treating

Early diagnosis and treatment of P.A.D. are important, as the condition can be progressive. If left untreated, the disease could result in wounds or sores that will not heal, limb loss, heart attack, stroke, or other complications.

If you have signs of P.A.D., the first step is to consult with your primary care doctor, who will review your medical history and perform a physical exam, including feeling for pulses in your legs and feet.

Your doctor can diagnose and help you manage the condition by treating any underlying medical problems and developing an appropriate program of exercise and lifestyle changes.

In more advanced cases, you may be referred to a board certified vascular surgeon, who will continue the diagnostic process, often using non-invasive studies to confirm the diagnosis.

Treatment for more severe cases of P.A.D. may involve a minimally invasive endovascular procedure where a small needle is used to access the body’s system of arteries. Once the blockage is identified, there are many different surgical tools that can be used to open the narrowed artery, such as angioplasty. Angioplasty involves inserting a tiny balloon into the artery to clear the blockage and then placing a stent to help prevent the artery from becoming blocked again in the future.

Traditional artery bypass surgery can also be performed to clear arteries.

Preventing P.A.D.

Heart healthy habits can help protect against P.A.D. and a variety of other common cardiovascular conditions. These habits include:

• Quitting smoking
• Maintaining a healthy weight
• Keeping your blood sugar and diabetes in good control
• Eating foods that are low in saturated fat
• Exercising regularly — aim for 30 to 45 minutes of exercise several times a week after receiving your doctor’s approval
• Maintaining healthy cholesterol and blood pressure levels

If you are at risk for P.A.D., seek the proper medical attention to treat your risk factors, and avoid smoking. If you have symptoms of P.A.D., see your doctor for an evaluation and possible referral so you can avoid future complications.

To find a physician affiliated with Penn Medicine Princeton Health, call 888-742-7496, or visit www.princetonhcs.org.

Elliot Sambol, MD, FACS, is a board certified vascular surgeon and a member of the Medical Staff at Penn Medicine Princeton Health.

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