Peripheral arterial disease: Straight talk about a silent health threat

August 19, 2010 By Alfred Gladstone, M.D.

If you're concerned about your heart health, keep an eye on your arms and legs. They're the most likely targets for peripheral arterial disease (PAD), a narrowing of the blood vessels that can lead to complications.

PAD involves buildup of plaque — the same sticky substance that leads to coronary artery disease — in the peripheral arteries outside your heart. Blocked arteries are less able to transport nourishing blood to the arms, legs and other body parts.

PAD often runs its course silently until the blood vessels are so clogged that physicians trained in vascular intervention (e.g., interventional radiologists, vascular surgeons or interventional cardiologists) must open them to avoid permanent damage to surrounding tissues and limbs. Unfortunately, an artery can be 60 percent or more blocked before the first warning sign — pain in the area — occurs.

PAD symptoms and diagnosis

PAD commonly occurs in the legs. Sufferers often complain of a cramping pain, claudication, when they walk. They may also experience numbness or tingling, red or bluish skin discoloration, changes in skin temperature, buttocks pain, impotence and infections that won't go away.

A number of tests are available to check for PAD. Three non-invasive, painless exams conducted at The Hospital of Central Connecticut's Vascular Center, New Britain General campus, are:

A neck ultrasound to assess your carotid arteries, which supply blood to the brain.

An abdominal ultrasound to assess the aorta, a major blood vessel that can develop an aneurysm, or bubble, in the vessel wall.

Blood pressures of each arm and leg to screen for peripheral arterial disease.
Depending on exam findings, a CT or MRI angiogram may be recommended. During these studies, dye is injected into a vein while CT or MRI images of the arteries are obtained.

Treating the condition

PAD treatments may include lifestyle changes, medications and/or surgery.

Medications include aspirin and blood thinners to help prevent clotting; cholesterol-lowering drugs called statins to reduce plaque that forms in the arteries; medications to help lower blood pressure and improve circulation; and a clot-busting drug to clear passageways.

An angioplasty removes plaque from your arteries. During the procedure, a tiny balloon is inserted into the blood vessel and the balloon is inflated to open the clogged area. A very small metal cylinder or “stent” may be permanently placed in the congested vessel to help keep it open. Atherectomy is another therapy and involves inserting a special cutting catheter into the vessel to slice through the sticky plaque. In some cases, bypass surgery is needed to build “detours” around blocked and damaged vessels so blood in those areas can continue to reach and nourish the body.

If you've been diagnosed with PAD or want to reduce your risk for PAD, consider these lifestyle changes:

If you smoke, stop.

Keep your blood pressure in check.

Watch your cholesterol.

Exercise.

Eat a low-fat, low-salt diet.

Get regular checkups.

Alfred Gladstone, M.D., is an interventional radiologist and a Hospital of Central Connecticut (HCC) medical staff member. Learn about the Vascular Center by calling 860-224-5193. For referrals to HCC physicians, please contact our free Need-A-Physician referral service by calling 800.321.6244.