Notes from the Parish Nurse - Peripheral Artery Disease

September is Peripheral Artery Disease (PAD) Awareness Month. This disease is a leading but preventable cause of death in the United States. It affects nearly 20 million Americans. PAD is an atherosclerotic disease that causes plaque (fats and cholesterol) to build up in the arteries in one’s arms and legs, though more commonly in the legs. Narrowed blood vessels make it harder for the blood to carry nutrients and oxygen to tissues in the area. When there is not enough blood flow to keep up with the demand of exercise, it results in leg pain called claudication. This pain is also intermittent because the leg pain starts with walking or exercise and goes away with rest.

Though some people have no symptoms with PAD, most people have a few common symptoms. The first symptom is usually pain, cramping, or discomfort in one’s legs or buttocks (intermittent claudication). The pain can be described as dull and aching, muscles tiring out, or an actual muscle spasm or cramp. The more activity, the more pain. Some people may feel numbness if the nerves are not getting enough blood flow. “An important detail about claudication is that it affects muscles only. It doesn’t cause arthritis and joint pain. The pain should also stop within a few minutes—or even less—once you stop to rest.”  Other symptoms include coldness, numbness, or weakness in one’s lower legs. The affected extremity may have shiny skin, skin color changes, slow growing toenails, hair loss or slow hair growth, more frequent skin and soft tissue infections of feet and legs, or toe and foot sores that don’t heal. Pulses in legs and feet often are weak or absent. If the condition is severe, pain might occur when one is lying down during rest or sleep.

There are a number of risk factors for developing PAD, but tobacco use is a significant one. Statistics show that 80% of people with PAD currently smoke or have smoked in the past. “Tobacco use increases the risk for PAD by 400%. It also brings on PAD symptoms almost 10 years earlier.” Other risk factors include having diabetes, high blood pressure, high cholesterol levels, obesity, kidney disease, blood clotting disorder, personal or family history of blood vessel disease, heart disease, or stroke, age (most frequently over 65 years), or being African American.

Early detection and treatment are important. “Half of the people who have PAD don’t have any symptoms. PAD can build up over a lifetime. Symptoms may not become obvious until later in life. For many people symptoms won’t appear until their artery narrows by 60% or more.” Techniques used to diagnose PAD are a physical exam, medical history, symptoms, feeling and listening to pulses in extremities, ankle-brachial index (ABI) which compares the blood pressure in one’s ankle to one’s arm, angiography which is imaging by using dye, MRI, CT scan, or vascular ultrasound.

There are two important goals for treating peripheral artery disease. The first is to reduce one’s risk of cardiovascular events such as heart attack or stroke. And secondly to improve one’s quality of live by easing pain that occurs when walking so exercise can be more comfortable. Lifestyle changes include quit using tobacco products; eat a balanced diet that is high in fiber and low in cholesterol, fat, and sodium; drink plenty of water to stay hydrated; exercise by walking regularly; manage health issues such as high blood pressure, diabetes, and high cholesterol; maintain a healthy weight; get good sleep; keep stress low with yoga or meditation; and have good foot and skin care. Medical treatments include medications such as blood thinners or statins, and medications used to control diabetes or high blood pressure. Surgical treatments include angioplasty to open a narrowed or blocked artery by inserting a stent, bypass surgery to insert a new blood vessel, or atherectomy to remove the plaque.