Joseph J. Naoum, MD
Assistant Professor of Surgery, LAU
Division of Vascular & Endovascular Surgery, UMCRH
Peripheral arterial disease, or PAD, occurs when blood vessels in the legs become narrowed or blocked when extra cholesterol and other fats circulating in the blood collect in the walls of the arteries and form the atherosclerotic plaque.
This process is called atherosclerosis and can be caused by many factors, such as smoking, high cholesterol and diabetes. It can occur in almost any artery and usually involves multiple arteries at the same time. Over time, plaque hardens within and around the artery walls, and may reduce the blood flow to the legs and feet. Diabetes increases the likelihood of developing PAD. In general, it is estimated that 1 out of every 3 individuals with diabetes over the age of 50 has a form of PAD. Diabetes alone puts individuals at risk for PAD. However, the risk is greater with factors such as smoking, high blood pressure, elevated cholesterol, being overweight, lack of physical activity, age over 50 years, and a personal or family history of heart disease or stroke.
Most people with diabetes and PAD do not have symptoms. Some individuals may experience mild leg pain or trouble walking and attribute it as a sign of increasing age. The most common symptom of PAD is called intermittent claudication. It is defined as pain, cramping, or aching in the buttocks, thighs and usually in the calves. The pain appears during walking and is relieved by rest. This pain is reproducible every time the person walks and is usually relieved by the same amount of time at rest. This is a sign that an arterial narrowing or blockage exists in the leg and less blood is reaching the muscles thus causing pain. More extreme presentations of PAD include numbness, tingling, coldness in the lower legs or feet and pain even at rest. For individuals with the most severe blockages, skin ulcers, non-healing wounds, or even gangrene can occur.
The ankle brachial index (ABI) is a simple test used to diagnose and characterize the severity of PAD. This test compares the blood pressure in the ankle to the blood pressure in the arm. If the blood pressure in the ankle is lower than the arm, it can be a sign of PAD. The American Diabetes Association recommends that people with diabetes over the age of 50 have an ABI to test for PAD. Other more sophisticated tests can be used for the diagnosis and patient evaluation. The arterial Doppler or ultrasound exam uses sound waves to pro- duce images of the flow of blood or to de- lineate the vessel itself. Arteriograms, computed axial tomography (CT) scans, and magnetic resonance angiography (MRA) use dye, X-rays and new imaging modalities and scanning techniques to show the blood vessels and their blockages.
Medical studies have demonstrated that regular walking exercise can help improve the symptoms of PAD. Medications can also have a positive effect. Other important beneficial steps include: quit smoking, control your blood sugar and achieve a target hemoglobin A1C less than 7%, control your blood pressure and reduce your bad LDL cholesterol to less than 100 mg/dl. In some cases more invasive procedures are used to treat PAD. For instance, balloon angioplasty is a minimally invasive procedure in which a small tube with a balloon is inserted and threaded into the affected artery. The balloon is then inflated, stretching and opening the narrowed artery, and then removed. A stent may be left in place to help maintain the artery open. Some instances require open surgery. In this case, a procedure is done to either open the affected artery or bypass the blockage using a patient’s own vein taken from another part of the body or a synthetic tube graft material. You should discuss your treatment options with your physician.
Taking care of your diabetes and the conditions that accompany it can lower your chances of developing symptoms of PAD.