What is PAD


Peripheral Arterial Disease is a common circulatory problem in which narrowed arteries reduce the blood flow to your limbs.


When you develop peripheral arterial disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes various symptoms, the most notable of which is leg pain when walking (claudication).

Peripheral arterial disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your legs as well as your heart and brain.

While many people with peripheral arterial disease have mild or no symptoms, some people experience leg pain when walking (claudication).

Claudication symptoms include muscle pain or cramping in your legs or arms that is triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. The calf is the most common location.

The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity.

Peripheral artery disease symptoms include:

  • Painful cramping in your hip, thigh or calf muscles after certain activities, such as walking or climbing stairs (claudication)
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared with the other side
  • Sores on your toes, feet or legs that won’t heal
  • A change in the colour of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet

If peripheral arterial disease progresses, pain may even occur when you’re at rest or when you’re lying down (ischaemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.


Who is at risk?


Up to 20% of people over 70 years of age have PAD. Most of them are diabetics, smokers, or have renal disease or other cardiovascular conditions.


According to the guidelines, the risk groups of PAD patients therefore includes: people over 50 who are diabetics, hypertensive, smokers, overweight or have high cholesterol, as well as everyone over the age of 65.

If the disease is not discovered early enough or treated the right way, it can have dangerous outcomes, such as heart attack, stroke, ulcers or amputation.

Causes and risk factors include:

  • Atherosclerosis
  • Hypertension
  • High cholesterol
  • Abdominal obesity
  • Advanced age
  • Smoking
  • Diabetes mellitus
  • Family History of PAD or coronary artery disease (CAD)
  • Kidney disease

Therefore, even if you don’t have symptoms of peripheral arterial disease, you may need to be screened if you are over the age of 50 and with one of the risk factors, or if you are older than 65. For diabetic patients we recommend screening even sooner, at 45 years of age.

Risk factors for PAD are similar to those for CAD and most patients may be suffering from both. Diabetes and PAD are also linked.

The key to treating PAD is early detection. If any of the risk factors mentioned above sound like they might pertain to you, ask your physician for a diagnostic test. If necessary, your doctor can work with you to determine the treatment plan that’s best for you.


Symptoms and Consequences


Despite a large percentage of asymptomatic cases of PAD, there are several common symptoms, the most prominent of which are pain and cramping in the legs while walking or exercising. This type of pain is known as claudication and is commonly located in the calf muscles of the affected leg(s), but can also be felt in the buttocks, thighs or feet.


Claudication can be accompanied by cramps, numbness and feeling of heaviness (in the legs), the sharpness of which often subsides when an individual with PAD takes a rest.

The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity.

But pain usually flares up again when the individual resumes walking. This phenomenon is called intermittent claudication.

Other symptoms of PAD (beside intermittent claudication)

  • Weak or entirely absent pulse in the legs and feet. An abnormal pulse in the posterior tibial artery (the artery at the back of the lower leg) has a 48.7% predictive value for PAD.
  • The colour of the skin on the affected leg changing to a blueish or pale hue. Individuals with moderate to severe PAD often exhibit pallor in an affected leg when it is in elevated position.
  • Lower temperature or coldness in the affected leg (in comparison with the unaffected limb or the rest of the body). This can be so pronounced, especially in individuals with severe PAD, that it can be felt by touch, without any complex diagnostic tools.
  • Scaly and shiny skin on the affected leg. Skin texture is noticeably different on the affected leg(s) in comparison with an unaffected limb or the leg of a healthy individual.
  • Poor toenail and hair growth on the affected leg. A diminished flow of nutrients in the blood leads to malformation of toenails and even complete hair loss.
  • Sores, ulcers and wounds on the feet, usually non-healing in nature. Most typical for PAD sufferers are arterial insufficiency ulcers (also known as ischaemic ulcers) which are the second-most common type (10 to 30% of all cases of ulceration) of lower-extremity ulcers.
  • Gangrene. The most extreme and obvious symptom/complication of PAD that ultimately requires partial or complete amputation of an affected limb to save a patient’s life. In the United States alone between the years 2000 and 2008, about 6.8% of patients hospitalised with PAD required lower-extremity amputation (LEA) (during the same time period).
  • Erectile dysfunction in men, especially if they are diabetic. There is a strong correlation between PAD and erectile dysfunction (ED), with one study showing that the likelihood of individuals with ED also having PAD was two-fold greater than in the control group without ED.

Peripheral Artery Disease (PAD) is one of the vascular diseases which are often asymptomatic, with studies suggesting that up to 40% of individuals with PAD have no symptoms, about 50% have symptoms that could be attributed to other medical conditions and only 10% have classic PAD symptoms.

If peripheral arterial disease progresses, pain may even occur when you’re at rest or when you’re lying down (ischaemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

One method of identifying undiagnosed PAD is measuring Ankle-Brachial Index (ABI).

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