Do you ever feel uncomfortable leg pain when you’re walking around or climbing stairs, but it goes away when you sit back down? Or, even worse, feel the pain even while you’re at rest? Lucky you if not, but if you do, then haven’t you wondered what it could be? It could be nothing, it could be an annoying side effect of aging, or it could be a sign of peripheral artery disease (PAD).

That may sound dramatic, but it’s actually much more likely than you’d think; about 8.5 million adults in the U.S. have PAD, yet only 25% of the general population are aware of what PAD is, and since sporadic leg pain is the most common symptom, it stands to reason that persistent leg pain very well could be PAD!

Let’s start with the basics – What exactly is PAD?

PAD is a condition in which your blood flow is impaired because of narrowed or blocked blood vessels. The blockage is usually caused by atherosclerosis, which is when plaque (fatty materials) clogs your arteries and restricts blood flow. PAD typically affects your legs, and since your body needs extra blood flow when it’s in motion (such as walking), the impaired blood flow results in the leg pain you feel. If the condition is left untreated, then PAD will progress to the point where you feel severe pain while at rest, known as “rest pain”. Don’t let PAD progress that far; knowing the symptoms and beginning treatment early will help prevent rest pain.

How do I know if I have PAD?

PAD typically has mild or unnoticeable symptoms in the beginning, which is why 40% of people don’t experience any symptoms.* The most common symptom of PAD is intermittent claudication, which is pain or cramps in the legs during activity that is relieved while at rest. Other common signs that can be seen or felt in the legs include:

• Weakness or numbness
• Unexplained hair loss
• Noticeable temperature differences
• Skin discoloration
• Weak or no pulse
• Slow-healing wounds
• Rest pain

Understanding Risk Factors

The most common contributing factors to the plaque buildup are:

• Smoking
• Overweight
• High cholesterol
• High blood pressure
• Aged 50 years or older
• Diabetes

Diabetes & PAD

Diabetes is a disease in which someone’s blood glucose (sugar) levels are too high and, if not properly managed, increases plaque buildup in the arteries which impairs blood flow. Someone with diabetes is at a high risk of developing atherosclerosis, which makes them at a higher risk of developing PAD. In fact, the risk is so high that PAD affects about 1 in 3 people with diabetes over 50 years old. That’s unfortunately not the worst of it, because someone with diabetes and PAD is extremely more likely to need a foot amputation. If improperly managed, someone with diabetes can develop nerve damage (neuropathy) as a result of high blood sugar levels. Someone with neuropathy may not feel an injury, and since PAD slows down the healing process, a wound left untreated could lead to severe infections which may result in the extremity needing to be amputated. Someone with diabetes should check their body everyday for any wounds and regularly see a doctor for examinations.

Preventing, Managing, and Treating

Unless it’s a severe case, treatment will focus around reducing symptoms and hindering further progression of PAD. It usually takes simple lifestyle changes to reverse the effects of PAD, and those lifestyle changes include what we all realistically know – be healthier! Maintaining healthy blood pressure, cholesterol, and glucose levels can greatly help to manage PAD, and managing those levels can be accomplished through simple steps: eat healthy, stay active, and quit smoking!

If left untreated, PAD can progress into an advanced stage in which surgery will be needed. Approximately 25% of PAD cases develop into the advanced stage where critical limb ischemia (CLI) occurs. This happens when the arteries become severely blocked and leads to extreme rest pain. At this point of the disease, a procedure may be needed to restore blood flow through the arteries in your legs, known as revascularization . Revascularization is needed to improve blood flow in order to save the limb from being amputated, and the two main treatments are:

• Angioplasty: a tiny balloon gets inflated into the artery to open the blockage, often used with the implantation of a stent for the purpose of propping the artery open and reducing the risk of another blockage.
• Artery Bypass Graft: blood vessels from another part of your body are taken and used to bypass the artery blockage.

What’s New in the PAD World?

Although the above treatments are effective in treating PAD, there is a 50% rate of restenosis (re-narrowing of the arteries) that occurs after surgery. This mainly occurs because new tissue grows inside the stent, which eventually leads to the formation of scar tissue that can grow and re-obstruct blood flow. This high frequency of in-stent restenosis has led to the medical breakthroughs of drug-eluting stents (DES) and drug-eluting balloons (DEBs).

DES and DEBs consists of the stent or balloon releasing paclitaxel, a drug used to prevent scar tissue formation, therefore leading to the prevention of restenosis.These are still being tested for their full effectiveness, but they have been shown to decrease the rate of in-stent restenosis. Luckily, a visit to the hospital is not needed for these procedures, not when there are office based labs (OBL).

Rise of the Office Based Lab (OBL)

OBL’s have been rising in popularity over the last decade because of their beneficial use to perform interventional procedures in a non-hospital setting. OBL’s have been proven to be better for both the patient and the healthcare system in its entirety, and here’s how:

• Better for the patient is measured by the safety, efficacy, and level of patient satisfaction, which includes the comfort of continuous care (meaning the same staff and surroundings), more personable experiences in a less intimidating environment, reduced healthcare costs, convenience for visitors, and lowered risk of nosocomial infections (hospital-acquired infections).
• Better for the healthcare system means that OBL’s allow physicians to have a broader range of services to offer the patient, result in fewer complications and follow-ups, and better administrative oversight.

Call your local CareCube today if you have any questions about PAD or if you want to learn more about our OBL!