Ask The Expert

Peripheral Arterial Disease

May 01, 2008|By Holly Selby

If you feel discomfort in your legs every time you go for a walk, it is possible that you have PAD, or peripheral arterial disease, particularly if you smoke or have diabetes, says Dr. Elizabeth Ratchford, assistant professor and director of the Clinical Vascular Medicine program at the Johns Hopkins School of Medicine's Division of Cardiology.

Twenty percent of people 70 or older have symptomatic PAD, and many more people in that age group have PAD but do not experience the symptoms, according to the American Heart Association.

The disease can be debilitating, causing people to curtail activities to avoid the discomfort. Additionally, those who have PAD are at greater risk for stroke and heart disease.

Can you further describe PAD?

PAD stands for peripheral arterial disease, which is basically blockages in the leg arteries. It can occur in other places, but when doctors talk about it, we usually are referring to the legs and arms. It is caused by atherosclerosis or the buildup of plaque [fatty deposits] in the arteries, which reduces blood flow.

How prevalent is PAD?

Most people don't know they have it. Symptoms include something that doctors call claudication, or discomfort in the legs when walking that is relieved by rest. People describe it as a leg cramp or an ache, and sometimes people will begin to limit what they do -- how much they walk -- because of the discomfort.

Other symptoms may include numbness, heaviness or weakness in the leg muscles; sores that don't heal; or color changes in the skin.

How would a person tell a leg cramp from the discomfort that potentially signals PAD?

People who have this symptom say that every time they walk one or two blocks it happens. And it is always relieved by rest.

This is different from the "Charley horse" you get at night, or if you go running and get a cramp in your leg.

Who is at risk for PAD?

Age is a risk factor. (Doctors should be looking for it in anyone over the age of 70.) And smoking or diabetes both are risk factors. If you do smoke, you are twice as likely to develop these leg blockages as you are to develop heart disease. We don't know why, but it probably has to do with the size of the arteries. High blood pressure is also a risk factor.

If you suspect you may have PAD, when should you consult a doctor?

These symptoms are never an emergency. This is plaque in the arteries, so it's not like anyone needs to rush to the emergency room. But they should mention the symptoms to their doctor so that their doctor can assess them.

How is PAD diagnosed?

The simplest way is with an ankle-brachial index. You put blood-pressure cuffs on both arms and both ankles and listen to the pulse and measure the ratio of blood pressure in the ankles compared to that in the arm. That is pretty much diagnostic.

What is the treatment for PAD?

My specialty is noninvasive treatment of vascular disease. Basically, we start with risk-factor modification: Treat the diabetes, stop smoking, treat high blood pressure, take aspirin or other blood thinner and exercise. Anyone with PAD should do those things. It is basically the medical management of all the things that cause the blockages.

Exercise is by far the most effective treatment, but it should be supervised. At Hopkins, the patients come to a center three times a week and are monitored on a treadmill. Usually, people can double the distance they can walk by the end of 12 weeks.

Is there new research that might affect treatment of blockages of the arteries?

At Hopkins, we are one of the sites for a National Heart, Lung and Blood Institute study called the CLEVER [Claudication: Exercise Versus Endoluminal Revascularization] Trial. It is a multicenter trial comparing supervised exercise, endovascular stenting [balloon angioplasty followed by insertion of a wire-mesh tube to prop open the artery] and medical therapy for the treatment of PAD.

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