Peripheral Vascular Disease

Peripheral arterial disease (PAD)

What is peripheral arterial disease? This means the development of plaque/blockages in the blood vessels of the peripheral vascular system, typically the blood vessels of the lower and upper extremities. Plaque is complex to define but in simple terms means deposits of lipids, calcium, smooth muscles over a period of time in a part of the blood vessel. This leads to narrowing of the blood vessels ultimately leading to varying degrees of blockage ultimately leading to symptoms. 

Why is it important to know about it? PAD has been known to be associated with cardiovascular morbidity and morbidity. It is associated with poor quality of life, overall decrease in functional status and limb loss. Despite its known effects, it still remains underdiagnosed and undertreated. A lot of times patients are diagnosed with it when they already have started forming ulceration and gangrene which is the most severe form of the disease process. 

Who is at risk? What are the risk factors?  Some major risk factors include Smoking, diabetes, hypertension and hyperlipidemia. Of these smoking is the major one.  Smoking has more than double the associated with PAD and has significantly worse outcomes. Thus smoking cessation for someone who smokes is one of the mainstays of prevention/progression of the disease. 

What are the signs and symptoms of Peripheral arterial disease? The classic symptom is claudication which means pain in the legs with walking which improves with rest. This pain may be experienced as a cramping sensation . Some people also describe a heaviness in the legs  and fatigue while walking. Depending on the extent of the disease, there can also be loss of hair on the legs, shiny appearance of the legs with some tightness. Interestingly though a major portion of the patient population is asymptomatic or experience atypical leg symptoms. As the disease gets severe it may present with pain at rest and in its most severe form it presents with foot ulceration and gangrene. 

Since PAD is asymptomatic in a majority of patients, screening becomes important. Screening is recommended for patients at risk of developing PAD. This includes patients more than 65 years old, patients 50-64 years old with a family history of PAD or one risk factor, patients less than 50 years with diabetes and an additional atherosclerotic risk factor or patients with known atherosclerotic disease. If you do fall in any of these categories , I would encourage you to talk to your Doctor about PAD screening. 

What is the treatment of Peripheral arterial disease? Lifestyle modification does remain a key aspect of prevention. I cannot stress enough  the importance of smoking cessation, controlling blood sugars , blood pressure and cholesterol. In addition to this there are medications like antiplatelets which can be used to prevent disease progression and also other medications to control symptoms. If symptoms become severe and do not respond to medications or there is evidence of tissue loss then further treatment with invasive, endovascular or surgical treatment may be required. 

When should you see a doctor?  If you are experiencing any of the symptoms discussed above or do meet the criteria to be screened for PAD, then I would recommend you make an appointment with a doctor to discuss this further sooner rather than later.