Peripheral Arterial Disease (PAD)
AUTHOR: David Taylor
What is PAD?
Normally the arteries carry blood away from the heart and deliver it to the body including the legs. This allows the leg muscles to exercise and work normally.
What causes PAD?
PAD is caused by blockage in the arteries supplying blood to the legs. The cause of the blockage is atherosclerosis or "hardening" of the arteries. This is the same disease that can cause heart attacks and strokes but in this case it is affecting the arteries of the legs.
What are the symptoms of PAD?
In it's mildest form PAD is silent, causes no symptoms and can only be detected with diagnostic testing.
Diagnosis and tests for PAD
Usually a physical exam of the pulses of the leg and a simple Doppler ultrasound of the leg arteries will diagnose the presence and severity of PAD.
Lifestyle modification for PAD
The most important thing for patients with PAD to do is to continue to exercise as much as they are able. Walking to the point of discomfort trains the leg muscles to work better and promotes improved circulation.
Non-surgical and medical management for PAD
All patients with atherosclerosis should be taking a number of medications to prevent progression of their disease and this includes patients with PAD. These also minimize the chance of other vascular complications such as stroke and heart attack.
Guidelines for Intervention for PAD
All patients with critical limb ischemia should have an intervention to prevent gangrene and risk of amputation. This applies to patients with leg or foot pain at rest when the cause is PAD. This also applies to patients with ulcers or gangrene when the cause is PAD.
Surgical treatment for PAD
Surgery can provide durable treatment for PAD, relieve symptoms and prevent amputation. Surgery involves removal of the blockages in the artery or in some cases bypass around the blockage.
Endovascular Treatment for PAD
Endovascular treatment of PAD offers a less invasive intervention than surgery to improve blocked arteries from PAD. It involves dilation of narrow or blocked arteries (balloon angioplasty) or dilation and stenting. The stent is a metal latice that holds the artery open.
When should I see my doctor?
You should see your doctor if you think you have PAD to discuss whether further investigation or treatment is needed.
References and Resources
The benefits of a tobacco free life are felt quickly. Here's a resource for smoking cessation.
CSVS Guidelines for Abdominal Aortic Aneurysm screening
“The 2018 CSVS guidelines suggest all men 65-80 and all women who have smoked or have heart disease and are between the ages of 65-80 should have an abdominal ultrasound (US) to rule out an abdominal aortic aneurysm (AAA).
Those older than 80 can be considered for screening, but it is important to talk to your doctor. Speak to your primary care physician or vascular surgeon to ensure you have been screened.