The Triad That Leads to P.A.D.
P.A.D. or Peripheral Arterial Disease is a disease of the circulatory system where blood flow to the periphery of the body, mainly the legs, is compromised or blocked. The blood vessels flowing towards the legs become compromised when plaque builds up within their walls. Plaque is a thick material, which can be made of fat, calcium or cholesterol and deposition within the blood vessels is a result of Atherosclerosis (hardening of the arteries). It builds up over a series of years going unnoticed by the patient and unfortunately when symptoms do arise, the degree of blockage is usually greater than 50%.
Due to the nature of the disease and the compromised blood flow to the legs, the tissues within the leg and foot do not receive adequate oxygen needed for optimum function. Therefore, they are forced to function without their appropriate requirements and the patient begins to experience symptoms. Symptoms take the form of “intermittent claudication:” pain in the calves after periods of walking. The only relief for intermittent claudication pain is rest. After a short period of rest, the pain subsides and the patient can begin walking once again. As the amount of disease increases, the pain becomes greater and the distance a patient can walk before pain ensues decreases. In severe cases of P.A.D. patients will experience ischemic type pain, or rest pain: pain in the legs, feet or toes without periods of activity that can be so severe that it keeps patients awake at night. Eventually, if the blood flow is extremely compromised or discontinued all together, tissue loss can result meaning that ulcerations on the toes will not heal, will become infected, and will likely need to be amputated.
The risk factors that increase a patient’s chances of developing Atherosclerosis and subsequent Peripheral Arterial Disease and are three: High Blood Pressure, High Cholesterol, and Smoking. Diabetes can also contribute to the disease, but keep in mind that although Peripheral Arterial Disease is commonly seen in the diabetic patient, it is not limited to that patient population alone.
If you are experiencing pain in your legs with walking/exercise that wasn’t there before and/or have any of the risk factors for P.A.D., see your Podiatrist at your earliest convenience! They will check the blood flow to your legs by doing a pulse exam; seeing if they can feel flow through the arteries traveling from your abdomen down into your legs. If they are unable to feel the flow, they will likely send you for additional tests at a Vascular Laboratory, where the level of blood flow in the legs can be determined. These tests are typically non-invasive and will take less than a half-hour to complete.
Once your symptoms have been confirmed and you are diagnosed with P.A.D. treatment options can be discussed with your Podiatrist or a Vascular Surgeon. It is likely that no treatment methods will be implemented if you can tolerate the symptoms, but once symptoms become intolerable, both non-surgical and surgical options can be discussed including oral medications, endovascular procedures or bypass procedures.
The most important thing patients can do to help themselves is to QUIT SMOKING. After that, it is important that you work with your Primary Care Physician to control your high cholesterol and high blood pressure. As was discussed, diabetes can also play an important role in development and progression of P.A.D., so, if you are diabetic it is imperative that you manage your blood glucose levels to control the disease and the associated risks that come along with diabetes itself.