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PATIENT INFO - PERIPHERAL ARTERIAL DISEASE (PAD)
Causes
Peripheral arterial disease, also called PAD, occurs when blood vessels in the legs are narrowed or blocked by fatty deposits and blood flow to your feet and legs decreases. If you have PAD, you have an increased risk for heart attack and stroke. An estimated 1 out of every 3 people with diabetes over the age of 50 have this condition. However, many of those with warning signs don't realize that they have PAD and therefore don't get treatment.
What does diabetes have to do with PAD?
If you have diabetes, you're much more likely to have PAD, a heart attack, or a stroke. But you can cut your chances of having those problems by taking special care of your blood vessels.
Who are at high risk for PAD?
- Smoking
- High blood pressure
- Abnormal blood cholesterol levels
- Overweight
- Not physically active
- Over age 50
- History of heart disease, or you've have had a heart attack or a stroke
- Family history of heart disease, heart attacks, or strokes
You can't change your age or your family history, but taking care of your diabetes and the conditions that come with it can lower your chances of having PAD.
Symptoms
Many people with diabetes and PAD do not have any symptoms. Some people may experience mild leg pain or trouble walking and believe that it's just a sign of getting older. Others may have the following symptoms:
- Leg pain, particularly when walking or exercising, which disappears after a few minutes of rest
- Numbness, tingling, or coldness in the lower legs or feet
- Sores or infections on your feet or legs that heal slowly
Peripheral artery disease symptoms include:
- Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs (intermittent claudication)
- Leg numbness or weakness
- Coldness in your lower leg or foot, especially when compared with the other side
- Sores on your toes, feet or legs that won't heal
- A change in the color of your legs
- Hair loss or slower hair growth on your feet and legs
- Slower growth of your toenails
- Shiny skin on your legs
- No pulse or a weak pulse in your legs or feet
- Erectile dysfunction in men
If peripheral artery disease progresses, pain may even occur when you're at rest or when you're lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.
Tests and diagnosis
Some of the tests your doctor may rely on to diagnose peripheral artery disease are:
- Physical exam – Your doctor may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds (bruits) over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb.
- Ankle-brachial index (ABI) – This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
- Ultrasound – Special ultrasound imaging techniques, such as Doppler ultrasound, can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
- Angiography – By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques, such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment — finding the narrowed area of a blood vessel and then widening it with an angioplasty procedure or administering medication to improve blood flow.
- Blood tests – A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes.
How is PAD diagnosed?
The ankle brachial index (ABI) is one test used to diagnose PAD. This test compares the blood pressure in your ankle to the blood pressure in your arm. If the blood pressure in the lower part of your leg is lower than the pressure in your arm, you may have PAD. An expert panel brought together by the American Diabetes Association recommends that people with diabetes over the age of 50 have an ABI to test for PAD. People with diabetes younger than 50 may benefit from testing if they have other PAD risk factors.
These other tests can also be used to diagnosis PAD:- Angiogram (AN-gee-oh-gram): a test in which dye is injected into the blood vessels using a catheter and X rays are taken to show whether arteries are narrowed or blocked.
- Ultrasound: a test using sound waves to produce images of the blood vessels on a viewing screen.
- MRI (magnetic resonance imaging): a test using special scanning techniques to detect blockages within blood vessels.
Treatments
People with PAD are at very high risk for heart attacks and stroke, so it is very important to manage cardiovascular risk factors. Here are some steps you can take:
- Quit smoking. Your health care provider can help you.
- Aim for an A1C below 7%. The A1C test measures your average blood glucose (sugar) over the past 2 to 3 months.
- Lower your blood pressure to less than 130/80 mmHg.
- Get your LDL cholesterol below 100 mg/dl.
- Talk to your health care provider about taking aspirin or other antiplatelet medicines. These medicines have been shown to reduce heart attacks and strokes in people with PAD.
Studies have found that exercise, such as walking, can be used both to treat PAD and to prevent it. Medications may help relieve symptoms.
In some cases, surgical procedures are used to treat PAD:
- Angioplasty, also called balloon angioplasty: a procedure in which a small tube with a balloon attached is inserted and threaded into an artery; then the balloon is inflated, opening the narrowed artery. A wire tube, called a stent, may be left in place to help keep the artery open.
- Artery bypass graft: a procedure in which a blood vessel is taken from another part of the body and is attached to bypass a blocked artery