Peripheral arterial disease, or PAD, is a condition in which arteries leading to the legs, feet, and sometimes arms become narrowed, blocking blood flow and causing symptoms such as cramping, pain, or tiredness in the legs when walking or climbing stairs. Having diabetes puts a person at increased risk of developing PAD. This video interview with diabetes expert Enrico Cagliero, MD, MPH, addresses common risk factors for and symptoms of PAD, approaches that can be used to reduce the risk of developing PAD, and treatment options that are available for those who are dealing with this painful condition.
Peripheral Arterial Disease
Enrico Cagliero, and I work at the Massachusetts General Hospital.
What is Peripheral Arterial Disease (PAD)?
So, what is Peripheral Arterial Disease? Its kind of a disease of the artery, the large vessels in the legs. Its part of the same disorders that you can have, arteries in the heart can cause heart attacks, or the arteries in the brain can cause stroke. And if the disease happens in the arteries in the leg, it can cause decrease blood flow and eventually can cause ulcers and can lead to amputations.
PAD Risk Factors
There are a number of risk factors that are typical for arterial disease in general, and one is smoking. That is a very strong risk factor, for especially for Peripheral Arterial Disease. High blood pressure, high cholesterol and diabetes are other risk factors for this disorder.
What are the symptoms for PAD?
The common symptoms for Peripheral Arterial Disease, are pain in the legs, that happens usually not at rest, but after walking. At different distance for individual patients, and then when stop walking the pain goes away within a few seconds to a minute. Now, there are patients that have Peripheral Arterial Disease and they have no pain whatsoever, but the majority have some pain that is not at rest but just when walking.
How to Diagnose PAD?
So, the test that are available to diagnose Peripheral Arterial Disease vary. So, the first test, a physical exam, which health care professionals can check the arteries in your leg and feet to be sure that they are normal. And then it come to other tests, like ultrasounds, which can measure the blood flow in the legs. There are other tests that are like, blood pressure cuff, again, measuring the circulation in the leg and measuring the blood pressure in the legs and comparing that in the arm to see if there is a blockage in the leg. And then the most complex tests are MRI or CT Scanning, in which there is a dye injected in the arteries, and then we can see if there is good blood flow in the legs.
Diabetes and PAD
So, someone with diabetes can definitely reduce the chance to develop this disease by first of all quit smoking, which again is the strongest risk factor. Taking good care of blood pressure, lowering cholesterol and keep the blood glucose levels as close to normal as possible.
PAD Treatment Options
The treatment options available for someone who has Peripheral Arterial Disease are varied. So, there are, actually one of the most effective way is exercise. An exercise regimen, usually supervised, but can also be done at home, helps by increasing the blood supply to the legs to decrease the symptoms, and keeping the blood vessels open as much as possible. There are a number of, actually there are two FDA approved drugs, pills that are available, but they are in a number of studies, they were less powerful than exercise. And then for patient that have severe disease, then intervention, there could be stenting going with a catheter in the arteries and opening the blood vessels. Usually it’s a mesh that keeps the vessel open, is a good alternative, and also the most definitive procedure is doing surgery, doing a bypass surgery, like a bypass in the heart, in this case it would be a bypass in the artery in the leg.
The drugs available to treat the disease, work with two ways. One, drugs like Aspirin, can help a little bit, by thinning the blood, and so helping the blood supply, although some studies show that is works and some studies show that perhaps it doesn’t work that well. And then there are drugs that work on muscle that are in the layer of the arteries by trying to dilate and enlarge a little bit the blood vessel and allow more blood flow into the legs. Again, there are drugs that are not incredibly effective, but they can help someone that has initial symptoms of the disease.
Why is Walking Good for PAD?
Walking is the best exercise, and so, usually the patients they go for a supervised, regimen, is walking a treadmill for a certain distance, depending when the symptoms come, and what are the limits. Otherwise, if people do this at home, they again walk until they develop the pain, then they rest and then they can, when the pain goes away, continue walking. If you do that on a continuous basis, eventually you can see that one can walk longer without developing pain, because the blood vessel and the blood supply to the leg increases.