Peripheral
Artery Occlusive Disease (PAD) & Claudication
Common Questions & Answers
What is peripheral arterial
disease(PAD)?
What are the symptoms
of PAD?
Who is at risk for PAD
and intermittent claudication?
How is PAD diagnosed?
How can PAD be treated?
What can be done to
treat PAD when lifestyle changes and medications are not enough?
How can I find out if
I have PAD?
Who are Interventional
Radiologists?
What is peripheral arterial disease
(PAD)?
Answer: Peripheral arterial disease, or PAD,
is a condition in which the arteries that carry blood to the
arms or legs become narrowed or clogged, interfering with the
normal flow of blood. The most common cause of PAD is atherosclerosis
(often called hardening of the arteries). Atherosclerosis is
a gradual process in which cholesterol and scar tissue build
up, firming a substance called ”plague” that clogs the blood
vessels. PAD may also be caused by blood clots.
What are the symptoms of PAD?
Answer: The disease, which affects both men
and women, often goes undiagnosed and many people mistakenly
think the symptoms are a normal part of aging.
The most common symptoms of PAD is called intermittent claudication,
a painful cramping in the leg or hip, particularly when walking.
Intermittent claudication occurs when there is not enough blood
flowing to the leg muscles during exercise. The pain typically
goes away when the muscles are given a rest.
Other symptoms may include numbness, tingling or weakness in
the leg. In severe cases, you may experience a burning or aching
pain in the feet or toes while resting, or develop a sore on
the leg or foot that does not heal. People with PAD may also
experience a cooling or color change in the skin of the legs
or feet, or loss of hair on the legs. In extreme cases, untreated
PAD can lead to gangrene, a serious condition that may require
amputation of a leg or a foot.
If you have PAD, you are also at higher risk of heart disease
and stroke.
Who is at risk for PAD and intermittent
claudication?
Answer: As many as 1 million Canadians have
PAD. It is estimated that 4 million of those suffer leg pain
symptoms. These who are at highest risk are:
- Over the age of 50,
- Smokers,
- Diabetic,
- Overweight,
- people who do not exercise, or
- People with high blood pressure or high cholesterol.
A family history of heart or vascular disease many also put
you at higher risk for PAD.
How is PAD diagnosed?
Answer: The most common test for PAD is the
ankle-brachial index (ABI), a painless exam in which ultrasound
is used to measure the ratio of blood pressure in the feet and
arms. Based on the result of your ABI, as well as your symptoms
and risk factors for PAD, the physician can decide if further
tests are needed. PAD also can be diagnosed non-invasively with
an imaging technique called magnetic resonance angiography (MRA|,
or with computed tomography (CT) angiography.
How can PAD be treated?
Answer: The best treatment for PAD depends
on a number of factors, including your overall health the severity
of the disease. In some cases, lifestyle changes are enough to
halt the progression of PAD and manage the disease. Your physician
may prescribe drugs when lifestyle changes are not enough. Procedures
that open clogged blood vessels also are sued to treat PAD.
Lifestyle changes. Most treatment plans will include a low fat
diet and a program of regular exercise. If
you are a smoker, it is absolutely essential that you stop the
use of all types of tobacco. If decreased blood flow to the legs is causing injury
to the feet and toes, a foot care program to prevent sores or
infection may be prescribed. This may include referral to a podiatrist.
Medication: Medications that lower cholesterol
or control high blood pressure may be prescribed. Medication
also is available that has been shown to significantly increase
pain-free walking distance in people with intermittent claudication.
Other medications that help prevent blood clots or the build-up
of plague in the arteries are available, as well.
What can be done to treat PAD
when lifestyle changes and medications are not enough?
Answer: There are a number of ways that physicians
can open blood vessels at the site of blockages and restore normal
blood flow. In many cases, these procedures can be performed
without surgery using modern, interventional radiology techniques.
Interventional radiologists are physicians who use tiny tubes
called catheters and other miniaturized tools and X-rays to do
these procedures.
Procedures performed by interventional radiologists include:
- Angioplasty - a balloon is inflated to open the blood vessel.
- Thrombolytic therapy – Clot-busting drugs are delivered
to the site of blockages caused by the blood clots.
- Stents – a tiny metal cylinder, or stent, is inserted in
the clogged vessel to act like a scaffolding and hold it open.
- Stent-grafts – a stent covered with synthetic fabric is
inserted into the blood vessels to bypass diseased arteries.
Sometimes, open surgery is required to remove blockages from
arteries or to bypass the clogged area. These procedures are
performed by vascular surgeons.
How can I find out if I have PAD?
Answer: If you suspect that you may have PAD,
it is important that you see your personal physician for an evaluation.
Who are Interventional Radiologists?
Answer: Interventional radiologists are doctors
who specialize in minimally invasive, targeted treatments performed
using imaging for guidance. They use their expertise in reading
X-rays, ultrasound, MRI and other diagnostic imaging, to guide
tiny instruments, such as catheters, through blood vessels or
through the skin to treat diseases without surgery. Interventional
radiologists are board-certified and fellowship trained in minimally
invasive interventions using imaging guidance. Your interventional
radiologist will work closely with your primary care or other
physician to be sure you receive the best possible care.
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