Are you at risk for PAD?


Dr. Philip Adler
Board certified interventional radiologist
Q: What is PAD?
A: Blood flows through an artery from the heart muscle pumping it along. In unhealthy arteries, plaque build-up in the wall can narrow the vessel making it difficult for the blood to flow properly. The initial stage of the condition is called "claudication," which only occurs when walking moderate distances without resting. The demand for oxygenated blood to fuel the leg muscles cannot be met and cramping ensues. An advanced stage occurs when the inflow is insufficient even at rest, called "rest pain." In severe cases, the muscles atrophy, legs feel cold and wounds do not heal. When the latter occurs, it could lead to amputation.

Q: How does a vascular problem affect the legs?
A: All body parts need proper inflow and outflow of blood. Arteries inflow blood to the legs from the heart to supply them with the oxygen necessary for them to work. Veins return the blood, depleted of oxygen, to the heart and lungs where it refuels with oxygen that is inhaled.
When arterial inflow is insufficient because of blood vessel narrowing or closures, a spectrum of symptoms can occur including leg pain that doesn't go away, foot or toe wounds that heal slowly or not at all, gangrene and a decrease in temperature of the lower leg or foot. This is known as peripheral arterial disease or PAD. When venous outflow is compromised, the blood remains in the legs longer than it should, creating its own set of issues.

Q: How do poorly functioning veins affect the legs?
A: Blood flows through veins differently. Muscles around the veins contract, sending blood toward the heart. Valves exist to prevent back flow, but they can leak. Even though the blood is pumped in the right direction, it can flow back down because of gravity. Alternatively, veins can also narrow, creating resistance for blood return. Being at the lowest part of the body and further from the heart, the inadequately returned blood can pool, making the veins bulge (varicose veins).
In time the fluid leaking out of the blood stream creates swelling and red blood cells breakdown discolors and thickens the skin. Excess blood in veins under the surface of the skin create a tension that may create a wound (venous ulcer).

Q: Can this condition lead to something more serious?
A: PAD and other vascular conditions, if left untreated, can lead to more severe conditions, like heart attack or stroke.

Q: What are the risk factors for vascular or venous disease?
A: Arterial disease risk factors:
-Diabetes
-Obesity
-High cholesterol
-Physical inactivity
-Hypertension (high blood pressure)
-Smoking
Venous disease risk factors:
-Family history of varicose veins
-Female
-Prior pregnancy
-Obesity

Q: What should I do if I think I'm at risk or have a leg vascular problem?
A: If you have risk factors, you should talk to your physician about being screened. He or she will be able to tell you if screening is required. In addition, to check for a weak pulse in the legs, your health care provider may use quick and painless methods to determine if there is an issue.