September is Peripheral Arterial Disease Awareness Month—and far too many of us don’t realize how common and dangerous this disease is. PAD is the leading cause of amputations in this country, and one person in 20 over the age of 50 has PAD.
Most of us have heard how clogged arteries can lead to heart attacks. But did you know the same disease process—atherosclerosis—that causes those arteries to harden and narrow can do the same to the vessels that take blood to your arms and legs?
Where sticky plaque clings to the walls of your arteries, blood can’t flow as easily. If the blockage affects the arteries going to your arms and/or legs, you have PAD.
The risky business of PAD
Like other forms of cardiovascular disease, PAD can affect anyone. But there are risk factors for PAD—some of which can be controlled and some which can’t. Some of the major risks include:
- Smoking: Some estimates put smokers at a 400 percent higher risk of PAD than nonsmokers.
- Diabetes: PAD and other cardiovascular diseases are more likely in people who suffer with diabetes.
- High cholesterol: The buildup of plaque in the arteries is linked to having high cholesterol levels.
- High blood pressure: This risk factor for PAD, stroke and other cardiovascular problems rarely has symptoms, so it’s important to have your blood pressure checked regularly.
- Aging: Unfortunately, your chances of developing PAD increase as you age. More than 10 percent of people over the age of 65 have PAD.
- Obesity: Having a body mass index (BMI) of 25 or higher increases the chances of developing cardiovascular disease, including PAD, especially in older adults.
More than 90 percent of PAD patients have at least one other chronic disease like diabetes or heart disease. Maintaining a healthy lifestyle and managing any diseases or conditions you have will keep you healthier in every way, including helping you avoid PAD.
When pain isn’t gain
Thanks in part to gravity, your legs are particularly impacted if blood flow is restricted. That’s why painful cramping or fatigue in your legs that begins and ends with exercise may be an early sign of PAD. Leg pain during sleep can also be a symptom of PAD.
Many signs of PAD are ignored since they are similar to the more typical aches and pains we all experience as we age. Some of the clues include:
- Sores or ulcers on your feet or limbs that don’t heal or heal slowly
- Nails and/or hair on limbs growing slowly
- One leg feeling colder to the touch than the other
- Limbs changing color—turning blue or pale
- Numbness or tingling in your hands or feet
Unfortunately, close to half of PAD cases go undetected. When PAD isn’t treated, you’re at a higher risk of losing a limb to amputation. This is because the tissues in your limbs aren’t getting the blood flow they need to stay alive, leading to tissue death, or gangrene.
Simple tests for PAD
Anytime you have concerns about the health of your limbs, you should see your primary care provider. Undiagnosed PAD is dangerous to your limbs as well as to your life. Your doctor will ask you about your symptoms, and a physical exam will add more information.
If your provider suspects you may have PAD, they may recommend a test to check. Common tests include:
- Ankle-brachial index: This simple blood-pressure test compares your pressure at your arm and at your ankle. Your provider can perform this test during your exam. If the test shows you’re not getting as much blood flow in your legs, your doctor will advise you on additional tests.
- Ultrasound with Doppler: Sound waves allow your provider to measure the blood flowing through your artery. If the blood isn’t flowing well, it may indicate a blockage.
- CT angiography: This special form of X-ray creates an image of your arteries and can be especially useful if you have a pacemaker or stent.
- Magnetic resonance angiography: Similar to an MRI, MRA creates an image of your arteries using magnetic fields instead of X-rays.
- Angiography: This form of X-ray imaging uses a contrast agent (a kind of dye) injected into your artery to detail the blood flow in your arteries and pinpoint any blockages.
A lifestyle for limb life
Depending on the severity of your symptoms and blockage, you may be able to improve your PAD through lifestyle changes and medications. This means you could feel better and literally save an arm and a leg by avoiding complications that lead to amputation.
PAD symptoms can be improved through regular physical activity. Like patients with other cardiovascular conditions, you’ll need to be on a special exercise program called cardiac rehabilitation.
Eating a heart-healthy diet will lower your risk of further PAD complications. Eating well will help you keep your cholesterol lower and reduce how much plaque builds up in your arteries—in your limbs as well as around your heart.
Your provider may also want you to take high blood pressure medications or drugs that lower your cholesterol. Sometimes a daily aspirin is recommended as well. Depending on your particular situation, your doctor may have you take medication to prevent blood clots.
It’s also important to reduce your risk factors for PAD. If you’re a smoker, you need to stop. It’s not easy to do that alone, but Adventist Health Portland offers a supportive stop-smoking class to help you take this important step for your legs, your arms, your heart and your lungs.
If you have Type 2 diabetes, managing your diabetes is a huge part of reducing the chance you’ll suffer the more severe complications of PAD like ulcers and amputations. Because diabetes can cause numbness in your feet known as neuropathy, it’s important to check your feet and legs for sores every time you take of your socks.
Saving life and limb
While most patients improve their PAD symptoms through lifestyle changes, sometimes minimally invasive treatments or even surgery are needed to relieve a blocked artery.
Nonsurgical procedures include inserting a thin tube, called a catheter, into your artery and then either:
- Stretching the narrow spot with a little balloon (angioplasty)
- Inserting a wire mesh cylinder (stent) to hold the narrow spot open
- Cutting away the blockage with a miniature knife (atherectomy)
“Fortunately most patients can be treated with these procedures, which involve just a tiny incision,” says Dr. Jed Peterson, an interventional radiologist with Adventist Health. “The sooner we can address your disease, the more likely you can avoid surgery.”
In the most severe cases, surgery may be needed. This might involve an arterial bypass, during which your surgeon will use a vein from another area of your body will be used to reroute or “bypass” blood flow around the clot.
If the lack of blood has caused your limb tissue to die, you may have to have the damaged tissue amputated entirely. That is physically and emotionally traumatic—all the more reason to look for early signs of PAD and to fully follow your provider’s recommendation for treating your condition.
A team in your fight against PAD
To avoid such worst-case scenarios, it’s important for you to team with your primary care provider to watch for signs of PAD, especially if you have risk factors for the disease.
If you get PAD, you’ll also need to team up with heart and vascular specialists like those at Northwest Regional Heart & Vascular to help you manage your condition and improve your symptoms.
And as summer shifts into fall, take a look at the risk factors you can control when it comes to PAD. Challenge yourself to shift your lifestyle for a healthier you in any season.
Author: LivingWell PDX Blog
Adventist Health is committed to creating a healthier Portland community.