For most people, a walk through the neighborhood or hike on a local community trail brings enjoyment, renewed energy and a feeling of accomplishment. For up to 10 million Americans, however, walking brings varying levels of discomfort or pain that usually continue until those individuals get off their feet and rest.
What this significant number of Americans share is a circulatory problem called Peripheral Artery Disease, usually referred to as P.A.D. In addition to walking, P.A.D. symptoms can also show up during other forms of leg-related exertion. Although this type of muscle pain — which doctors call intermittent claudication — is most often experienced in the calf, it can also occur in the thigh, hip and buttock.
The causes of P.A.D. and who’s at risk
Peripheral artery disease takes place when the arteries carrying blood from your heart to your legs become narrow or blocked due to atherosclerosis, a buildup of plaque inside the walls of the blood vessels. These arteries also supply oxygen-rich blood to the stomach, arms and head, but P.A.D. is most commonly associated with the arteries leading to the legs. This reduced blood flow is what causes the aching, cramps and sometimes numbness in the extremities.
There are a number of factors that can increase your risk for developing P.A.D. Some of them, like getting older or having a family history of arterial disease, are outside of your control. But other risk factors, like smoking, high blood pressure high cholesterol, obesity, lack of exercise and poorly managed diabetes can be avoided or definitely reduced. Among these various activities or conditions, smoking represents the single greatest risk factor for restricted blood flow and peripheral artery disease.
The symptoms you
should look for
Although it doesn’t occur with everyone, the classic symptom for P.A.D is leg pain caused by walking, exercising, climbing stairs or even standing still for a long time. Some people may also experience hair loss on the leg with skin that appears shiny and may feel cool to the touch compared to other parts of the body. At times, toes can feel numb and cold. Another symptom to be aware of is sores on the legs or feet that don’t seem to heal properly.
Is peripheral vascular disease a serious condition?
It can be. In fact it can be life-threatening. Because P.A.D. is caused by the same kind of fatty deposit buildup in the arteries that’s associated with heart disease, it is often the first warning sign that you may have a serious health concern. When the arteries leading to the legs are narrowed or blocked there’s a possibility that your whole circulatory system, including the heart and brain, are also affected. The result is a greater chance of stroke or heart attack. Having P.A.D. also puts you at higher risk for infections and tissue damage in the affected areas of your limbs.
How P.A.D. is diagnosed
The first step in determining the presence of peripheral artery disease is a thorough physical exam that looks for signs of the condition like the kind of changes in the skin that were mentioned before. If any symptoms are reported or apparent, the next diagnostic step is generally an ankle-brachial index. This simple and painless test, usually called an ABI, compares the blood pressure in your upper arm and your ankle. If the blood pressure in your ankle is significantly lower than your arm, that’s an indication that you may have P.A.D. The ABI is done in combination with a specialized ultrasound test to provide a more complete picture of blood flow in the leg.
If the condition seems to be severe or if more information is needed — for example, if the ABI and ultrasound don’t correlate with your symptoms — your doctor may perform an arteriogram. This test involves injecting dye into one of the arteries and then taking an x-ray. The resulting image can show the exact location and extent of the blockage in the artery as well as treat any existing lesions at the same time.
The good news about treatment
For many people, P.A.D. can be effectively treated and managed with lifestyle changes. The most important change is for smokers to stop as soon as possible. Exercise and a healthy diet are also important behaviors that will help manage the condition. In addition, medications may be used to help control cholesterol and blood pressure, both of which are risk factors for P.A.D.
In most cases, no further treatment of the narrowed artery is needed. If the blockage is extensive, however, and the person with P.A.D. experiences pain as well as limitations on walking and other activities, or if there are ulcers on the leg that don’t heal, it may be necessary to improve blood flow in the leg through surgical procedures.
We can now provide pain relief and improve function in the leg – as well as reduce the potential for amputating a limb that isn’t getting enough blood – through the same kind of minimally invasive treatments, like angioplasty and stenting that are used to eliminate blockages related to heart disease. These treatments, which require specialized training on the part of the surgeon, are called endovascular because they take place within the blood vessel and usually only require an incision the size of a large needle.
For people who for various reasons aren’t good candidates for minimally invasive procedures, lower extremity bypass surgery, also called peripheral vascular bypass, is an effective option. This procedure reroutes blood flow from above the blocked section of the artery to another blood vessel below the obstruction. There are different “versions” of lower extremity bypass surgery designated by the artery being bypassed and the arteries where blood flow is restored.
The decision on which type of minimally invasive or more conventional surgery to perform is based on the overall health of the patient, the location and severity of the blockage in the leg and any relevant medical history or prior treatment.
Added convenience for the Northern Neck and Middle Peninsula
Along with a highly trained team, we have the diagnostic technology and specialized equipment needed to treat P.A.D. available right here at Riverside Tappahannock Hospital. From state of the art imaging equipment to the latest stents and balloons as well as a dedicated team of nurses and technicians, we are able care for this complicated and life limiting disease for people living in the Northern Neck and Middle Peninsula and I’m very gratified to be part of this resource.
If you have any symptoms of P.A.D. or any concerns about your circulation, talk with your primary care provider. What you stand to gain is not only the chance to avoid lifestyle limitations and discomfort, but also the peace of mind that comes with reducing your risk for other health issues.
Wirt Cross, MD, served as a former Medical Officer and Battalion Surgeon in the U.S. Navy and is currently in the U.S. Navy Reserve. He, his wife and three children enjoy the many advantages of living in the Tappahannock area.
For an appointment with Dr. Cross, please call Riverside Surgical Specialists, Tappahannock at (804)443-6232.