Peripheral Artery Disease (PAD)

Do you get leg pain after walking a short distance? Leg pain with exercise may mean you have peripheral artery disease (PAD). PAD occurs when atherosclerosis, or hardening of the arteries, causes a buildup of plaque in the arteries to the legs. The buildup of plaque causes a narrowing or occlusion of the artery and the muscle cannot get enough oxygen. Early on, PAD causes pain, just like angina makes our heart muscle hurt. More severe cases can lead to pain at rest, ulcers, infections, gangrene and amputation.

We all get some degree of PAD with age. Other risk factors are smoking, diabetes, high cholesterol, high blood pressure and a strong family history of vascular disease. PAD affects between 8-12 million people in the United States- but at least half of those affected have no obvious leg symptoms. This is important because people with PAD are 3-6 times more likely to die from a heart attack or stroke.

Although there is no cure for PAD, there are ways to stop the progression and improve symptoms in milder forms. Cessation of smoking, controlling diabetes, cholesterol and high blood pressure are important in stopping progression of PAD. Exercise and some medications may improve symptoms in some cases.

The major symptoms of PAD are: pain in the muscles of the leg involving the calf and/or buttocks during walking or exercise or pain in the ball of the foot and toes. Foot pain at night may improve when hanging one’s foot off the bed or getting up to walk. Ulcers or sores on the foot that will not heal, and gangrene of the toes or foot are signs of severe, advanced PAD.
PAD is diagnosed by physical exam of the arteries of the legs. If pulses cannot be felt, then a noninvasive test can be done to determine the pressures and the degree of PAD. For mild symptoms that do not interfere with one’s lifestyle, a simple exercise program with certain medications may be all that is needed.

For more severe forms of PAD - pain that interferes with one’s lifestyle, some cases of severe pain, non-healing ulcers, gangrene - an angiogram (dye test) will be needed to determine the treatment. If the vessel is narrowed or if there is a short occlusion or blockage, the area may be treated with a balloon angioplasty, and in some cases, a stent may be indicated (similar to the treatment of coronary arteries). This is usually carried out in the angiography suite in the hospital as an outpatient procedure.

If an angioplasty cannot be done, surgery may be necessary. This involves a bypass around the occluded segment with the patient’s own vein (like a heart bypass) or with an artificial graft material.

If PAD is left untreated, the more severe forms can lead to amputation of the toes, foot or leg. More information can be obtained from: American Vascular Association (www.vascularweb.org or 1-877-AVA-2010), or Vascular Disease Foundation (1-866-PAD-INFO or 1-866-723-4636) www.vdf.org.

John D. Frusha, MD is a board certified vascular surgeon with Vascular Associates of Baton Rouge.