Peripheral Artery Disease

Peripheral Artery Disease (PAD) is a circulatory condition where narrowed arteries reduce blood flow to the limbs, most commonly affecting the legs. It is a progressive disease that develops slowly over time due to plaque buildup in the arteries, a condition known as atherosclerosis. PAD can cause leg pain while walking, numbness, and in severe cases, tissue damage or amputation. Despite its seriousness, PAD often goes undiagnosed or misattributed to aging or joint issues.

Peripheral Artery Disease is a type of peripheral vascular disease that results from the narrowing of arteries outside of the heart and brain. The reduction in blood flow means that oxygen and nutrients cannot reach the muscles and tissues effectively, especially during physical activity. PAD is a warning sign of widespread arterial disease and is linked to a higher risk of heart attack and stroke.

PAD affects over 200 million people globally. In India, estimates suggest that around 10-15% of adults over the age of 60 may have PAD, though the actual number may be higher due to underdiagnosis. Risk increases significantly with age, and it's more prevalent among smokers, diabetics, and individuals with high cholesterol or hypertension.

PAD can be categorized into different types based on the location and severity of the artery blockages:

1. Aortoiliac Disease: Affects the arteries in the abdomen and pelvis.
2. Femoropopliteal Disease: Involves arteries in the thighs and knees.
3. Infrapopliteal Disease: Impacts the arteries in the lower legs and feet.
4. Acute Limb Ischemia: A sudden decrease in limb blood flow, often due to embolism or thrombosis.
5. Chronic Limb-Threatening Ischemia (CLTI): A severe form of PAD characterized by rest pain, ulcers, or gangrene.
   
    

PAD is primarily caused by atherosclerosis, a condition in which fatty deposits build up on the artery walls. Other contributing factors include:

• Smoking
• Diabetes
• High blood pressure (hypertension)
• High cholesterol
• Inflammatory conditions (e.g., vasculitis)
• Obesity
• Sedentary lifestyle
• Family history of cardiovascular disease
  
   

Many people with PAD may not experience symptoms until the disease is advanced. Common symptoms include:

• Intermittent claudication: Cramping pain in the legs or hips during walking or exercise, relieved by rest
• Numbness or weakness in the legs
• Coldness in the lower leg or foot
• Sores or wounds on the toes, feet, or legs that won’t heal
• A change in leg color (bluish or pale skin)
• Slower growth of toenails or leg hair
• Erectile dysfunction in men
   

Early diagnosis is key to managing PAD. Common diagnostic tests include:

• Ankle-Brachial Index (ABI): A comparison of blood pressure in the ankle and arm.
• Doppler Ultrasound: Visualizes blood flow through vessels.
• Angiography: Uses contrast dye and imaging (CT or MRI) to detect blockages.
• Blood Tests: To check cholesterol, blood sugar, and inflammatory markers.
  
   

PAD treatment aims to manage symptoms, stop progression, and reduce cardiovascular risks. Options include:

Lifestyle Modifications:

• Quitting smoking
• Regular walking and exercise programs
• Eating a heart-healthy diet
• Weight loss

Medications:

• Antiplatelet agents like aspirin or clopidogrel (Brand: Disprin Tablet)
• Cholesterol-lowering drugs (statins)
• Blood pressure medications
• Medications to improve walking distance, such as cilostazol

Surgical & Interventional Treatments:

• Angioplasty and stenting: Opens narrowed arteries.
• Atherectomy: Removes plaque from artery walls.
• Bypass surgery: Redirects blood flow around a blockage.
   

While not substitutes for medical treatment, alternative therapies may provide supportive benefits:

• Supervised exercise therapy (SET)
• Acupuncture for pain relief
• Herbal supplements like Ginkgo biloba (consult a doctor before use)
• Yoga and Tai Chi for circulation and mobility
   

Key risk factors for developing PAD include:

• Smoking (the strongest risk factor)
• Diabetes
• High cholesterol
• High blood pressure
• Age over 50
• Obesity or lack of exercise
• Family history of atherosclerosis or PAD
   

Untreated PAD can lead to serious health consequences:

• Critical limb ischemia
• Non-healing wounds or ulcers
• Tissue death (gangrene)
• Amputation
• Heart attack and stroke
   

Living with PAD requires consistent self-care and medical follow-up:

• Stick to your medication and treatment plans
• Participate in a structured walking program
• Keep your feet clean and inspect them daily
• Choose proper footwear to avoid sores
• Communicate any changes in symptoms to your doctor
• Monitor blood pressure, blood sugar, and cholesterol regularly
   

1. "PAD is just leg pain or aging" – False. It’s a serious vascular disease that requires attention.
2. "Only smokers get PAD" – While smoking is a major risk, others including diabetics and hypertensives are at risk too.
3. "Exercise worsens PAD" – Actually, supervised exercise improves blood flow and symptoms.
4. "No symptoms means no PAD" – Many patients are asymptomatic early on.
5. "Amputation is inevitable" – Early diagnosis and treatment can prevent complications.
   
    

You should consult a healthcare provider if:

• You experience leg pain while walking that goes away with rest
• You have wounds or ulcers on your legs/feet that don’t heal
• You notice numbness or discoloration in your limbs
• You have risk factors like diabetes, smoking, or high cholesterol
   

• What tests do I need to confirm PAD?
• How advanced is my condition?
• What lifestyle changes should I make?
• What treatment options are best for me?
• How can I prevent it from getting worse?
• Do I need to see a specialist?
   

• Encourage and join them in lifestyle changes like walking or quitting smoking
• Help them keep track of medications and doctor’s appointments
• Be empathetic and patient—pain and mobility issues can affect their mental health
• Educate yourself about the condition to provide better support

Peripheral Artery Disease is a serious but manageable condition. With early diagnosis, lifestyle changes, and proper treatment, individuals with PAD can lead active, fulfilling lives. Raising awareness and ensuring regular health screenings are key to preventing complications like heart attack, stroke, or limb loss.