Peripheral Arterial Disease (PAD): America’s Silent Killer — Risk Factors, Symptoms & Treatment Options 

Peripheral Arterial Disease (PAD) affects roughly 18 million Americans. Due to a lack of knowledge in the United States, many Americans do not even know they have PAD, as they do not present any symptoms. In fact, the Cardiovascular Coalition (CVC) estimates that somewhere between 25-50% of the population are unaware they have the condition! Thankfully, there are some great resources and organizations available today to fight the spread of PAD. In this article, we’re going to examine the risk factors and causes of PAD, PAD symptoms, methods of diagnosis, and most importantly, some minimally-invasive treatment options. We’ll also share a special patient success story and a few important resources at the end.

Risk Factors & Causes of PAD

There are a range of risk factors that can contribute to your chances of developing PAD. Some cannot be avoided, such as family history, but others can be mitigated by adopting healthy living practices. However, it’s important to note that patients who smoke or who have diabetes have markedly reduced blood flow, which puts them at the highest risk for developing the disease. The main risk factors for PAD are the following:

• Smoking
• Diabetes
• Increased Age
• Physical Inactivity & Obesity
• High Cholesterol
• High Blood Pressure
• Family History of PAD, Heart Disease or Stroke

PAD is caused by a narrowing of the arteries, which reduces blood flow to the limbs, often in the lower extremities. Frequently, this circulatory issue is caused by atherosclerosis, or what happens when fatty deposits build up on the artery walls. This fatty buildup can greatly reduce blood circulation in patients — affecting not only blood flow to the heart, but also blood flow to the arms or legs.

A prolonged lack of blood supply and oxygen can create ischemia in the legs or feet, which is referred to as Critical Limb Ischemia (CLI), and is the most severe form of PAD. When undiagnosed, patients with prolonged CLI may be at risk of losing their limbs. If caught in time by an experienced interventional radiologist, the limbs can be saved. Additionally, PAD increases a patient’s risk for coronary artery disease, stroke or a heart attack. Like many illnesses, early diagnosis and treatment of PAD is key to preventing more serious issues down the line.

PAD Symptoms & Diagnosis

Many patients who have PAD do not present anything outright, but the typical PAD symptoms include pain, tightness, or fatigue in the legs, calves, or buttocks during physical activity. Once the patient has stopped exercising, the pain typically goes away. This cramping pain is called intermittent claudication. The following are some practices that can help prevent claudication:

• Quit smoking
• If diabetic, maintain even blood sugar levels
• Eat foods low in saturated fat
• Exercise Frequently
• Maintain a healthy weight
• Lower your Cholesterol levels
• Lower your Blood Pressure levels

At VIP, we use a simple test called the Ankle-Brachial Index, or ABI, to determine if a patient has PAD. This noninvasive test measures blood pressure in the ankles and compares it with blood pressure in the arms at rest and after exercising to see if there are significant differences in pressure. Abnormal results can indicate PAD as the cause of pain.

Minimally-Invasive Treatment Options for PAD

If a patient has CLI, they will need to have their vascular anatomy evaluated. Vascular imaging, including CT (computed tomographic) angiography, MR (magnetic resonance) angiography, or Ultrasound is then utilized to study blood circulation. If obstructions are severe, an angiogram, or arteriogram, may be necessary.

Angiograms are minimally-invasive procedures conducted by interventional radiologists that enable the physicians to see where there is blockage in the arteries. During the procedure, the interventional radiologist uses X-rays and contrast dye to identify narrowed or blocked sections. The physician can then place balloon catheters in the blocked arteries to open them up. Lastly, the physician will place stents in the arteries to keep them open after the angiogram.

PAD Patient Success Story

Here at VIP, our team has successfully treated many patients with PAD. One of our biggest success stories is patient Dr. Gloria Hutchinson. Not only did we save Gloria’s right leg from amputation, but we subsequently saved her left leg from being amputated only a few years later! Gloria’s story is sadly not uncommon. When she went to the hospital after suffering complications from a non-healing wound, she was told by the physician on call that amputation was the only option for her, due to her infection spreading to the bone. To Gloria, this did not seem like a true option at all, and she struggled with knowing what to do. She finally decided that she did not want to have her leg amputated.

Shortly thereafter, her daughter found VIP, and interventional radiologist Dr. Bret N. Wiechmann was able to see her mother. After fully evaluating her PAD symptoms and her vascular anatomy, Dr. Wiechmann determined Gloria was a viable candidate for an angiogram. The procedure was successful, and Gloria’s leg was saved! A few years later, Gloria had history repeat itself; this time, with her left leg. Thankfully, she knew to head straight to VIP for a consultation. Today, she is a proud grandmother to her first grandson. Without the proper diagnosis and treatment, Gloria would be a double amputee — or worse. Statistics for patients living with amputated limbs are not promising; mortality rates are close to 50% one year post amputation, and almost 71% three years post amputation.

PAD Resources

If you think you might have PAD,  your first step is to visit your primary care provider. If your provider finds that your current symptoms may be related to PAD, they can refer you to an outpatient treatment center like Vascular and Interventional Physicians in Gainesville, Florida. Of course, be sure to support organizations like the CVC that are working hard to spread awareness and to make sure patients get the best treatment possible for the disease. To take further action, call your Member of Congress today to stress the importance of PAD Awareness Education — both in physicians, and in patients!