What is peripheral artery disease (PAD)?

What is peripheral arterial disease (PAD)?

We may want to start even more basic than this. Arteries by and large carry oxygen rich blood away from the heart where as veins return blood back to the heart and the lungs to be replenished. Arterial disease occurs when the arteries become narrowed (stenosis) or blocked (occluded) with plaque and can no longer perform this vital function adequately. The most common causes for atherosclerotic plaque build up are cigarette smoking, high blood pressure, high cholesterol, and diabetes. Some people also have a genetic predisposition but this is less common. Arterial disease is usually a systemic problem so all arteries are usually involved to some degree, therefore, multiple organ systems may be involved; commonly the heart and kidney’s.

Peripheral artery disease (PAD) refers to the arteries that supply the muscles and tissues in the legs. However, to restate the point that this is a systemic problem, studies have shown that patients with PAD have a 70 to 90% chance of having coronary (heart) artery disease. Many times, PAD is the most obvious sign of a much bigger problem. 

The symptoms of PAD range from leg muscles that cramp while walking to wounds on the feet that don’t heal to gangrene with possible limb loss. Most people will present with leg muscle cramps during exertion. This is known as claudication. This happens because as one walks, the muscles in the legs require more oxygen which the diseased arteries cannot deliver. The pain resolves quickly with rest and recurs with exertion of similar intensity. Claudication is very reproducible in that it will occur with about the same distance of walking or at or about the same level of exertion. It is rare to have pain at rest unless arterial disease is severe. It’s not usually pain when rising from a seated position, leg cramps at night or leg pain that gets better with exercise. 

Treatment depends on the severity of symptoms. Claudication will remain stable for a long period of time especially if you modify and control the risk factors. So if the symptoms are not disabling, you modify  your risk factors (no smoking!), and exercise regularly, you may not need any intervention. If the symptoms are disabling or you have severe symptoms (poor wound healing, rest pain, tissue loss) then both minimally invasive as well as open surgical options may be available. We’ll talk about options to treat PAD in our next blog.

My best to you all,

 

JC

Author
Joseph M Caruso, MD, FACS

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