Peripheral artery disease
Peripheral artery disease
Peripheral artery disease (PAD) (sometimes also called peripheral vascular disease) is a condition that is common in people with diabetes. It is estimated that people with diabetes are 3 times more likely to develop PAD than people without diabetes.1 As with coronary heart disease (CHD) where the arteries that supply blood to the heart get blocked, PAD occurs when fatty deposits (called plaques) form on the inner walls of arteries outside of the chest, typically in the legs. The word peripheral refers to the limbs outside of the center of the body. In PAD, the build-up of plaques causes a narrowing of the blood vessel, constricting the flow of blood.
How can I decrease my risk for PAD
Increased risk for development of PAD is linked to several factors that are common in cardiovascular disease. To lower your risk for PAD, you should:2:
- Stop smoking (if you smoke). Cigarette smoking promotes a number of health problems, including cerebrovascular disease. If you have type 2 diabetes and smoke, you should consider stopping. Talk with your doctor about your options for quitting smoking. There are many smoking cessation programs and some medications that you can use to help you kick the habit. Keep in mind that quitting smoking is hard to do and often takes several attempts. You may need some help, so talk to your doctor about what you can do to kick the habit and don’t give up until you’ve succeeded!
- Get and keep your blood pressure under control. at or below your target level, using lifestyle modifications and/or medication. The American Diabetes Association (ADA) recommends that you keep your blood pressure below 140/80 mmHg or perhaps lower (130/80 mmHg) if you are in a certain patient group.3)
- Keep your low-density lipoprotein (LDL) cholesterol and triglyceride levels under control at or below target levels, using lifestyle modifications and/or medications (specifically statins). LDL cholesterol level should generally be below 100 mg/dL and in some cases below 70 to 80 mg/dL. Talk to your doctor about what your lipid targets should be as they can depend on underlying illnesses or health conditions.4
- If you are overweight, lose weight and keep it off. Try to lose 5% to 10% from your starting weight and keep as much of this weight off as possible.
- Get regular moderate exercise. Regular exercise can help you lower your risk for heart disease and can benefit you in many other ways if you have diabetes. Talk to your doctor before you start an exercise program.
What are the symptoms of PAD?
How PAD effects you can vary from individual to individual. But there are some typical symptoms that are related from loss of adequate blood supply to the limbs in the body, including2:
- Pain in the calves or thigh when walking or climbing stairs
- Feeling of coolness in the foot
- Hair loss on the legs or feet
- Change of skin color (to white or red) affecting foot or calf
- Foot pain that develops at night, after going to bed
- Wounds (also called ulcers) on leg or feet that are slow to heal
- Gangrene (areas of dead tissue that turn black) affecting the foot
How is PAD diagnosed?
Your doctor can diagnose PAD using a specialized physical exam to evaluate blood circulation in your legs and feet. In addition, your doctor will note typical signs and symptoms of PAD, such as loss of hair on legs and changes in your skin and nails. Taking the pulse in the leg or using a device called a Doppler ultrasound to listen to the pulse can also provide valuable information that is helpful in diagnosing PAD.
How is PAD treated?
Once you’ve been diagnosed with PAD, your doctor will suggest a course of treatment depending the severity of your condition and the presence of other health complications. Great advances have been made in recent decades to develop less invasive surgical approaches to PAD. These approaches are associated with less risk, especially in the elderly and people with complex multiple health conditions.2
Specific treatment options for PAD include angioplasty, stenting, atherectomy (laser or rotational), endarterectomy, or bypass surgery. In some cases, where blockage is severe and damage to tissue is irreversible, amputation may be necessary.
Minimally invasive procedures. Minimally invasive procedures for PAD are sometimes referred to as endovascular procedures. The term endovascular means that the procedure is performed inside of the artery without opening up the artery, but by accessing the artery through a vessel in the body. The type of endovascular procedure used will depend on various factors, including how much calcium is present in the artery (high amounts of calcium can make plaques more difficult to treat), the amount of blockage in an artery, and the location of the blockage.
More invasive procedures. Endarterectomy is a more invasive approach to correcting a blocked artery that involves opening the artery and removing the blockage. It is often used in PAD where a blockage is limited to a specific area. For instance endarterectomy is typically used if a blockage is limited to the groin area and removal can improve blood flow to the leg or legs.
Open bypass surgery is an invasive surgical approach to PAD that is used in cases where an aggressive approach is needed to save a limb or to improve circulatory function. Open bypass surgery typically uses a vein from another area of the body to bypass the blocked artery. For instance, if you have a blockage in an artery in your calf or thigh, your surgeon may bypass this blockage by using a vein from your leg to carry blood from the artery in your groin (the femoral artery) to the artery in your foot (the dorsalis pedis artery). In bypass surgery, the first step may be to improve and stabilize other medical conditions. For instance, if your blood glucose is not controlled, your doctor will work with you to help you achieve better control. Additionally, you should make other lifestyle modifications to minimize risk for further advance of PAD. The healthier you are, the better chance that your open bypass surgery will be a successful and durable correction.