Spotlight On: Peripheral Arterial Disease

What is peripheral arterial disease?

Our expert this month is Nancy Harthun, M.D., an Associate Professor of Surgery at the University of Virginia Health System whose specialties include treating patients with PAD.

PAD is atherosclerosis, or hardening of the arteries, that leads to blockages forming in the arteries that supply the legs with blood.

Peripheral arterial disease (PAD) affects as many as 8 million Americans, and people with PAD are at higher risk for limb amputation, heart attack and stroke. But many Americans know little about PAD, its risk factors or its symptoms, according to a survey published this fall in Circulation, the journal of the American Heart Association.

Just 26 percent of those surveyed said they were familiar with PAD; among the survey respondents who were familiar with PAD, just 25 percent knew that PAD is associated with an increased risk for heart attack and stroke, 50 percent knew diabetes and smoking increased their PAD risk and only 14 percent knew PAD could lead to limb amputation.

What are the symptoms of PAD?

Early in the disease, most people have no symptoms. As the disease progresses, the first symptom is called claudication, a discomfort that arises in leg muscles during exertion, such as walking a long distance or walking up hills or steps. This discomfort is relieved soon after the exertion is stopped. Later symptoms can involve unremitting, severe pain in the feet or toes. During the later stages of this disease, skin injuries may not heal or skin ulcers may develop spontaneously.

When should you consult your healthcare provider?

Anyone with symptoms should seek evaluation. If you do not have symptoms, but have one risk factor for the development of PAD, it would be reasonable to seek a screening if you're older than 40. Risk factors include a history of smoking, diabetes, a family history of PAD, high cholesterol and high blood pressure.

Left untreated, what can PAD cause?

If left untreated, severe cases of PAD can result in limb loss. Less severe cases can result in significant limitations on your activities and quality of life.

What steps can you take to prevent PAD?

Treatment of the risk factors prevents PAD or the progression of PAD if you've been diagnosed as having it. Quitting smoking and the medical management of high cholesterol, diabetes and high blood pressure are all critical components to preventing PAD.

How is PAD treated?

The majority of patients with PAD do not require specific treatment, except for addressing the risk factors listed above. Medication and exercise programs can lessen the severity of claudication. In severe cases of PAD, the arteries can be re-opened with balloon angioplasty and stenting. Another good alternative for long-term treatment is surgical placement of a bypass graft to route blood around existing blockages.