This brochure has been developed by Jackson Heart Clinic to help you understand Peripheral Artery Disease (PAD). The cardiologists and staff know that an informed patient can better participate in decisions that impact health care. Working with you, we can better diagnose your problem and start treatment that will help prevent venous ulcers from becoming worse and help you enjoy life as fully as possible.
What is it?
To understand Peripheral Artery Disease or PAD, it is important to remember how much we depend on the cardiovascular system to support life. This system consists of the heart and the blood vessels. The heart is the pump that keeps the blood moving throughout the body. The blood vessels are the pipes that carry the blood to and from the heart. Arteries carry blood away from the heart. Veins carry blood back to the heart. The whole purpose of this system is to carry fresh blood that is full of oxygen and nutrients to the entire body. It then brings oxygen-depleted blood back to the lungs to start the cycle all over again.
When your circulation is impaired for any reason, your body simply cannot get the oxygen and nourishment that it needs.
Peripheral Vascular Disease (PVD) is a broad term that describes any disease or disorder of the blood vessels that are outside of the heart. There are many types of PVD. The focus of this brochure will be to discuss Peripheral Artery Disease (PAD).
Peripheral Artery Disease (PAD) is a narrowing of the peripheral arteries that bring blood to the body. It is a very common problem affecting one of every twenty Americans over the age of 50. Up to 75% of patients that have PAD will have no symptoms. The diagnosis of PAD also increases the likelihood of a heart attack or stroke.
Research shows that people are not well informed about PAD. It is increasingly common among our patient population. Women, in particular, are increasingly diagnosed with PAD. This parallels the increased rates of obesity among women.
Is PAD dangerous?
If PAD is not treated it can become dangerous and even become life-threatening. The disease of blood vessels leading to the brain can cause a stroke. Blockage in the blood vessels to the limbs can cause significant pain and lifestyle limitations. It ultimately can lead to amputation. Tissue without adequate blood flow can die.
The good news is that PAD can be managed or even reversed with proper care! That is why it is vitally important to understand the disease process and have an adequate diagnosis.
What causes PAD?
Atherosclerosis is the main cause of peripheral vascular disease. Atherosclerosis is the build-up of plaque in blood vessels. This causes the opening in the blood vessels to become progressively narrowed until the blood has difficulty passing. They may become completely blocked resulting in severe limitations of blood flow. These severe blockages are often the cause of a heart attack, stroke, and limb loss.
Other less common causes of PAD include injury, an irregular anatomy (abnormal structure) of muscles or ligaments, infection, previous radiation exposure, various connective tissue disorders, and aneurysm. All of these can damage vessels or disrupt blood supply.
What are the symptoms of PAD
Many people do not have any symptoms related to PAD. Those that do, however, most commonly experience pain in the affected extremity. We mostly think about the lower extremities, but this can also affect the hands and arms. Pain can be associated with a tired, weak, heavy, or numb feeling. In severe cases, the pain may be ongoing and occur at rest. Tissue lacking blood flow may develop wounds and ulcers. This can lead to amputation. Pain can be minor to severe.
Claudication is pain that occurs in the buttocks, thigh, or calf of the leg with exercise and typically goes away within five minutes after exercise is stopped. The pain may occur off and on, like cramps (intermittent claudication). This is usually a classic symptom associated with PAD of the lower extremities.
How is PAD diagnosed?
Ankle-Brachial Index (ABI): This is a noninvasive test that involves the use of blood pressure measurements to determine blood flow and pressure differences between the arms and legs. The pressures are supposed to be the same in your arms and legs. If the leg pressure is a lot less, it means that there may be a blockage in the arteries of the legs.
Doppler/ultrasound studies: This noninvasive exam measures blood flow within blood vessels, tissues, and organs by looking directly at the vessels with an ultrasound probe. It can directly visualize the blockage or more commonly, estimate blockage based on the speed in which blood is flowing through a vessel.
Angiograms and Computed Tomographic Angiography (CTA): An angiogram involves injecting a dye into an artery and then taking X-rays that will show whether or not there is a blockage or a narrowing. CTA can be used to examine any arterial system in a noninvasive way. The direct angiograms involve placing a tube directly into the artery to be studied.
What are the treatments for PAD?
The first and foremost treatment for any vascular disease is the modification of existing risk factors.
What are the risk factors?
Your cardiologist will address your risk factors and will develop a treatment plan especially designed for you. Risk factors can be reduced by making lifestyle changes. However, often a medication will be needed to reduce levels of cholesterol and help keep the blood flowing. If you need help with these changes, your cardiologist will offer more detail and support. In addition to slowing the progression of the disease, treatment is also aimed at lowering your risk of a heart attack, stroke and other serious complications of vascular disease.
The treatment recommended by your cardiologist depends on your age and overall health, the severity of your PAD, and most importantly, the symptoms that you are suffering from.
Treatment of PAD may include one or more of the following:
- Lifestyle changes: Symptoms of PAD will often decrease with certain lifestyle changes. When such changes are made, it may also keep the disease from becoming worse.
- Medication: Your cardiologist may prescribe different types of medications for:
- Revascularization & surgery:
Percutaneous intervention (PCI): The goal of PCI is to improve the flow of blood within a blood vessel in a minimally invasive manner. This is done by inserting a catheter in the artery to be treated and then threading an instrument into the narrowed blood vessel. Angioplasty opens the vessel by inflating and deflating a tiny balloon. Atherectomy involves removal of the atherosclerotic plaque from the body. Stenting involves the insertion of a tiny wire mesh expandable tube (stent) that helps to prop open a blockage.
Generally, surgery is not needed to treat PAD, except in very advanced cases. Surgery to improve blood flow is commonly known as a bypass and involves taking a graft (usually a vein or sometimes an artificial tissue) and using it to literally bypass a blocked blood vessel. The cardiologist considers many different options before recommending a procedure.
Foot care… A must for those with PAD!
Those with PAD must be especially careful about caring for their feet. When circulation in your feet is poor, you are more prone to infection and sores that do not heal well. Good foot care can prevent complications like gangrene and amputation.
Tips for foot care include:
Remember these important facts!
This brochure has provided thorough information about PAD symptoms, diagnosis, and treatment. Although PAD can be serious and even life-threatening, it can be treated so that your symptoms are manageable and the progress of the disease lessened. With your new knowledge of the problem, you can work with your cardiologist at Jackson Heart Clinic to develop a plan that works best for you and your unique needs. It is our goal for you to have the highest possible level of cardiovascular health!
Explore these resources for more information about PAD. American Heart Association (Local)
4830 McWillie Circle
Jackson, MS 39206
Phone: (601) 321-1200
Fax: (601) 321-1201
American Heart Association (National) Customer Service
Center for Disease Control (CDC)
Division for Heart Disease and Stroke Prevention
For Peripheral Artery Disease Fact Sheet http://www.cdc.gov/DHDSP/data_statistics/fact_sheets/fs_PAD.htm
For General information: firstname.lastname@example.org
4770 Buford Hwy, NE Mail Stop F-72
Atlanta, GA 30341-3717
American College of Cardiology: Cardio smart www.cardiosmart.org
National Institutes of Health
National Heart, Lung, and Blood Institute, National Institutes of Health – NHLBI At this website you will find links to information about every aspect of PAD. You can also write or call for a hard copy of the information. email@example.com www.nhlbi.nih.gov/
Other Contact Information: Building 31, Room 5A52,
31 Center Drive MSC 2486
Bethesda, MD 20892-2470
301-592-8573 (Voice, Information Center)
301-592-8563 (FAX, Information Center)
The P.A.D. Coalition:
This site is provided by an alliance of leading health organizations, vascular professional societies, and government agencies to raise awareness of PAD. It offers many resources.
c/o Vascular Disease Foundation 8206 Leesburg Pike Suite 301 Vienna, VA 22182 888.833.4463