Peripheral
Artery Occlusive Disease (PAD) & Claudication
Common Questions & Answers
What is peripheral arterial disease(PAD)?
What are the symptoms of PAD?
Who is at risk for PAD and intermittent claudication?
How is PAD diagnosed?
How can PAD be treated?
What can be done to treat PAD when lifestyle changes and medications
are not enough?
How can I find out if I have PAD?
Who are Interventional Radiologists?
What is peripheral arterial disease (PAD)?
Answer: Peripheral arterial disease, or PAD, is a condition
in which the arteries that carry blood to the arms or legs
become narrowed or clogged, interfering with the normal flow
of blood. The most common cause of PAD is atherosclerosis (often
called hardening of the arteries). Atherosclerosis is a gradual
process in which cholesterol and scar tissue build up, firming
a substance called ”plague” that clogs the blood vessels. PAD
may also be caused by blood clots.
What are the symptoms of PAD?
Answer: The disease, which affects both men and women, often
goes undiagnosed and many people mistakenly think the symptoms
are a normal part of aging.
The most common symptoms of PAD is called intermittent claudication,
a painful cramping in the leg or hip, particularly when walking.
Intermittent claudication occurs when there is not enough blood
flowing to the leg muscles during exercise. The pain typically
goes away when the muscles are given a rest.
Other symptoms may include numbness, tingling or weakness
in the leg. In severe cases, you may experience a burning or
aching pain in the feet or toes while resting, or develop a
sore on the leg or foot that does not heal. People with PAD
may also experience a cooling or color change in the skin of
the legs or feet, or loss of hair on the legs. In extreme cases,
untreated PAD can lead to gangrene, a serious condition that
may require amputation of a leg or a foot.
If you have PAD, you are also at higher risk of heart disease
and stroke.
Who is at risk for PAD and intermittent claudication?
Answer: As many as 1 million Canadians have PAD. It is estimated
that 4 million of those suffer leg pain symptoms. These who
are at highest risk are:
- Over the age of 50,
- Smokers,
- Diabetic,
- Overweight,
- people who do not exercise, or
- People with high blood pressure
or high cholesterol.
A family history of heart or vascular disease many also put
you at higher risk for PAD.
How is PAD diagnosed?
Answer: The most common test for PAD is the ankle-brachial
index (ABI), a painless exam in which ultrasound is used to
measure the ratio of blood pressure in the feet and arms. Based
on the result of your ABI, as well as your symptoms and risk
factors for PAD, the physician can decide if further tests
are needed. PAD also can be diagnosed non-invasively with an
imaging technique called magnetic resonance angiography (MRA|,
or with computed tomography (CT) angiography.
How can PAD be treated?
Answer: The best treatment for PAD depends on a number of
factors, including your overall health the severity of the
disease. In some cases, lifestyle changes are enough to halt
the progression of PAD and manage the disease. Your physician
may prescribe drugs when lifestyle changes are not enough.
Procedures that open clogged blood vessels also are sued to
treat PAD.
Lifestyle changes. Most treatment plans will include a low
fat diet and a program of regular exercise. If
you are a smoker, it is absolutely essential that you stop
the use of all types of tobacco. If decreased blood flow to the legs is causing
injury to the feet and toes, a foot care program to prevent
sores or infection may be prescribed. This may include referral
to a podiatrist.
Medication: Medications that lower cholesterol or control
high blood pressure may be prescribed. Medication also is available
that has been shown to significantly increase pain-free walking
distance in people with intermittent claudication. Other medications
that help prevent blood clots or the build-up of plague in
the arteries are available, as well.
What can be done to treat PAD when lifestyle changes and medications
are not enough?
Answer: There are a number of ways that physicians can open
blood vessels at the site of blockages and restore normal blood
flow. In many cases, these procedures can be performed without
surgery using modern, interventional radiology techniques.
Interventional radiologists are physicians who use tiny tubes
called catheters and other miniaturized tools and X-rays to
do these procedures.
Procedures performed by interventional radiologists include:
- Angioplasty - a balloon is inflated to open the blood
vessel.
- Thrombolytic therapy – Clot-busting drugs are delivered
to the site of blockages caused by the blood clots.
- Stents – a tiny metal cylinder, or stent, is inserted in the clogged
vessel to act like a scaffolding and hold it open.
- Stent-grafts – a stent covered with synthetic fabric is inserted into
the blood vessels to bypass diseased arteries.
Sometimes, open surgery is required to remove blockages from
arteries or to bypass the clogged area. These procedures are
performed by vascular surgeons.
How can I find out if I have PAD?
Answer: If you suspect that you may have PAD, it is important
that you see your personal physician for an evaluation.
Who are Interventional Radiologists?
Answer: Interventional radiologists are doctors who specialize
in minimally invasive, targeted treatments performed using
imaging for guidance. They use their expertise in reading X-rays,
ultrasound, MRI and other diagnostic imaging, to guide tiny
instruments, such as catheters, through blood vessels or through
the skin to treat diseases without surgery. Interventional
radiologists are board-certified and fellowship trained in
minimally invasive interventions using imaging guidance. Your
interventional radiologist will work closely with your primary
care or other physician to be sure you receive the best possible
care.
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