- September 4, 2020
- Posted by: cmcdonald
- Category: Peripheral Artery Disease
Who is at risk for Peripheral Artery Disease?
There are many different groups of patients that are at risk for Peripheral Artery Disease. First of all, smokers. Patients who are heavy cigarette smokers have a very high risk of Peripheral Artery Disease and they tend to develop it at a relatively early age. While most patients with Peripheral Artery Disease may not present until their 70s or late 60s, a smoker may be present in their 50s with the symptoms of Peripheral Artery Disease. So smokers are important to the risk group.
Diabetics are at very high risk as well. Patients who are long-term diabetic, particularly insulin-dependent diabetics but even non-insulin-dependent diabetics, are at much higher risk of developing Peripheral Artery Disease. They tend to get disease in the vessels in the calves and in the feet, and sometimes it’s a little bit more extensive than the other patient groups.
Other risk factors are high blood pressure, patients with coronary artery disease, hyperlipidemia or high cholesterol, patients with kidney failure, patients who are on dialysis have a very high incidence of Peripheral Artery Disease, and elderly patients. Patients who are over 80 also have a much higher incidence of Peripheral Artery Disease.
Why should a patient get a PAD screening?
I think a person would be wise to take advantage of a free PAD screening. PAD has been found to occur in up to 5% of the population in patients who are over 65, yet it’s generally under-diagnosed. Most primary care physicians are not aware of PAD, they don’t know how to diagnose it. It is sometimes misdiagnosed as infection, gout, or back problems. So it’s definitely a disease that is under-reported and therefore if you get a screening and if it is positive, there’s an easy treatment for it that can help you to relieve the symptoms.
What are some warning signs or symptoms that you should get a PAD screening?
Patients with Peripheral Artery Disease may begin with mild symptoms or actually go straight to severe symptoms. A mild symptom associated with Peripheral Artery Disease is something called claudication, which means pain in the back of the calf when walking. In general, when you’re not walking, you’re not stressing the blood vessels. You don’t need as much blood flow. If you’re sitting, you need a very small amount of blood flow to the legs to maintain consistency. But when you’re walking, you’re exercising and you need a lot more blood flow to the legs. If you have a blockage in the blood vessel, you can’t get that extra blood flow that you need into the legs, and therefore your body will develop pain because it needs the oxygen to feel normal. Therefore the first sign may be claudication. You may start walking a block or two blocks and start developing pain in the back of the calf, which makes you have to stop and rest. That’s one of the earliest signs of claudication.
A more significant and a later sign of Peripheral Artery Disease is something called rest pain. Normally, you shouldn’t have any pain within your feet or your toes at rest. Sometimes, when you’re not getting enough blood flow, you may get severe pain, coolness, or numbness in the toes. Even when you’re lying down, it’s hurting and may require you to shake the toe, rub the toe, or even have to sit up to have gravity help you get some blood flow into that foot. That’s a later sign for Peripheral Artery Disease. More severe stages are seen in patients who have developed a small wound. We know diabetics are at risk of developing severe infections even just with minor injuries. They may cut the toes wrong and get a small wound that, within a couple of days, can develop into a very severe infection. Poor wound healing, particularly in the extremities, is another sign. Lastly, gangrene, which is when a toe or a foot turns black, is the latest sign. This is indicative that the limb or organ is dead and it has to be removed.
Why are there so many amputations in the United States when there are alternative treatments?
In general, patients who develop tissue loss, patients who develop wounds that don’t heal, patients who develop infections, or gangrene, these patients are at high risk of developing what’s called a systemic infection. In other words, once they get an infection in that area, and there’s no blood flow to that area, the infection can rapidly progress and spread to the rest of the body. In these situations, sometimes you may just have to amputate the toe, or even the foot or even the leg to prevent overwhelming sepsis from occurring. Sometimes you have no choice, in the setting of a severe infection or in a really large amount of dead tissue, you’ve got to get rid of that quickly to prevent the patient from dying. So that’s one reason why you have to have an amputation.
The more likely scenario is that a patient develops a wound in the toe which starts to progress, then may develop a spot of gangrene or they may develop a red toe which becomes painful. In those cases, you have a little bit more time. A lot of times, people who are not skilled in revascularization may feel there’s no other choice but they’d better just get this thing off and treated. Therefore they’ll recommend an amputation. Now that we have exquisite techniques to get down into the really small blood vessels in the feet and the toes, there are a lot more options that we have to save the limb.
September is PAD Awareness Month. What do you feel is the most important thing for patients to understand about PAD?
PAD is a very common disease in the United States, particularly in patients who have high blood pressure, diabetes, or coronary artery disease, as well as a history of smoking or high cholesterol. These are risk factors that are very common in a lot of patients. It can be easily diagnosed with what’s called an ankle-brachial index. We measure the blood pressure in the arm and the leg. If the blood pressure in the leg is below the blood pressure in the arm, it is indicative that there’s a blockage somewhere in the blood vessels in the legs. It can be diagnosed and treated relatively easily in the early stages. Once you get to the later stages, it’s much more difficult to treat. Unfortunately, if it’s caught too late, it may end up with tissue loss or amputation. It’s something that people should be aware of, and if they have it, they should get treated.