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Inova Talk: Is it normal aging or PAD?

Have you experienced cramps or tiredness in your leg muscles? This could be due to normal aging, or it could be a symptom of a more serious condition called Peripheral Arterial Disease (PAD). PAD is also known as “hardening of the arteries.” If left untreated, PAD can cause irreversible damage. However, with some simple screenings, this common circulation problem can easily be diagnosed and treated. Dr. Richard Neville and Dr. Charles Murphy had a conversation about PAD risk factors, how the disease is evaluated and diagnosed along with the latest in treatment options.

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Peripheral arterial disease (PAD), also known as poor circulation, occurs when there is narrowing of the arteries. Often PAD is the result of atherosclerosis, sometimes referred to as hardening of the arteries. When symptoms are present, the most common are cramping, discomfort, or tiredness in the leg muscles while walking or exercising.

PAD is a slow and progressive circulation disorder. Areas affected by PAD, such as the arms and legs, may not receive adequate blood flow.  If left untreated, the poor circulation can cause irreversible damage. The most advanced stages of PAD can lead to legs and feet with such severe blockage that they do not receive the oxygen-rich blood required for growth and repair of painful sores. This condition, if left untreated, can potentially lead to gangrene, amputation and significant disability.

Risk factors and symptoms

  • Discomfort, aching, heaviness, numbness, burning, or cramping in your calves, thighs, hips, buttocks, or feet that occurs while walking or climbing stairs. The discomfort gets better after you stop.
  • Other common sensations are heaviness, tingling, or fatigue. Rest usually helps, but raising your legs – as when you lie in bed – may make the discomfort worse.
  • The skin on your leg turns pale or bluish when you elevate it
  • Your foot turns a dusky red when you stand or sit
  • The hair on your foot stops growing or your toenails stop growing
  • You have sores on your toes, feet, or legs that heal slowly or not at all
  • Other factors that increase the risk for PAD are age, smoking, diabetes, high blood pressure, obesity, high cholesterol, heart disease, and stroke. A family history of these conditions may also increase risk.

PAD often goes undiagnosed for a long time. Most people mistake the symptoms of PAD for something else. Sometimes people experience no symptoms at all until the disease has become advanced. Work closely with your doctor to ensure a greater chance of early diagnosis and treatment if needed.

The same process that causes PAD can also affect the coronary arteries that feed the heart muscle. Patients with PAD are also at risk for coronary artery disease (CAD) and are 4 to 5 times more likely to suffer a heart attack or stroke. Once you are diagnosed with PAD you should also be screened for presence of coronary artery disease.

Diagnostic tools

We use many different types of tests to diagnose PAD. The single most important test is a thorough history and physical examination by a qualified and experienced vascular specialist.

Additional tests may be used to define the severity of the PAD and may include:

  • Doppler ultrasound exam of an extremity
  • Angiography
  • CT angiography

Treatment options

Treatment options vary and depend on the overall health of the patient and the severity of the PAD. Treatment may range from improving overall cardiovascular health to endovascular or bypass surgery. Learn more about treatment for PAD arrows