Circulation Testing
Find Relief From Your Peripheral Artery Disease Symptoms.
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Don’t Live in Fear, Let Dr. Wigley Treat Your PAD
Learn More About Peripheral Artery Disease
Peripheral Artery Disease results from fatty deposits (plaque) built up in the arteries outside the heart (peripheral arteries), mainly the arteries supplying the legs and feet. This buildup narrows or blocks your arteries and reduces the amount of blood and oxygen delivered to your leg muscles and feet. The iliac, femoral, popliteal, and tibial arteries are commonly affected.
It is important to get treatment. Risks are high.
- People with PAD are at higher risk for heart attack and stroke.
- Left untreated, PAD can lead to gangrene and amputation.
- If you smoke, you have an especially high risk for PAD.
- You can take control by leading a heart-healthy lifestyle and following the recommendations of your healthcare professional.
- People with high blood pressure or high cholesterol are at risk for PAD.
- PAD is easily diagnosed in a simple, painless way.
- If you have diabetes, you have an especially high risk for PAD.
- Most cases of PAD can be managed with lifestyle changes and medication.
PAD Risk Factors You Can Control
Certain risk factors for PAD can’t be controlled, such as aging or having a personal or family history of PAD, cardiovascular disease or stroke. However, you can control many risk factors including:
Cigarette smoking
Smoking is a major risk factor for PAD. For example, smokers may have four times the risk of PAD than nonsmokers.
Physical inactivity
Physical activity increases the distance that people with PAD can walk without pain and helps decrease heart attack or stroke risk. Supervised exercise programs are one of the treatments for PAD patients.
Obesity
High blood cholesterol
High cholesterol contributes to the build-up of plaque in the arteries, significantly reducing the blood flow. This condition is known as atherosclerosis. Therefore, managing your cholesterol levels is essential to prevent or treat PAD.
Diabetes mellitus
High blood pressure
It’s sometimes called “the silent killer” because it has no symptoms. Instead, work with your healthcare professionals to monitor and control your blood pressure.
It’s important to learn the facts about PAD. As with any disease, the more you understand, the more likely you’ll be able to help your healthcare professional make an early diagnosis and start treatment. PAD has common symptoms, but many people with PAD never have any symptoms at all.
Taking care of only one risk factor is not as effective as taking care of all those that you can control. Develop a heart-healthy lifestyle and cooperate with your healthcare professionals. Your heart will thank you by functioning better and lasting longer.
Treatment for PAD focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow the progression or even reverse the symptoms of PAD.
What can you do to help slow the progression of PAD?
Certain risk factors for PAD can’t be controlled, such as aging or having a personal or family history of PAD, cardiovascular disease or stroke. However, you can control many risk factors including:
Diet
Many PAD patients have elevated cholesterol levels. A diet low in saturated fat, trans fat and cholesterol can help lower blood cholesterol levels, but medication may be necessary to maintain the proper cholesterol levels.
Physical Activity
The most effective treatment for PAD is regular physical activity. Your doctor may recommend a program of supervised exercise training for you. You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs three times a week can result in decreased symptoms in just four to eight weeks. Exercise for intermittent claudication takes into account the fact that walking causes pain. The program consists of alternating activity and rest in intervals to build up the amount of time you can walk before the pain sets in. It’s best if this exercise program is undertaken in a rehabilitation center on a treadmill and monitored. If it isn’t possible to go to a rehabilitation center, ask your healthcare professional to help you plan a program that’s best suited to your situation.
Smoking Cessation
Tobacco smoke greatly increases your risk for PAD and your risk for heart attack and stroke. Smokers may have four times the risk of developing PAD than nonsmokers. Stop smoking. It will help to slow the progression of PAD and other heart-related diseases.
Procedures
For a minority of patients the above recommendations and treatments aren’t enough, and minimally invasive treatment or surgery may be needed. Minimally invasive procedures consist of angioplasty or stent placement (as is done in the heart for CAD) or clot-removal treatment. They are nonsurgical and are performed by making a small incision through which a catheter is inserted to reach the blocked artery. A tiny balloon is inflated inside the artery to open the clog. A stent — a tiny wire mesh cylinder — may also be implanted at this time to help hold the artery open. Sometimes a medicine can be given through the catheter or a special device can be inserted through it to remove a clot that’s blocking the artery.
How Is Peripheral Arterial Disease Diagnosed?
Peripheral arterial disease (P.A.D.) is diagnosed based on your medical and family histories, a physical exam, and results from tests.
P.A.D. often is diagnosed after symptoms are reported. An accurate diagnosis is important, because people who have P.A.D. are at increased risk for coronary artery disease (CAD), heart attack, stroke, and transient ischemic attack (“mini-stroke”). If you have P.A.D., your doctor also may want to look for signs of these conditions.
Primary care doctors, such as internists and family practitioners, may treat people who have mild P.A.D. For more advanced P.A.D., a vascular specialist may be involved. This is a doctor who specializes in treating blood vessel problems.
A cardiologist also may be involved in treating people who have P.A.D. Cardiologists treat heart problems, such as CAD and heart attack, which often affect people who have P.A.D.
Medical and Family Histories
To learn about your medical and family histories, your doctor may ask:
Whether you have any risk factors for P.A.D.
- About your symptoms, including any symptoms that occur when walking, exercising, sitting, standing, or climbing
- About your diet
- About any medicines you take, including prescription and over-the-counter medicines
- Whether anyone in your family has a history of cardiovascular disease
Physical Exam
During the physical exam, your doctor will look for signs and symptoms of P.A.D. He or she may check the blood flow in your legs or feet to see whether you have weak or absent pulses.
Your doctor also may check the pulses in your leg arteries for an abnormal whooshing sound called a bruit (broo-E). He or she can hear this sound with a stethoscope. A bruit may be a warning sign of a narrowed or blocked section of artery.
During the physical exam, your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb.
He or she also may check for poor wound healing or any changes in your hair, skin, or nails that may be signs of P.A.D.
The procedure is done as follows:
The doctor measures the systolic blood pressure of both arms while the patient is lying down. (The systolic pressure is the “top” number in a blood pressure measurement. It is the force that blood exerts on the artery walls as the heart contracts to pump out the blood. For example, in a blood pressure reading of 120/80, 120 is the systolic number.)
The doctor then puts blood pressure cuffs on four different locations on each leg. An ultrasound probe is passed over arteries in the foot. The signal emitted from the strongest artery is recorded as the cuffs are inflated and deflated. This is the ankle’s systolic pressure.
The doctor divides the systolic pressure in the ankle by the systolic pressure in the arm. The result is called the ankle-brachial index (ABI), also called ankle-arm pressure index (API).
What the results mean:
ABI over 0.90. This result often rules out PAD, but if the patient has specific risk factors for artery disease, the doctor may still suspect PAD. In such cases, the patient takes a treadmill test and another ABI measurement. If the API index drops, then the doctor makes a diagnosis of peripheral artery disease.
ABI below 0.90. This is usually sufficient information to diagnose PAD. The lower the index the greater the risk for heart attack, stroke, or other serious circulatory or heart events. (In patients with diabetes, the doctor may perform additional tests, which may include ultrasound, pressure measurement in the first toe, or others that might confirm or dismiss a diagnosis of PAD.)
ABI less than 0.50. These measurements are highly associated with impaired leg function.
ABI less than 0.40. These measurements indicate very severe blockage in the leg arteries and a risk for gangrene.
Circulation Testing
Doppler Ultrasound and Ankle-Brachial Index
Ultrasound is a procedure that uses sound waves to “see” inside your body. This procedure is performed to evaluate possible narrowing of the blood vessels, resulting in symptoms including:
- Leg pain when walking
- Resting leg pain
- Foot, ankle, heel or toe ulcers
- Skin discoloration