Here we will cover the expectations, life expectancy with PAD, and information you need to understand PAD in general. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 18 million people in the United States suffer from Peripheral Artery Disease (PAD), a common circulatory problem in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Over time, plaque can harden and narrow the arteries limiting blood flow to your organs and other parts of your body.
Approximately 160,000 to 180,000 of the estimated 18 million Americans with PAD will undergo a limb amputation as a result of PAD-related conditions this year, resulting in lower quality of life, high medical costs, and shorter life expectancy with PAD. But even with these alarming numbers, general population awareness of PAD is estimated at only 25 percent.
As a vascular specialist, Majdi Ashchi, DO, FACC, FSCAI, FABVM, FSVM has treated hundreds of PAD patients over the course of his 30-year career, so he knows the importance of recognizing PAD as soon as possible. With today’s technology, minimally invasive procedures can be performed in our outpatient cath lab to improve artery flow significantly and ultimately save limbs.
“As a doctor, telling a patient a limb cannot be saved is one of the worst pieces of news to give,” said Dr. Ashchi. “That’s why early diagnosis is so important, so these effective and life-changing procedures can be performed in time. I urge all patients to talk to their medical provider if they are experiencing pain when walking or unusual discomfort. Early diagnosis and intervention cannot only save a patient’s limb but potentially life as well.
During the month of September, I encourage everyone to participate in PAD Awareness month by showing support for the PAD community and helping the public better understand the risks, effects, and symptoms of PAD.”
The chance of having PAD increases as you get older with people over age 50 having a higher risk for PAD, but the risk is increased if you:
- Smoke, or used to smoke
- Have diabetes
- high blood pressure
- Have abnormal blood cholesterol levels
- Are of African American ethnicity
- Have had heart disease, a heart attack, or a stroke
- Have a family history of PAD, heart attack, or stroke
Understanding Peripheral Arterial Disease (PAD)
What is PAD?
PAD is short for Peripheral Arterial Disease. The term PAD encompasses a large series of disorders that affect arterial beds exclusive of the coronary arteries. People have PAD. when the arteries in their legs become narrowed or clogged with fatty deposits, or plaque. The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis. When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. Some people call this poor circulation.
PAD occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries that supply the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease.
The good news is that like other diseases related to the arteries, PAD can be treated by making lifestyle changes, taking medicines, or undergoing leg artery angioplasty or other endovascular intervention type procedures (laser, stents, atherectomy, rotational atherectomy, etc.) or traditional vascular surgery, if needed. You can live well with PAD
Is PADserious? Who is at risk?
- PAD is a serious disease commonly affecting 1/3 of Americans over the age of 50.
- The hardened arteries found in people with PAD are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain. That is why people with PAD have a two- to six-times greater chance of death from a heart attack or a stroke with or without symptoms.
- A patient with symptoms from PAD has a higher risk of death than a patient with PAD but no symptoms. PAD has a higher risk of death than certain well-known cancers such as breast cancer, prostate cancer, and Hodgkin’s disease.
- When the blood flow to the legs is greatly (or severely) reduced, people with PAD may have pain when walking. PAD may cause other problems that can lead to amputation of a toe, foot, or leg. People with P.A.D. may become disabled and not be able to go to work. As time goes on, they may have a very poor quality of life.
Who is at risk?
The chance of having PAD increases as you get older. People over age 50 have a higher risk for P.A.D., but the risk is increased if you:
- Smoke, or used to smoke
- Diabetes
- High blood pressure
- Abnormal blood cholesterol levels
- Are of African American ethnicity
- Have had heart disease, a heart attack, or a stroke
- Have a family history of PAD, heart attack, or stroke.
What are the warning signs or symptoms?
P.A.D. develops slowly over many years.
In the early stages, most people with PAD have no symptoms. Only about one out of four people with PAD actually feel typical symptoms of PAD in their leg muscles (known as “claudication”, defined below). By that time, their arteries may be so clogged and hardened that they are not getting enough oxygen to supply their leg muscles. The most common signs of PAD include one or more of these problems:
- Cramps, tiredness, or pain in your legs, thighs, or buttocks—that always happens when you walk, but that goes away when you rest. This is called claudication.
- Foot or toe pain at rest often disturbs your sleep.
- Skin wounds or ulcers on your feet or toes that are slow to heal, or that do not heal.
Sometimes, people ignore their leg pain and think it is just a sign that they are getting older. As a result, many people with PAD do not know they have it and do not get treatment. It is important to discuss any leg or thigh pain you may be having with your health care provider since it may be a warning sign of a serious disease such as PAD. Ulcers can be on the hands or legs. Ischemic ulcers from arterial disease are not the same as non-PAD ulcers.
How do I find out if I have PAD?
If you think you have P.A.D., see your health care provider and talk about any symptoms you are having and go over your medical history and your risk factors for P.A.D.
Your provider will examine the pulses in your feet and legs. If your provider finds those pulses are weak and thinks you may have P.A.D., your provider may order a test called the ABI, which stands for ankle-brachial index.
The ABI is the best test for finding out if you have P.A.D. It uses sound waves to find out if there is a reduction in blood flow in the arteries. It also compares the blood pressure in your ankles with the blood pressure in your arms.
Diagnosis
Diagnosis of PAD with tests that measure blood pressures in the leg (segmental pressure), toe pressures (toe-brachial index or TBI), or artery blood flow (with ultrasound) is possible. Performing more sophisticated tests such as PVR (pulse volume recordings), CTA (Cat scan), magnetic resonance angiography (MRA), catheterization, or angiography is also possible.
For most people with PAD, these life-saving steps may be enough to slow down the disease and even improve any symptoms. If needed, your health care provider can refer you to a specialist for procedures or surgery to treat arteries that are severely experiencing a blockage. These procedures often help people with PAD to improve symptoms and to avoid losing a foot or leg.
Treatment
PAD Treatment is possible with lifestyle changes, medicines and surgery, if needed.
Since people with PAD are at high risk for heart attacks and stroke, they must take charge of controlling their risk factors related to cardiovascular disease. These life-saving steps will help to prevent and control PAD:
- Get help to quit smoking and set a quit date now.
- Lower your blood pressure to less than 140/90 mmHg or less than 130/80 mmHg if you have diabetes or chronic kidney disease.
- Lower your LDL (bad) cholesterol to less than 100 mg/dl or to less than 70 mg/dl if you are at very high risk for a heart attack or stroke (if you smoke, have diabetes, or have chronic kidney disease).
- Manage your blood glucose to reach an A1C level of less than 7 and practice proper foot care if you have diabetes.
- Talk to your doctor about taking antiplatelet medicines such as aspirin or clopidogrel (Plavix) to prevent clotting. Pletal and Zontivity are other medicines with approval for PAD and vascular diseases.
- Follow a healthy eating plan to control your blood pressure, cholesterol, and blood glucose (for diabetes).
- Get regular exercise such as walking for 30 minutes at least 3 or 4 times per week.
Remember: Finding and treating PAD early can help keep your legs healthy, lower your risk for heart attack or stroke, and save your life and limbs.
Our board-certified interventional cardiologist and vascular specialist, Dr. Majdi Ashchi has extensive experience with interventions to treat simple to complex vascular blockages in any vascular bed or organ including carotids (neck arteries), arms, kidney arteries, stomach or intestinal arteries, leg arteries as well as heart arteries.
Our experts use simple balloon angioplasty or medicated balloon angioplasty, bare metal to medicated stents to more complex atherectomy devices, laser catheters, and clot buster catheters to remove clots or cholesterol plaques.
To make an appointment with our specialists, please contact us at 904.339.2335 or visit DrAshchiHeart.com for our locations.