Ask an Expert: Peripheral Artery Disease (PAD)

Ask an Expert: Peripheral Artery Disease (PAD)

Tuesday, February 20, 2018

Welcome to “Ask an Expert,” a Q&A series with Sarasota Memorial’s team of doctors, nurses, and other health experts, where you can get thorough answers to your health and wellness queries from a local source you can trust. Have a medical- or wellness-related question that you’d like to “Ask an Expert”? Email them to AskAnExpert@smh.com.

It’s estimated that one in 20 Americans over 50 has peripheral artery disease, and between 12 and 20 percent of Americans older than 65 suffer from the disease, though many don’t know they have it because they have no symptoms. We spoke with SMH Cardiopulmonary Rehab Team Lead Meredith Cleveland to learn more about peripheral artery disease, its signs and symptoms, and what can be done to diagnose or treat it.

What Is PAD?

Often referred to as “poor circulation,” peripheral artery disease (PAD) is the most common disease of the arteries. It occurs when leg arteries become narrowed or blocked, restricting blood flow to the legs and feet, and causing leg pain, ulcers or sores. 

PAD is often a sign of a more widespread build-up of fatty deposits in the arteries, known as atherosclerosis. This condition can reduce blood flow to the heart and brain, as well as the legs. 

What are some symptoms of PAD?

People with PAD often do not experience symptoms until the disease is advanced, and most symptoms are the result of leg muscles not getting enough blood. 

The primary symptom is what’s called “claudication,” leg pain that doesn’t go away with continued walking but is relieved by rest. It mostly affects the calves but can begin in the buttock region (hips or thighs) and radiate down the leg. Present in up to 40 percent of PAD sufferers, claudication can feel like your legs are burning, searing, aching or cramping. 

Other common symptoms include:

  • Pain in the legs or feet that wakes you up at night
  • Numbness or sensation loss in the affected leg
  • Toe or foot wounds that will not heal or heal very slowly
  • Differences between limbs’ color and/or temperature
  • Decreased hair and nail growth on the impacted limb
  • Foot pain at rest

What puts me at risk for PAD?

According to the American Heart Association (AHA), people who have cardiovascular risk factors also are at risk for peripheral artery disease. 
Risk factors for developing PAD include:
  • High blood pressure
  • High cholesterol (especially increased triglycerides)
  • Smoking
  • Diabetes
  • Family history of vascular disease
  • Obesity
  • Inactive lifestyle
  • Male over age 50

Why is it so important to diagnosis PAD?

If you have PAD symptoms, diagnosis and treatment are vital to preventing a major cardiovascular event, as well as permanent damage to your limbs. 

Perhaps most critical is the link between peripheral arterial disease and coronary arterial disease. Both conditions are the result of atherosclerosis—the hardening of arteries. 

If atherosclerosis is occurring in the lower extremities, it is likely happening in the arteries leading to the heart as well. The AHA reports that having PAD increases your risk of heart attack and stroke. To minimize risks associated with peripheral arterial disease, talk to your doctor about diagnosis and treatment. 

How is PAD diagnosed?

Most tests used to diagnose peripheral arterial disease are non-invasive or minimally invasive. 

The most common—and simplest—diagnostic test is called the Ankle-brachial index (ABI). Blood pressure measurements are taken on the arms and ankles using an ultrasound device called a Doppler. Ankle systolic pressures are divided by the highest arm pressure to establish an ABI for each leg. This test can be done before and after exercise on a treadmill. 

Sometimes a patient’s vascular history and symptoms is enough for a doctor to diagnose them. However, confirming the diagnosis and assessing the blockage’s location and severity will require further testing. 

Either an angiography X-ray dye procedure or a Computed Tomography Angiography scan (CTA) can be used to more precisely define the blockage’s location, if a procedure is indicated.

How is PAD treated?

PAD treatment options depend on the severity of the case, but they typically combine medical therapies with working to lower lifestyle-related risk factors.

Non-surgical treatment options include:
  • Aspirin regimen
  • Diet changes
  • Smoking cessation
  • Controlling hypertension, high cholesterol or diabetes
  • Prescribed exercise program
If peripheral arterial disease is not diagnosed or treated early, plaque continues to build up along artery walls, and eventually, it can completely block blood flow. When arteries are completely blocked, more invasive treatments are necessary to restore blood flow to the lower extremities and prevent tissue death.

Surgical treatment options include:
Angioplasty and/or stenting—A thin tube or catheter is threaded through the clogged artery. A balloon is inflated, flattening plaque along the artery walls. A metal stent, which sometimes contains clot-preventing medication, can be placed at the balloon site as well.

Bypass—This surgical procedure uses a graft to redirect blood flow around a blocked area. The procedure creates an alternate passage for blood flow, bypassing an obstructed or damaged vessel. The graft can come from a healthy section of the patient's own vein or a synthetic material might be used.

Atherectomy—For this procedure, a vascular surgeon inserts a specialized catheter into a blocked artery to remove a buildup of atherosclerotic plaque from within the vessel. The catheter contains a sharp rotating blade and a collection system that allows the surgeon to remove the plaque from the vessel wall and to collect the resulting debris.

What kind of exercise can improve PAD patients’ conditions?

For PAD patients, a structured walking program can make a big difference, enabling them to double or triple the distance they can walk before symptoms flare up or before hav¬ing to rest. 

To increase endurance and physical capability, PAD sufferers should walk until the point of increasing moderate pain, then rest briefly, and then repeat the process. This improves their ability to walk more than any other known exercise—and most medical and surgical treatments. Not only is walking one of the best exercises for patients with PAD, it is also the simplest and least expensive.

Supervised exercise programs are another option for treating PAD. These programs follow an exercise prescription based on the patient’s goals and health condition, and patients are usually supervised by exercise physiologists. These programs offer a safe setting, which is especially beneficial for those who have other health problems. 

Research has shown that supervised walking program participants improve their walking ability in addition to reducing their risk for heart disease and stroke. 

Sarasota Memorial now offers supervised exercise programs for PAD patients at two locations: Call 941-917-6725 (Clark Road facility) or 941-257-2850 (North Port facility) for more information.


Meredith ClevelandSarasota Memorial's Cardiopulmonary Rehabilitation Team Lead Meredith Cleveland, BS, CCRP, is also the program director for the SMH Ornish Reversal Program. As an exercise physiologist, she has a passion for improving people’s health and overall well-being and works very closely with patients with cardiac and pulmonary diseases and other medical issues. 
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