Close Cousins: Screenings Encouraged for both Peripheral Arterial & Coronary Artery Disease

As a vascular surgeon in East Tennessee where there is a high prevalence of obesity, diabetes, and coronary artery disease in the population, my cardiologist colleagues and I routinely share many of the same patients.

Peripheral arterial disease (PAD), the progressive buildup of plaque in the arteries outside the heart (usually in the legs), is usually caused by atherosclerosis, the same disease process that causes heart attack and stroke. High cholesterol, high blood pressure, obesity, smoking, diabetes, and a sedentary lifestyle all contribute to atherosclerosis. These cardiovascular risk factors are nearly always present in my PAD patients. Not surprisingly, PAD patients have a 1 in 3 chance of having coronary artery disease.

The most common PAD symptom/complaint is claudication, which is often described as a tired ache-like cramp in the legs when walking that is relieved when activity stops. People often dismiss leg cramps as a natural part of aging or arthritis, and may never mention it to their physician. An estimated, one in 20 Americans over age 50 has PAD, but are unaware of the condition. If PAD risk factors are not controlled, this atherosclerosis of the arteries can progress and lead to limb threat and possible amputation.

As PAD progresses, so does the inability to walk even short distances without having to stop frequently. The arteries can eventually become clogged with plaque and the blood flow so restricted, that the foot doesn’t get enough oxygen to meet its basic needs to remain viable. When we see patients in this advanced state of limb threat, there’s a high risk of limb amputation if steps aren’t quickly taken to intervene.

Patients who present with PAD symptoms, especially those with heart disease and other high risk factors, should be encouraged to be screened for peripheral arterial disease. The simple ankle-brachial index (ABI) test, which compares the blood pressure in the ankles to the arms, can show how well blood is flowing to the legs. A Doppler ultrasound test may be used to determine where a specific artery is blocked.

Fortunately, like heart disease, the progression of PAD can be slowed or stopped with lifestyle changes, medication, or a combination of both. Being physically active, especially with a walking program, can increase blood flow to the affected leg. For smokers, the most important intervention is to stop smoking immediately. Strict glucose control in diabetics and eating a low-cholesterol, low-fat diet, can also help reduce the buildup of plaque in the arteries. Medications to lower cholesterol, blood pressure, and diabetes are also a part of PAD treatment.

For patients whose PAD has advanced to the stage that it is disrupting their ability to work, enjoy favorite activities, or threatening a limb, circulation may be restored by opening the blockage with a minimally invasive procedure. This outpatient endovascular procedure is performed through a catheter that opens the blocked artery and restores circulation to the leg and foot. If a long section of an artery is blocked, bypass surgery may be needed.

PAD treatments are not “cures,” but can provide a very durable result, especially in patients who have minimized the risk factors listed above and embraced a more active lifestyle and healthier diet. PAD is often a gateway indicator to one’s overall cardiovascular health. Early detection and treatment of peripheral arterial disease can help improve patients’ quality of life and reduce the risk of amputation.

Richard M. Young, MD, FACS, is a vascular surgeon with Premier Surgical Associates at Fort Sanders Regional in Knoxville, Tennessee. He is board certified in vascular surgery by the American Board of Surgery and a Fellow of the American College of Surgeons.

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