Family Conversations Workshop

PAD:Those Aching, Painful Legs!

You start out on a walk, but after a few minutes your legs become so painful that you have to stop. In a few minutes you feel better. You start walking again, and it happens again. So you stop taking those walks. Pretty soon it gets so bad that youre unable to do anything that requires even a short walk.

Is this just another inevitable part of growing older? Maybe not. Maybe its treatable. Maybe its Peripheral Artery Disease, or PAD (sometimes called Peripheral Vascular Disease, or PVD).

PAD affects approximately 12 million Americans. It starts silently, but can become so painful that your lifestyle is severely affected. However, prompt treatment can help!

PAD most commonly develops in people over age 50, and is caused by atherosclerosishardening of the arteriesthe same plaque buildup process that causes heart attacks and strokes. But with PAD, the clogged arteries are located downstream, below the heart. PAD can involve not only the feet and legs, but also the kidneys, arms, intestines and other body parts. Because it covers so many different areas of the body, it is diagnosed and treated by a variety of medical specialists. Vascular surgeons, interventional radiologists, cardiologists, gastroenterologists and nephrologists (kidney specialists) all treat patients with PAD.

Causes of PAD

The causes of PAD are the same lifestyle, genetic and aging risk factors that contribute to coronary artery disease: smoking, diabetes, a diet high in saturated fats, obesity, inactivity, high cholesterol and high blood pressure. Being more than 50 years old and/or having a family history of peripheral artery disease, heart disease, strokes or abdominal aortic aneurysms also put you at greater risk.

Testing for PAD

The common test for PAD involves an ABI, or anklebrachial index, which is a simple and painless test. With a regular blood pressure cuff and a stethoscope, your blood pressure is measured in both arms and ankles, and your pulse is checked in arms and legs as well. Other tests may include a duplex ultrasound (a test that combines conventional ultrasound with Doppler technology to see the structure of blood vessels as well as real-time images of the movement of the blood through your vessels), magnetic resonance angiography or MRA (a test that uses magnetic fields and radio waves to produce two- and three-dimensional images of the vessels), and computed tomography angiography or CTA, which uses X-rays to visualize blood flow in arteries and veins. Testing may also include an ultrasound study of the abdomen for signs of an aortic aneurysm (a balloon-like bulge in the aortathe bodys largest blood vessel).

You probably need to get a workup if you

have claudication (leg pain while walking that goes away when you rest)

feel numbness and tingling or coldness in the lower legs and feet

have ulcers (sores) on legs or feet that do not heal quickly

have heart disease, carotid artery disease or kidney trouble

have diabetes

smoke and are between the ages of 5069

are more than 70 years old

experience abdominal pain, especially when it is associated with meals or when it spreads around to the back

Treatment for PAD

Treatment involves aggressively treating the cause of arteriosclerosis.

Lifestyle changes: Smoking cessation and structured exercise are often all that is needed to alleviate symptoms and prevent further progression of the disease.

Medications: Drugs to lower your cholesterol and blood pressure, blood thinners and clot-prevention medications can help to control the symptoms of PAD.

Angioplasty and Stenting: Angioplasties and stents (called peripheral interventions) are used to treat blocked arteries in the legs and kidneys, just as is done with heart arteries. A thin catheter is threaded through the femoral artery in the groin and a tiny balloon is used to open the blocked vessel. Sometimes a tiny wire stent is used to keep the artery open.

Cryoplasty: This type of angioplasty is a new procedure in which the balloon is filled with nitrous oxide, which freezes the plaque inside the artery during the angioplasty. This may help to decrease the risk of reoccurrence of the blockage, explains Stuart Zarich, MD, Chief of Cardiology at Bridgeport Hospital.

Surgery: Vascular surgeryto remove blockages, bypass the blocked vessels, or repair aneurysmsis an integral part of the treatment of PAD, which can be done at the same time as peripheral interventions or as a stand-alone procedure.

So dont accept leg pain. Consult your doctors and ask if screening for Peripheral Artery Disease might be right for you.