WSFA.com: News Weather and Sports for Montgomery, AL.Trouble walking may be a sign of peripheral arterial disease

What is PAD?

Peripheral arterial disease (PAD) is narrowing of the arteries beyond the heart due to atherosclerosis. Atherosclerosis is the buildup of plaque inside artery walls. It's also called "hardening of the arteries." Plaque is made up of excess cholesterol, fat, platelets and other substances in your blood. In PAD, plaque buildup reduces blood flow to muscles and organs. PAD most often occurs in the arteries to the legs. But it also is a sign of a likely plaque buildup in arteries throughout your body, including the heart (coronary artery disease) and the major arteries to the brain (carotid artery stenosis). This can put you at risk for heart attack and stroke.

What are the symptoms?

At first, you may not have symptoms from PAD. Over time, you can develop leg pain when walking that stops with rest. This is called intermittent claudication. This can often be treated with medication, surgery or a procedure such as angioplasty. Other symptoms of PAD include:

• Pale or bluish, cold skin
• Lack of leg hair and nail growth
• Weak or missing pulses in the legs or arms
• Erectile dysfunction, especially in men who also have diabetes
• Poor wound healing in the legs and feet

What are other complications of PAD?

Plaque can also block flow to the kidneys and cause severe high blood pressure that is hard to control. Calcium deposits can form in the wall of the aorta. The damaged wall may balloon out. This can cause an aneurysm, which may bleed suddenly.

More blockages can form in the leg arteries, further cutting off blood supply. Poor circulation can prevent healing of foot sores. At this point, there is a risk of gangrene (dead tissue), which may require amputation.

Risks factors for PAD

Risk factors for PAD include:

• Diabetes
• High cholesterol
• Smoking
• Age 50 years or older
• History of heart disease, stroke or atherosclerosis

How is PAD diagnosed?

Diagnosis of PAD is based on your report of symptoms plus a physical exam. Your doctor will also look for signs of other conditions that often accompany PAD, such as coronary artery disease or carotid artery stenosis. Your doctor will check the strength of blood flow in your legs. In PAD, pulses in the legs may be weak or absent. He or she will listen for a bruit using a stethoscope. A "bruit" is a whooshing sound as blood flows through a narrow area in an artery. Your doctor will do a simple test, called an ankle-brachial index, that compares the blood pressure in the ankles with the arms. This test can tell if you have PAD but cannot determine which arteries are involved. To diagnose PAD in specific arteries, your doctor may do:

• Doppler ultrasound. This test uses sound waves to measure the flood of blood in an artery and to check for blockages.
• Arteriogram. This uses x-ray pictures taken after a dye is injected into a blood vessel. The test can show the exact location and extent of blockage in an artery.
• Magnetic resonance angiogram (MRA). This uses magnetic and radio waves to make pictures of arteries to see if there is reduced blood flow. The test is often done to show the condition of blood vessels to the brain, kidneys and legs.

How is PAD treated?

An essential part of treatment is lifestyle changes that can reverse the buildup of plaque in the arteries. If you smoke, ask your doctor for information on quitting. If you have high cholesterol, follow a low-cholesterol, low-fat diet and take any medication that you have been prescribed. If you have diabetes, work with your doctor to lower your hemoglobin A1C to goal. If you have high blood pressure, stick to a low-sodium diet and take any medications as directed. These same lifestyle interventions can also help to prevent PAD from developing in the first place.

Medications may be prescribed to:

• Treat leg pain (intermittent claudication)
• Reduce risk of blood clots
• Reduce your risk of heart attack or stroke
• Lower your cholesterol if diet intervention isn't enough
• Help lower your blood sugar, if you have diabetes
• Help lower your blood pressure, if you have hypertension

Several procedures may help improve the blood flow to your legs:

• Angioplasty. A tiny balloon is passed into the artery, widened to expand the blockage and then removed.
• Stent. A wire mesh may be put in place during angioplasty to keep the narrowed area open.
• Bypass surgery. A graft is used to re-route your blood flow, restoring circulation to your limb. Grafts are made from synthetic material or can come from your own blood vessel.

What you can do about PAD:

• Tell your doctor. If you have pain in your calf when you walk, a major leg artery may be blocked.
• Stop Smoking. Smokers are more likely to develop PAD than nonsmokers. PAD advances quickly in smokers and is harder to treat if they keep smoking. If you smoke, this is the most important thing you can do to control PAD.
• Control your cholesterol. The same healthy diet that protects you against heart disease and stroke can also help prevent PAD.
• Exercise. Getting regular exercise is often an effective treatment for intermittent claudication. It also cuts your risk for heart disease. Ask your doctor what activity level is right for you.
• Keep your blood sugar under control if you have diabetes. Diabetes can cause plaques to form more quickly in your arteries. Keep your blood sugar as close to your goal as possible. Ask your doctor about your personal goal.
• Keep your blood pressure under control.