Peripheral Artery Disease – Connection of feet to the heart

What is peripheral arterial disease (PAD)? What are the risk factors for developing PAD?

Peripheral artery disease (PAD) refers to narrowing of the arteries of the legs, arms, neck and abdomen. (“Peripheral” means away from the heart). Atherosclerosis is a disease process wherein fatty plaques are deposited in the wall of arteries leading to luminal narrowing and obstruction of these arteries. Atherosclerosis is the most common cause of PAD. The most commonly affected arteries in PAD are the arteries of the lower limbs. The most common symptom of PAD is cramping pain ("intermittent claudication") in the calf, thigh or hip while walking or climbing stairs and it is typically relieved on taking rest. Blockages in the arteries can restrict blood flow to the limbs. If left untreated, the tissue can become infected or die, a condition called gangrene.

People who smoke and/or have diabetes are at especially high risk of developing PAD. Other risk factors for PAD are advancing age, high blood sugar and blood pressure, altered cholesterol levels, heart disease, stroke, poor diet, physical inactivity, obesity etc.

How do you diagnose PAD?

The diagnosis of PAD begins with a physical examination of the pulses in the legs which may be feeble distal to the level of obstruction. The initial bed-side test of choice includes the Ankle-brachial index (ABI) measurement which is a non-invasive doppler examination that compares the ankle blood pressure to the arm blood pressure. If ABI measurement < 0.9, it is suggestive of PAD and further non-invasive testing is usually performed to characterize the anatomic location and severity of the disease in the lower limbs such as doppler ultrasound imaging, computed tomography angiography, magnetic resonance angiography, peripheral angiography etc.

Does having PAD increase my risk of having a heart attack?

PAD is similar to coronary artery disease (CAD); both PAD and CAD are caused by atherosclerosis and are included under the term ‘cardiovascular disease’. All blood vessels are either directly or indirectly connected to the heart. Atherosclerosis is a systemic disease involving heart and almost all blood vessels in the body. People with PAD have a higher risk of developing CAD, heart attack or stroke. PAD is common in people who have CAD. These two conditions have overlapping risk factors. In fact, the presence of PAD can be a marker of coexisting CAD or the future development of CAD. So in a patient with PAD and ABI < 0.9, further investigation is needed for detecting CAD.

What is the treatment for PAD?

Treatment for PAD focuses on reduction of symptoms and halting the progression of the disease.

· Lifestyle changes: healthy diet, regular exercise, quitting smoking etc

· Medications: Blood thinner medication, cholesterol lowering medication; medications to reduce claudication pain

· Supervised Exercise training known as cardiac rehabilitation has been shown to have significant benefits.

· Comorbidities like hypertension, diabetes mellitus and dyslipidaemia should be treated.

Severe PAD may be treated by:

1) Angioplasty / stenting: catheter is inserted from the groin and balloon dilatation of the blocked artery is performed followed by stenting

2) Bypass surgery : vein graft is used to reroute blood around the blocked segment of the artery

3) Amputation may be needed for critical limb ischaemia with gangrene

What lifestyle changes I should make if I have PAD?

PAD is strongly linked to smoking. Life style changes for a patient with PAD include quitting smoking, eating healthy diet, exercising regularly, maintaining optimal body weight etc. These will help to slow the progression of PAD.

How can I prevent PAD, if I don't have it yet?

The following strategies can prevent the development of PAD:

· Eat lots of fruit and vegetables but keep trans-fat, sodium and sugar low in diet

· Exercise regularly for at least 30 minutes daily

· Keep blood pressure, blood sugar, and cholesterol levels at optimum

· Avoid smoking