Expert advice for managing Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is a serious condition that affects more and more people. The number of people with the disease worldwide has skyrocketed from about 164 million in 2000 to 202 million in 2010, according to new estimates from University of Edinburgh researchers. The disease occurs when fatty deposits accumulate in the peripheral arteries, restricting blood flow and oxygen to the legs and feet. The condition affects people of all ages, but more so the elderly, with 1 in 6 people older than 80 years being diagnosed worldwide. If you think you or a loved one may suffer from the disease or if you are a medical professional looking to share some information for patients to take home—consider the following.


Do ask your primary care provider if you should undergo the ankle-brachial index test

If you have been experiencing pain and discomfort in the lower legs particularly when active, including discomfort when walking, sores or wounds on toes, legs and feet that heal slowly, poorly or not at all, ask your primary care provider to test you for PAD. The ankle-brachial index test is a quick, noninvasive way to check your risk of the disease. The ankle-brachial index test compares your blood pressure measured at your ankle with your blood pressure measured at your arm. A low ankle-brachial index number can indicate narrowing or blockage of the arteries in your legs, which can lead to other circulatory problems, heart disease or stroke.

Do ask your doctor what you can do to lower risk of heart attack, stroke, or dying early

If the test confirms that you do have PAD, consult with your doctor about lifestyle changes you should make. PAD increases your risk of coronary heart disease (CHD; also called coronary artery disease), heart attack, stroke and transient ischemic attack. If you have PAD, you have a 1 in 2 chance of having heart artery blockage.

Do talk to your doctor about an exercise program and medications before considering any procedures

There are many treatment options for PAD, including non-surgical options, so before you consider a bigger procedure ask your doctor about all of your options. This includes simple exercise programs you can adopt (in most people with mild to moderate PAD, aspirin and cholesterol medication work well). A regular walking program is highly recommended as it helps alleviate pain—the trick is to walk until you can’t any further. Stop, take a bit of a rest, and then start again. You should do this for 20-30 minutes every day.

Do ask your doctor to test you for PAD if you have diabetes

Diabetes patients are at a much higher risk for PAD and when left untreated, patients experience severe symptoms in the lower limbs, often leading to infection and sometimes amputation. It’s better to be proactive and get tested early.

Do ask about procedures that can improve your blood flow if medication and exercise aren’t helping

There are various advanced procedures to treat PAD, such as a bypass graftg surgery, where your doctor uses a blood vessel from another part of your body or a man-made tube to make a graft. This procedure will not cure PAD but may increase blood flow in the affected limb. Another option is angioplasty to restore blood flow through a narrowed or blocked artery. During this procedure, a catheter (thin hollow tube) with a balloon at the tip is inserted into a blocked artery. The balloon is then inflated, which pushes plaque outward against the artery wall. This widens the artery and restores blood flow. Other techniques, including atherectomy (a procedure that removes plaque buildup from an artery), stents, and medicated stents, are available.


Do not assume leg discomfort is due to arthritis, aging or being out of shape

PAD is very prevalent, but many patients don’t even know they have it. They assume the discomfort is just another “side effect to aging.” While that may be, PAD is a serious condition; if left untreated it will cause many other health problems. Thus, it is better to get tested and begin treatment, rather than assume it’s nothing.

Do not assume you need an operation or procedure to improve leg blood flow

While there are many procedures available to treat PAD, they should not be the first course of action. Many times PAD can be treated with lifestyle modifications and medication. Sometimes, a good walking program is all you need. Make sure to talk openly with your doctor about options and understand what he or she is telling you.

Do not smoke

If you are a smoker, this is another reason to quit. Smoking is one of the main risk factors for PAD and increases your risk of developing the disease by four times. On average, people who smoke and develop PAD have symptoms 10 years earlier than people who don't smoke. In addition, smoking even one or two cigarettes a day can interfere with the success rates of PAD treatments. Quitting smoking can slow the progression of PAD.

Do not forget to wear appropriate fitting shoes and socks

Proper shoes and socks will help avoid skin ulcers and higher risk procedures. This is particularly important for diabetes patients because if they can’t feel their feet and get ulcers, PAD will slow the healing process due to improper blood flow.

Do not take just one person’s advice, particularly surrounding a major operation

If your physician has suggested a major operation to treat your PAD. you may consider asking for a second opinion. You could be eligible for a less invasive procedure, or even medication and exercise alone. Make sure to go through all treatment options and possibilities before considering a major operation. If you are a caregiver, do your homework and make sure to ask the doctor lots of questions. If you are not completely clear on what the recommendation is and why, don’t hesitate to ask follow up questions.

Jumping cartoon

PAD is a prevalent disease but can easily go undetected and untreated. Make sure to take charge of your health as a patient and consult with your physician if you experience any symptoms, even if they seem to be “signs of aging.” Once diagnosed, make sure to consider all treatment options with your physician and commit to a walking program. If you are a caregiver, be sure to do research on the disease and ask the physician to go over information with you—especially if something is not quite clear. Encourage your loved one to adopt an active lifestyle, and if they are a smoker, to quit.

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Michael R. Jaff, DOProfessor, Medical Director, and Founder

Michael R. Jaff, DO is Professor of Medicine at Harvard Medical School, Chair of the MGH Institute for Heart, Vascular, and Stroke Care, Medical Director of the Vascular Center, and the Medical Director of the Vascular Diagnostic Laboratory at t...

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