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Senior Citizen's Guide to Cleveland

Peripheral Artery Disease

Atherosclerosis is a common disorder in older individuals that leads to blockages in the arteries supplying blood flow to the brain, arms, legs, kidneys, and intestines. It is said that blockages to the leg arteries, known as peripheral artery disease or PAD, affects approximately 8-12 million Americans and one in five individuals over the age of 70 years. Despite its high prevalence and poor prognosis, PAD remains under diagnosed and under treated. For this reason, we are pleased to have the opportunity to raise awareness of PAD among the Senior Citizen’s Guide readership.

The risk factors for PAD are similar to those for coronary artery disease (or blockages in the heart arteries) and include older age, tobacco smoking, diabetes mellitus, high blood pressure, and high cholesterol. Having atherosclerosis in other areas, such as in the heart arteries (coronaries) can also increase the risk of having PAD.

Symptoms associated with PAD can include claudication, which is leg pain, tiredness, or burning that becomes apparent with walking and subsides within 5-10 minutes of rest. Other symptoms can include coldness or color changes of the feet, hair loss on the feet or toes, or a non-healing sore on the legs. Interestingly, most patients with PAD either have no symptoms at all or have less typical types of leg pain. Unfortunately, asymptomatic PAD seems to have the same negative impact on over health as symptomatic PAD.

In most cases, PAD is first diagnosed by measuring blood pressures in the ankles and the arms and calculating something called the ankle-brachial index (ABI test) which compared blood pressure in the ankle to the arm. In a patient without PAD, the blood pressure at the ankle should be the same or little higher compared to the arm. In PAD, ankle blood pressure and the ABI are reduced. The other ways to diagnose PAD include vascular ultrasound, computed tomography (CAT scan), and magnetic resonance angiography (special type of vascular MRI scan). However, these tests are not generally used to make the initial diagnosis.

Peripheral artery disease is serious disease in terms of negative effects on quality of life and function. It is also a potentially life threatening disease. In many large research studies, having PAD has been shown to increase the risk of heart attack, stroke, or death. Furthermore, about 15-20% of patients with PAD will progress to having critical limb ischemia, the most severe form of PAD. Critical limb ischemia causes pain at rest due to inadequate blood flow or non-healing ulcers. Patients with critical limb ischemia are at an increased risk of loosing a part of the foot or leg to amputation.

The current treatment for PAD includes modification of cardiovascular risk factors: aggressive cholesterol control, blood pressure management, anti-platelet medications (aspirin or clopidogrel), quitting smoking, and exercise (walking generally best type). In patients with PAD and leg pain (claudication) that is severely impairing life-style and quality of life, additional treatments to restore blood flow to the legs may be offered. Bypass surgery can improve blood flow to the leg by providing an alternative route for blood flow (the bypass graft) around the blockages in the legs. Endovascular therapy is a minimally invasive procedure that is now being used more and more commonly for treatment of PAD. Using special catheters and wires, balloons are inflated in the blocked arteries to restore blood flow and special metal scaffolds known as stents are placed to keep the arteries open.

To summarize, PAD is a serious disease that you may not have been aware of. Fortunately, there are many treatment options available for patients with PAD once the diagnosis has been made.

Ask your doctor if you could have PAD if:

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