Do your legs hurt when you walk? Could it be Peripheral Artery Disease (PAD)?

Do you experience pain or numbness in your legs, especially when you walk a short distance or climb stairs? Doesn't it go away after sitting for a while? Many people think that this is a normal part of aging or joint pain, but it could be a sign of something more serious. Today we're talking about a condition called Peripheral Artery Disease, or PAD, which causes these symptoms. This is a condition that can be easily managed if detected early.

Simply put, what is Peripheral Artery Disease (PAD)?

Okay, let's put it this way. We have a network of blood vessels ( arteries ) that carry blood to all parts of our bodies, right? It's like the plumbing system that carries water throughout a house. Peripheral Artery Disease (PAD) is when those blood vessels, especially those that carry blood to the legs, hips, and sometimes the arms, gradually become narrowed.

Imagine that over time, the water pipes in your home become rusty and clogged with dirt, reducing the flow of water from the tap. Similarly, things like fat and cholesterol accumulate in our blood vessels and form a 'plaque'. In medicine, we call this (atherosclerosis) . This plaque reduces the space inside the blood vessels. This then hinders the flow of blood through them. That pain starts when the muscles in the legs do not receive the oxygen and nutrients they need from the blood.

This disease affects more than 200 million people worldwide. The risk of developing it increases with age. Therefore, it is very important to be aware of this.

What are the symptoms of PAD?

Many people do not show any symptoms at first. However, as the disease progresses, these symptoms may appear. Let's look at the main symptoms.

For men, this disease can cause impaired blood supply to the penis , leading to erectile dysfunction .

Who is at higher risk of developing PAD?

Although anyone can develop this disease, some people are at higher risk. See if you have any of these risk factors .

• For smokers : This is the main and most serious risk factor . Smoking damages the smooth inner walls of blood vessels and accelerates the formation of clots.
• For people with diabetes : High blood sugar levels can also damage blood vessels. A person with both diabetes and smoking is two to four times more likely to develop PAD than someone without either condition.
• For those with high blood pressure: As pressure increases, the walls of blood vessels become damaged and it becomes easier for clots to form.
• For those with high cholesterol or triglyceride levels: The more fat in the blood, the greater the chance of it being deposited in the blood vessels as plaque.
• For those with chronic kidney disease.
• If someone in your family has had PAD, heart disease, or stroke.

What are the possible serious consequences if left untreated?

If you ignore this, thinking it's just a leg problem, it could have serious consequences.

One is when the blood supply to the leg stops completely and the tissue begins to die. This is called gangrene . If this happens, amputation of a finger, toe, or part of the leg may be necessary to stop the infection from spreading throughout the body. But don't worry, doctors are doing their best to prevent this from happening.

How does the doctor diagnose this disease exactly?

When you go to see your doctor, he will first ask you about your symptoms. Then he will examine your legs. In particular, he will feel the pulses in different parts of your legs to check for any changes in blood flow.

Then, several tests can be done to confirm the disease:

• Ankle-brachial index (ABI): This is a very simple, painless test. It measures the pressure in your arm and the pressure in your ankle and compares the two. Normally, the pressure in your ankle should be slightly higher than the pressure in your arm. If it is low, it means there is a problem with the blood flow to your leg.
• Vascular ultrasound: This is like a scan to see a baby. It can look at the speed of blood flowing through the blood vessels and find any blockages.
• Pulse volume recording (PVR): This measures how much blood is flowing to the legs.
• CT angiogram / MRA (Magnetic resonance angiogram – MRA): These can take detailed pictures of blood vessels and pinpoint the exact location and extent of blockage.

What are the treatments for PAD?

Treatment depends on the severity of your symptoms. In the early stages, they can be well controlled with lifestyle changes and medication.

1. Lifestyle changes

This is the foundation of treatment.

• Exercise: Exercise, especially supervised exercise (Structured Exercise Therapy), is very effective. Here, you are made to walk on a treadmill. When your legs start to hurt, you stop for a while, and when the pain subsides, you walk again. This stimulates the growth of new blood vessels in your legs.
• Heart-healthy foods: It is very important to adopt a diet that is high in vegetables, fruits, nuts, and whole grains, and low in oil and salt.
• Quitting Smoking: I repeat, the best thing you can do for yourself is to quit smoking today if you do. Talk to your doctor for help with this.

2. Medicines (types of medicines)

Your doctor may prescribe these types of medications.

• Blood thinners: They reduce blood clotting and facilitate blood flow. (Ex: Clopidogrel, Aspirin)
• Cholesterol-lowering medications (Statins): They reduce the buildup of plaque in blood vessels.
• Blood pressure medications: Reduce damage to blood vessels.
• Vasodilators: These drugs help to slightly dilate blood vessels, increasing the distance you can walk without pain. (Ex: Cilostazol)

3. Special care for feet

It is very important for someone with PAD to take care of their feet.

• Check your feet daily for wounds, cracks, and discoloration.
• Wash your hands with soap every day and dry them thoroughly, even between your toes.
• Never walk barefoot.
• Use loose, well-fitting, soft shoes and socks.

4. Procedures and Surgeries

If the disease cannot be controlled with medication and lifestyle changes, or if the disease is severe, you may have to resort to this type of treatment.

• Angioplasty: A thin tube (catheter) is inserted into the blocked blood vessel and a balloon-like device is inflated at the end to widen the blockage. Sometimes a small mesh-like device called a stent is inserted to keep it from closing again.
• Atherectomy: Atherectomy involves scraping and removing the plaque inside the blood vessel using a catheter.
• Peripheral artery bypass surgery: Similar to heart bypass surgery, a new artery is created by using a blood vessel taken from another part of the body or an artificial artery to bypass the blocked artery.

When should I see a doctor? When should I go to the ETU?

If you feel these things, definitely see your doctor.

• If symptoms have just started or if existing symptoms are getting worse.
• If walking is so difficult that you can't even do normal tasks.
• If your legs hurt even just standing.
• If you have a wound on your leg that won't heal.

Situations when you need to go to the hospital urgently:

PAD is a lifelong condition. But if managed properly, you can live a normal life. It's important to maintain regular contact with your doctor.

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