Do you also feel pain or aching in your legs, especially in your calves, when you walk, especially for short distances? Does it go away after you sit down for a while and rest, but does it come back when you walk? If so, this is something that may be important to you. We call this condition 'Peripheral Artery Disease' , or PAD for short. Let's talk about it simply, in a way that you can understand.
What is 'Peripheral Artery Disease'?
Simply put, Peripheral Artery Disease is a condition where fatty deposits (plaque) build up in the arteries that carry blood to your legs, gradually narrowing them. Think of it like a water pipe getting clogged with dirt and slowly reducing the flow of water. Our arteries are like pipes. They are very smooth on the inside, so blood can flow smoothly without clotting.
However, as this 'plaque' (a layer of fat and cholesterol) gradually builds up on the walls of the arteries, the space inside the artery becomes smaller. In medicine, this is also called 'atherosclerosis' . Sometimes, the hard surface of this 'plaque' ruptures, allowing 'platelets' (a type of blood cell that helps blood clot) to form, further narrowing the artery.
When an artery becomes blocked, blood cannot flow through it. The tissues in the legs that are supplied by that artery are deprived of oxygen and nutrients. This can damage those tissues and eventually cause them to die (gangrene) . This condition most commonly affects the toes and feet.
Some people develop PAD quickly, while others develop it more slowly. There are many other factors that affect this, such as where in your body the plaque is located and your overall health.
How common is this 'peripheral artery disease' (PAD)?
PAD is actually a more common condition than you might think. It is estimated that between 8 and 12 million people in the United States suffer from this condition. However, it is sometimes misdiagnosed and untreated. Therefore, the true number may be higher.
How does PAD affect my body? What are the symptoms?
The main and most common symptom of PAD is claudication . This is pain in the legs (especially the calves) when you walk or exercise. This pain goes away when you rest. This happens because the leg muscles are not getting enough oxygen.
But the effects of PAD are not limited to walking difficulties. This increases the risk of developing nonhealing sores on your legs or feet . If PAD becomes severe, these sores can turn into gangrene, possibly even requiring amputation of the foot or leg. Imagine our uncle Siripala, he can't even walk a short distance to the store, he always says that his leg hurts, it could be something like this.
What are the common symptoms of PAD?
Not everyone with PAD will have symptoms. About 50% may have no symptoms at all. This happens gradually. Symptoms may begin to appear when the artery is 60% or more narrowed.
Common symptoms include:
- Pain, cramping, or aching in the legs or buttocks (intermittent claudication) that occurs when walking or climbing stairs. This decreases with rest.
- Burning, intense pain in the feet and toes (ischemic rest pain) even when at rest, especially when lying in bed at night .
- Cold skin on the feet.
- Seeing redness or other color changes in the skin.
- Frequent skin and soft tissue infections (especially in the feet or legs).
- Non-healing ulcers on the feet and toes.
Important: If you have these symptoms, it is very important to see a doctor as soon as possible for advice. Because if PAD is diagnosed early, treatment can begin before serious complications such as a heart attack or stroke occur.
Are there stages of PAD?
Yes, doctors use several methods to classify PAD. The Fontaine classification is a bit simpler. Here are the stages:
- Stage I: Asymptomatic.
- Stage IIa: Mild leg pain during exercise (mild claudication).
- Stage IIb: Moderate to severe leg pain (moderate to severe claudication).
- Stage III: Pain in the legs even at rest (Ischemic rest pain).
- Stage IV: Ulcers or gangrene.
What are the possible complications of PAD?
If left untreated, people with PAD may need to have a leg or foot (and rarely a hand) amputated . This risk is especially high in people with diabetes mellitus.
Because our circulatory systems are interconnected, the effects of PAD are not limited to the affected limb. People with atherosclerosis in the arteries of the legs can also have the condition elsewhere in the body. This means that a person with PAD is at a much higher risk of developing coronary artery disease, heart attack, stroke, or transient ischemic attack (TIA) , a mini-stroke, than someone without PAD. A person with heart disease has about a 1 in 3 chance of having PAD in the legs.
What is the main cause of PAD?
The main cause is the development of atherosclerosis in the arteries of the legs (and rarely the arms). Just like in the arteries of the heart, fatty deposits (plaque) build up on the walls of the blood vessels, gradually narrowing the arteries and eventually blocking them.
What are the risk factors for PAD?
Tobacco use is the most important and powerful risk factor for PAD and its complications. In fact, 80% of people with PAD are current or former smokers. Tobacco use increases the risk of developing PAD by about 400%. It can also delay the onset of symptoms by up to 10 years.
Compared to non-smokers, people who smoke and have PAD are more likely to have:
- Death from a heart attack or stroke .
- Poor results of bypass surgery on the legs.
- Having to amputate an arm or leg.
Whether you are a woman or a man, you are at risk of developing PAD if you have one or more of these risk factors:
- Use of tobacco products (this is the strongest factor).
- Having diabetes (Diabetes Mellitus).
- Being 50 years of age or older.
- Having African American descent (although this is not very relevant to Sri Lanka, it is good to know).
- Having a personal or family history of heart disease or blood vessel disease.
- Having high blood pressure (Hypertension).
- Having high cholesterol (Hyperlipidemia).
- Abdominal obesity.
- Having a blood clotting disorder.
- Having kidney disease (this can be both a risk factor and a result of PAD).
How is PAD diagnosed? (Diagnosis)
When you see a doctor, he or she will examine you and ask about your medical history and risk factors. Some noninvasive tests may also be done to find out if you have PAD and, if so, how severe it is. These tests can help find out if there is a blockage in a blood vessel:
- Ankle-brachial index (ABI): This measures blood pressure in the ankle and arm.
- Pulse volume recording (PVR).
- Vascular ultrasound.
Sometimes, an invasive test called an angiogram may be necessary to detect arterial blockages.
Can PAD be reversed?
Yes, some studies have shown that exercise and controlling cholesterol and blood pressure can reverse the symptoms of PAD .
With early detection, lifestyle changes, and treatment, PAD can be stopped from getting worse. If you think you are at risk for PAD, or if you already have symptoms, see your family doctor, a vascular medicine specialist, or a cardiologist to start a prevention or treatment program right away.
What are the treatments for PAD?
PAD can be treated with lifestyle changes, medications, and medical procedures.
There are two main goals of PAD treatment:
1. Reducing your risk of cardiovascular events , such as heart attacks and strokes.
2. Reduce pain while walking and improve your quality of life.
Lifestyle changes
PAD treatment starts with making lifestyle changes to reduce your risk factors. Here are some things you can do:
- Quitting tobacco products completely. Ask your doctor about programs that can help you quit smoking.
- Eat a balanced diet that is high in fiber and low in cholesterol, fat, and sodium. Limit fat to 30% of total daily calories. Saturated fat should not exceed 7% of total calories. Avoid foods made with trans fats, such as partially hydrogenated and hydrogenated vegetable oils.
- Exercise. Start a regular exercise program, such as walking. Walking is a good treatment for PAD. People who walk regularly can increase the distance they can walk before their legs hurt.
- Manage other health conditions such as high blood pressure, diabetes, and high cholesterol.
- Keep your stress levels low. Things like exercise, yoga, and meditation can help with this.
- Practice good foot and skin care to prevent infections and reduce the risk of complications.
Medications
Medications such as antihypertensive medications , statin medications, and diabetes medications can help control risk factors for PAD and reduce the risk of stroke and heart attack.
Your doctor may prescribe an antiplatelet medication, such as aspirin or clopidogrel, to prevent blood clots. They may also give you a medicine called cilostazol to increase the distance you can walk. This medicine helps people with intermittent claudication exercise for longer periods of time before their legs hurt.
Supervised exercise programs
A medically supervised exercise program can help reduce leg pain and help you walk further. This usually involves walking on a treadmill at least three days a week.
People with PAD should walk for 30 to 60 minutes a day, even at home. The most common advice is to use the "Start/Stop" exercise:
- Walk until the pain is moderate, then stop.
- Wait until the pain is completely gone.
- Start walking again.
Minimally invasive or surgical treatments
For some people, even after months of exercise and medication, leg pain can be so severe that it interferes with daily activities. In more severe cases, it may be necessary to improve blood flow to reduce pain even when resting, or to help heal an injury.
More advanced cases of PAD, which cause severe pain and walking limitations, may require endovascular (minimally invasive) or surgical treatment. Some of the same treatments used for heart disease are also used for PAD:
- Angioplasty: Widening a blocked artery using a balloon-like device.
- Stent placement: Insertion of a small mesh tube to keep the artery open.
- Peripheral artery bypass surgery: Creating an alternative route for blood flow (often using another vein in the body) to bypass the blocked artery.
- Atherectomy: Removal of plaque deposited inside the artery using a special instrument.
Possible problems after treatment
If you experience any of the following problems after these treatments, you should notify your doctor immediately. These may be signs of an infection or other complication:
- Swelling, bleeding, or pain where the catheter was inserted.
- Chest pain.
- Difficulty breathing.
- Fever or chills.
- Dizziness.
- Swelling of the legs.
- Stomach pain.
- The surgical incision opens.
How long it takes to recover from treatment varies depending on the treatment you had. You may need to stay in the hospital for one or more nights. While an atherectomy may take a few days to recover, an angioplasty may take about a week. A peripheral artery bypass graft may take about 6 to 8 weeks to fully recover.
How to reduce the risk of PAD? (Prevention)
Once you know you have risk factors for PAD, you may be motivated to prevent it. The same advice for keeping your heart healthy applies to taking care of your blood circulation:
- Control your weight.
- Eat a diet that is low in fat, low in sugar, and includes at least five servings of fresh fruits and vegetables daily.
- Do not use tobacco products.
- With your doctor's approval, exercise for at least 30 minutes a day, most days of the week.
If you have heart disease, talk to your doctor about your risk factors for PAD. Tell your doctor about any symptoms you have, such as leg pain, weakness, or numbness.
What can you expect if you have PAD?
Like many health conditions, PAD is easier to treat if it's detected early. The rate at which PAD progresses varies from person to person. It depends on many things, including where the plaque is located and your overall health.
PAD is a condition that you may have throughout your life. Although there is no cure for PAD, you can manage it. You can prevent PAD from getting worse by doing these things:
- Not using tobacco products.
- Exercising regularly.
- Limit fat and eat a healthy diet.
- Managing your risk factors, such as diabetes, high cholesterol, and high blood pressure.
How do I take care of myself? (Self-care)
It is important to take good care of your feet to prevent non-healing wounds. Foot care for people with PAD includes:
- Wear comfortable, well-fitting shoes.
- Check your feet and legs daily for blisters, cuts, cracks, abrasions, or sores. Also look for redness, warmth, ingrown toenails, corns, and calluses. Just like someone with diabetes, you need to take care of your feet.
- Don't delay in treating even a minor foot or skin problem.
- Keep your feet clean and well moisturized (do not apply moisturizer to an open wound).
- After bathing, trim your nails while they are still soft. Cut straight across and file them flat with a nail file.
In some cases, your doctor may refer you to a podiatrist , especially if you have diabetes. He or she can help with bunions, bunions, or other foot problems.
When should you see a doctor?
See a doctor in the following cases:
- If you get a bad infection in a wound on your foot, the infection can spread to your muscles, tissues, blood, and bones. If the infection is severe, you may need to be hospitalized.
- If it is too difficult to walk to do even normal tasks.
- If you have pain in your legs even when you are at rest , this is a sign of poor blood supply.
Emergency: If you can't feel your leg, can't move it, or the skin on it is a different color than the rest of your leg, go to the emergency room immediately. This means that the blood supply to your leg has stopped without warning.
What questions should I ask my doctor?
- Do I need medication to reduce my risk of PAD?
- How far should I walk when I start a walking program?
- Do I need surgical treatment for PAD?
Finally, remember this (Take-Home Message)
You can do a lot to prevent or slow the progression of Peripheral Artery Disease, or PAD, by making lifestyle changes. Keep all your follow-up appointments with your doctor and vascular specialist, and take all of your medications as prescribed. Knowing the warning signs of PAD complications will help you know when to seek help. Take care of your legs, because they will carry you a long way!
` Peripheral artery disease, PAD, leg pain, blocked arteries, blood circulation, smoking, diabetes, cholesterol, atherosclerosis, claudication
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