2. Peripheral Artery Disease (PAD)
Also referred to as peripheral vascular disease, claudication, vascular disease, or leg cramps from poor circulation
Ruth Townsend, MS
Director, Health & Well-being Solutions

3. What is Peripheral Artery Disease (PAD)
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 legs
Plaque is also called atherosclerosis
Made up of fat, cholesterol, calcium, fibrous tissue, and other substances

4. PAD: Arteries that Can be Affected

5. Normal and Atherosclerotic Arteries

6. Why Does PAD Matter?
PAD increases your risk for coronary heart disease, heart attack, stroke, TIA – it might be the first warning sign
Dangerous because it restricts circulation to the limbs, organs and brain.
Without adequate blood flow legs, feet, arms, brain and vital organs suffer damage
Pain, numbness
Have difficulty fighting infection – gangrene, tissue death

7. Understanding the Cause and Your Risk for PAD
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 PAD
Obesity – 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

8. Understanding the Cause and Your Risk for PAD (cont)
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 diseases
Physical inactivity – Get moving now! Physical activity increases the time or distance one can walk without pain; also helps decrease risk of heart disease or stroke
High Blood Pressure – Manage with medications, diet and exercise , and stress management

9. 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 flow
Age-Plaque builds up in your arteries as you age, combined with other risk factors like smoking or diabetes, puts one at an even higher risk
People who smoke and/or have diabetes are at especially high risk

10. Symptoms of PAD
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 claudication
Working muscles need more blood flow than resting muscles

11. Location of PAD Determines the Location of Pain
Claudication pain, cramping, or other discomfort varies from individual to individual. Some have severe debilitating discomfort while other have minimal symptoms
The severity depends on:
how many arteries are affected, how narrowed (blocked) the arteries are, and how many collateral or secondary vessels are available
How quickly you walk and whether you walk on an incline or up stairs
Claudication location:
In the upper 2/3 of the calf is usually due to PAD in the main artery of the thigh, superficial femoral artery
Lower 1/3 of the calf is due to disease in the popliteal artery behind the knee
Upper thigh pain results from blockage in the superficial femoral artery, common femoral artery or iliac artery
Buttock pain results from blockage in the abdominal aorta
Foot pain results from blockage in the tibial or peroneal arteries

12. Diagnosis of PAD
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 is normal
Imaging:
Ultrasound- see which areteries are blocked and where
CT- good if patients have pacemaker ot stent
MRA – like CT but don’t use xRays

13. Treatment for PAD Medical therapy Reduce Risk Factors:
Medication to lower/manage cholesterol, high blood pressure, diabetes,
Anti-platelet agents (Aspirin and Plavix)
Exercise – min at least 3x/week; supervised better
Medication to improve walking distance
Cilostazol
Revascularization
Angioplasty and Stenting
Surgery

14. Treatment for PAD (cont)
Lifestyle Change
Modify lifestyle in conjunction with medical treatment
Increase physical activity
Modify diet
Manage stress
See handout

15. Prevention of PAD Reduce risk factors – modify lifestyle
Be physically active – walk
Be screened for PAD

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