1. Peripheral Arterial Disease >Increasing Awareness >What is PAD >Risk factors >Symptoms of PAD >Screening & Treatment Options

2. What is PAD Peripheral arterial disease begins when the lining of an artery is damaged.Peripheral arterial disease begins when the lining of an artery is damaged. Leading to the development of plaque & fatty deposits which limit blood flow to your legs, & affects the arterial walls ability to expand.Leading to the development of plaque & fatty deposits which limit blood flow to your legs, & affects the arterial walls ability to expand. This decrease in blood flow and oxygen can cause pain in your calves, thighs, & even buttocks with walking/exercise.This decrease in blood flow and oxygen can cause pain in your calves, thighs, & even buttocks with walking/exercise. Peripheral disease can also exist in the vessels leading up to and into the arms and the neck as well.Peripheral disease can also exist in the vessels leading up to and into the arms and the neck as well.

3. How Common is PAD * Affects about 1 in 20 people over the age of 50, * Affects about 1 in 20 people over the age of 50, or over 12 million people in the United States. or over 12 million people in the United States. PAD is only diagnosed in 50% of the population.PAD is only diagnosed in 50% of the population. 50% of all patients with PAD are completely asymptomatic or have atypical symptoms. 50% of all patients with PAD are completely asymptomatic or have atypical symptoms. * Symptomatic PAD carries at least a 30% risk of death within 5 years and almost 50% within 10 years, primarily due to MI (60%) or stroke (12%) death within 5 years and almost 50% within 10 years, primarily due to MI (60%) or stroke (12%)

4. Risk Factors for PAD Age 50-69 and history of smoking or diabetes.Age 50-69 and history of smoking or diabetes. Age > 70Age > 70 Smoking !!!!!Smoking !!!!! DiabetesDiabetes HypertensionHypertension DyslipidemiaDyslipidemia Overweight & SedentaryOverweight & Sedentary African American EthnicityAfrican American Ethnicity H/O Heart, carotid, renal artery disease, or stroke.H/O Heart, carotid, renal artery disease, or stroke. Family H/O of PAD, Heart disease or stroke.Family H/O of PAD, Heart disease or stroke.

5. Treating & Managing PAD with Lifestyle Changes & Risk Factor Modification #1 is Smoking Cessation!!!!!!!#1 is Smoking Cessation!!!!!!! Lowering BP less than 130/80Lowering BP less than 130/80 LDL goal of <100, or <70 if you are high risk for heart attack and stroke.LDL goal of <100, or <70 if you are high risk for heart attack and stroke. Good management of Diabetes (A1c of <7.0)Good management of Diabetes (A1c of <7.0) Follow a Mediterranean diet!!Follow a Mediterranean diet!! Regular exercise most days of the week!!Regular exercise most days of the week!! Compliance with Medications prescribed by your Physician.Compliance with Medications prescribed by your Physician.

6. Major Goals of Treating & Preventing PAD Prevention and/or progression of the diseasePrevention and/or progression of the disease Increased functionality & quality of lifeIncreased functionality & quality of life Improved ability to walk, as well as time and distance of pain free walking.Improved ability to walk, as well as time and distance of pain free walking. Decrease in death and disability from other vascular disease such as Heart Attack & Stroke.Decrease in death and disability from other vascular disease such as Heart Attack & Stroke.

7. Symptoms of Peripheral Arterial Disease/PAD: Muscle pain, ache, cramping, numbness, or sense of fatigue. Classically in the calves, & may move to thighs or buttocks=Claudication.Muscle pain, ache, cramping, numbness, or sense of fatigue. Classically in the calves, & may move to thighs or buttocks=Claudication. Symptoms of claudication are usually brought on by exertional, weight bearing exercise (walking), & is typically relieved by short (<2 min.) periods of rest.Symptoms of claudication are usually brought on by exertional, weight bearing exercise (walking), & is typically relieved by short (<2 min.) periods of rest. Foot or toe pain at rest that may disturb sleep.Foot or toe pain at rest that may disturb sleep. Cold legs, skin color changes due to poor circulation.Cold legs, skin color changes due to poor circulation. Atrophic changes of the legs, such as loss of hair & shiny skin.Atrophic changes of the legs, such as loss of hair & shiny skin. Skin wounds or ulcers on feet or toes that are slow to heal, or that do not heal.Skin wounds or ulcers on feet or toes that are slow to heal, or that do not heal.

8. Proper Foot Care Wash feet daily with warm water, and mild soap, & use of topical moisturizers is suggested unless you have open wounds.Wash feet daily with warm water, and mild soap, & use of topical moisturizers is suggested unless you have open wounds. Trim toe nails straight across to avoid ingrown nails---infection.Trim toe nails straight across to avoid ingrown nails---infection. Inspect feet daily for any bruises, sores, cuts, blisters, areas of redness or swelling.Inspect feet daily for any bruises, sores, cuts, blisters, areas of redness or swelling. Any skin lesions or ulcerations should be addressed by your physician, due to the increase risk for infection (especially in diabetics)Any skin lesions or ulcerations should be addressed by your physician, due to the increase risk for infection (especially in diabetics)

9. Claudication Pain Scale 0 = No claudication pain0 = No claudication pain 1 = Initial, minimal pain1 = Initial, minimal pain 2 = Moderate, bothersome pain2 = Moderate, bothersome pain 3 = Intense pain3 = Intense pain 4 = Maximal pain, cannot continue4 = Maximal pain, cannot continue

10. PAD Exercise Guidelines - The Warm up: This is the same  3-5 minutes walking @ an intensity level which does not elicit claudication symptoms. - Mode: Treadmill or track walking (Weight bearing Exercise) is considered the best. However, low impact exercise can and should be part of your regimen as well. Resistance training, and stretching can be added. - Duration: Walk or exercise until you reach intense pain. Rest between intervals until pain subsides, before resuming the next interval. Walk the number of intervals it takes to initially accumulate 35 minutes. - Progression & Intensity: Once you can walk 8-10 minutes, prior to reaching a 2-3 on the claudication scale, increase your intensity. In addition, add 5 or more minutes each week until you have reached a total exercise time of 50-60 minutes. - Frequency: Work up to a minimum of 5-6 times/week. - Cool down: 3-5 minutes of walking or non-weight bearing equipment.

11. Diagnosing PAD Physical exam---Assessment of lower extremities.Physical exam---Assessment of lower extremities. Non-invasive testing:Non-invasive testing: –ABI –Ultrasound –MRA’s or CT scans AngiographyAngiography

12. Invasive Treatment Options Angioplasty, Athrectomy, &/or Stenting, can be an option, in some cases.Angioplasty, Athrectomy, &/or Stenting, can be an option, in some cases. Surgical options include reconstruction of the artery, &/or bypass, when appropriate.Surgical options include reconstruction of the artery, &/or bypass, when appropriate.

13. Medications Compliance with medications is very important!Compliance with medications is very important! Medications frequently ordered:Medications frequently ordered: –Those for optimal Blood pressure control –Cholesterol lowering medication –Anti platelet therapy (Asprin & Plavix) to reduce the risk of heart attack, stroke, and other vascular complications. –Medications to control your diabetes if you are diabetic or prediabetic. –Pain medication