Peripheral artery disease (PAD) or lower-extremity artery disease (LEAD) as it is also called, may often be entirely asymptomatic, but that doesn’t mean it can’t be diagnosed using modern diagnostic methods. However, certain groups of patients are more at risk than others and should therefore be given priority before others.
The connection between PAD and overall cardiovascular health is well researched and ABI score is recognised as an important indicator for improving the accuracy of cardiovascular risk prediction beyond the FRS (Framingham Risk Score). Risk factors for development of PAD are, therefore, virtually the same as for many other CVDs, but some have more weight than others.
Overview of risk factors for PAD
- Smoking. The biggest risk factor for development of many CVDs, including PAD, is tobacco smoking (more than twofold increase in risk in comparison with those who have never smoked, although some subgroups, like females are even worse affected).
- Diabetes. The other serious risk factor, which greatly increases the incidence and severity (major amputation rates are 5 to 15 times higher in diabetic than non-diabetic patients with PAD) of PAD.
- Age. An important risk factor as older individuals are statistically more likely to have PAD.
- Obesity. Unhealthy weight is a risk factor for many CVDs, not just PAD.
- Dyslipidaemia. Abnormal levels of blood lipids contribute to the atherosclerotic process (underlying mechanism of PAD).
- Hypertension. High blood pressure is a risk factor for both the development of PAD and the severity of outcome (increased risk of ischaemic stroke and myocardial infarction).
- Family history. The genetic aspect of PAD is relatively poorly researched, but studies have shown that those individuals with a family history of the disease are at a greater risk.
Overview of symptoms of PAD
- Intermittent claudication.
- Weak or entirely absent pulse in the legs and feet.
- The colour of the skin on the affected leg changing to a blueish or pale hue.
- Lower temperature in the affected leg (in comparison with the unaffected limb or the rest of the body).
- Scaly and shiny skin on the affected leg.
- Poor toenail and hair growth on the affected leg.
- Sores, ulcers and wound on the feet, usually non-healing in nature.
- Erectile dysfunction in men, especially if they are diabetic.
There are several diagnostic methods suitable for identifying PAD and assessing its severity, but some are more convenient and (cost) effective than others. Generally speaking, each attempt at PAD diagnosis should start with a physical examination and a detailed questionnaire in order to determine whether the examined patient is a candidate for further examination with a diagnostic device (ABI assessment).
The standard method of measuring ABI is by using a Doppler probe and a sphygmomanometer (accuracy dependant on examiner’s skill), but there are far better options, like an oscillometric-plethysmographic device, which is especially suitable for preventive screening . Assessment on the basis of ABI is also suitable for other diagnostic purposes besides diagnosing PAD.
Patients in risk groups are particularly susceptible to PAD and often have worse morbidity and higher rates of adverse outcomes, including death. They are prime candidates for an ABI assessment, which should be followed-up by immediate treatment or periodic preventive screening and lifestyle modification.