What is Peripheral Arterial Disease?

WHAT IS PERIPHERAL ARTERIAL DISEASE? Pad or peripheral arterial disease is essentially a blockage of the arteries in the lower extremities. That is what we mean by peripheral arteries -- leg arteries blocked by hardening of the arteries, buildup of cholesterol, plaque and calcium. This in part is a process of aging, but certainly also brought on by smoking.

 Diabetes is another risk factor, as is hypertension. There are other degenerative factors that we cannot explain completely because there are people who don't smoke, who don't have diabetes, who get blockages in their arteries. Problem is that a lot of these patients with symptoms are mistaken for having arthritis. Patients will say that every time I try to walk I have pain in my legs. These are often elderly patients and so these symptoms are mistaken for arthritis and the health practioner may ask them to take aspirin.

It is very important to ask for the typical symptom of the patient. The typical symptoms of blockage of the arteries in the legs are that every time the patient walks he has to stop after a certain distance. Let's say he walks one block. He will say that a year ago I use to walk two blocks. Three blocks. Now, in the past six months I can only walk one block because my legs cramp up. This is very classic for atherosclerosis or peripheral artery disease.

And it is always constant because the blood doesn't come and go away the next day. So the complaint is constant, very consistent. Every time I walk I must stop and when I feel better I go. This is called claudication which means in Latin limp. So the patient has to limp to start walking. So that anyone who has this symptom shouldn't be brushed off that he is old and simply has arthritis. One should examine to see if he has arterial disease because if he does have arterial disease we can follow him.

Risk factor modification is very important. For a lot of these patients, because every time they walk, they have pain, they become couch potatoes. They don't exercise anymore. They don't walk anymore. They just sit thinking that they are .going to harm their legs. It is just the other way. We would like them to exercise as much as possible. Just by walking a lot of these patients can improve their symptoms. But of course if it starts becoming worse we have methods to treat this.

Now a days we can do balloon angioplasty. If an artery is narrow we can pass a wire through the artery, followed by a balloon and then open it up. Then we put in a stent -- just like we can put a stent in the heart. If it is seriously blocked we can do a bypass from the healthy areas above the block to a healthy area beneath the block. This is how we can save the limbs. Because if there is not enough circulation, even a trivial trauma -- even cutting a nail -- if you injure it, it may not heal.

And peripheral arterial disease and a diabetes is a bad combination. A wound may progress into gangrene, which means death of the tissue. A patient can lose the limb and end up with amputation. So this is an area where it is very important to pick up the presence of arterial disease before the catastrophe happens.