Peripheral Artery Disease (PAD) - PowerPoint Presentation

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Peripheral Artery Disease (PAD)

Also referred to as peripheral vascular disease, claudication, vascular disease, or leg cramps from poor circulation Ruth Townsend, MSDirector, Health & Well-being Solutions

PAD is similar to coronary artery disease, except it affects the legs, stomach, vital organs, arms, and head Most commonly occurs in the arteries of the legs Caused by the build up of plaque in the arteries that carry blood to you head, organs, arm and legsPlaque is also called atherosclerosisMade up of fat, cholesterol, calcium, fibrous tissue, and other substances

What is Peripheral Artery Disease (PAD)

PAD: Arteries that Can be Affected

Normal and Atherosclerotic Arteries

PAD increases your risk for coronary heart disease, heart attack, stroke, TIA – it might be the first warning signDangerous because it restricts circulation to the limbs, organs and brain. Without adequate blood flow legs, feet, arms, brain and vital organs suffer damagePain, numbnessHave difficulty fighting infection – gangrene, tissue death

Why Does PAD Matter?

The most common cause of PAD is atherosclerosis caused by plaque build up. Atherosclerosis may develop when certain factors damage the inner layers of the arteries. These are risk factors:Cigarette smoking: STOP!!! Smokers may have 4x the risk of PAD than non-smokers; is considered main risk factor for PADObesity – Reduce your weight, try to achieve and maintain normal weight. People with BMI of 25 or higher are more likely to develop heart disease and stroke even if they have no other risk factors

Understanding the Cause and Your Risk for PAD

Diabetes – If you have diabetes manage it and your blood sugars. People with diabetes are at a much greater risk of developing PAD and other cardiovascular diseasesPhysical inactivity – Get moving now! Physical activity increases the time or distance one can walk without pain; also helps decrease risk of heart disease or strokeHigh Blood Pressure – Manage with medications, diet and exercise , and stress management

Understanding the Cause and Your Risk for PAD (cont)

High Cholesterol – Manage your cholesterol levels with medications, diet and exercise. High cholesterol contributes to the plaque build up in the arteries and can significantly reduce blood flowAge-Plaque builds up in your arteries as you age, combined with other risk factors like smoking or diabetes, puts one at an even higher riskPeople who smoke and/or have diabetes are at especially high risk

Understanding the Cause and Your Risk for PAD (

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The most common symptoms of PAD involving the lower extremities are painful cramping, pain or tiredness in the calf, thigh or hip muscles while walking, climbing stairs, or exercising This is called claudication. Because the pain or cramping typically goes away with rest, but comes back again with exercise, it is called intermittent claudicationWorking muscles need more blood flow than resting muscles

Symptoms of PAD

Claudication pain, cramping, or other discomfort varies from individual to individual. Some have severe debilitating discomfort while other have minimal symptomsThe severity depends on: how many arteries are affected, how narrowed (blocked) the arteries are, and how many collateral or secondary vessels are availableHow quickly you walk and whether you walk on an incline or up stairsClaudication location:In the upper 2/3 of the calf is usually due to PAD in the main artery of the thigh, superficial femoral arteryLower 1/3 of the calf is due to disease in the popliteal artery behind the kneeUpper thigh pain results from blockage in the superficial femoral artery, common femoral artery or iliac arteryButtock pain results from blockage in the abdominal aortaFoot pain results from blockage in the tibial or peroneal arteries

Location of PAD Determines the Location of Pain

Diagnosis of PAD (Claudication) is based upon signs and symptoms and confirmed with non-invasive tests:Ankle-Brachial (arm) Index – resting BP at ankle compare to BP in the arm. Ankle systolic divided by arm systolic = Index. .9-1.3 is normalImaging:Ultrasound- see which areteries are blocked and whereCT- good if patients have pacemaker ot stentMRA – like CT but don’t use xRays

Diagnosis of PAD

Medical therapyReduce Risk Factors:Medication to lower/manage cholesterol, high blood pressure, diabetes,Anti-platelet agents (Aspirin and Plavix)Exercise – 45-60 min at least 3x/week; supervised betterMedication to improve walking distanceCilostazolRevascularizationAngioplasty and StentingSurgery

Treatment for PAD

Lifestyle ChangeModify lifestyle in conjunction with medical treatmentIncrease physical activityModify dietManage stressSee handout

Treatment for PAD (cont)

Reduce risk factors – modify lifestyleBe physically active – walkBe screened for PAD

Prevention of PAD

American Heart Association. August 2014NIH. November 2015UpToDate. March 2015

References