Risk Factors for Peripheral Arterial Disease

September is Peripheral Arterial Disease awareness month. PAD is a chronic condition affecting 20 million people in the U.S. If left untreated, it can result in unnecessary limb amputations. This has been seen disproportionately in people from minority communities. It involves a buildup of plaque in the arteries— much like how your kitchen sink builds up and gets clogged over time—due to a variety of reasons, primarily smoking, high cholesterol, high blood pressure, obesity, increased age, and diabetes. The buildup can lead to narrowing or complete occlusion of the arteries and a reduction in the amount of blood getting to the feet. 

Symptoms: It may start as claudication, pain in your calves after walking a certain distance that goes away on stopping and comes back after walking a certain distance. Claudication typically follows a more benign course in that only 25% of patients will progress to limb loss in five years. Compare this with the more aggressive “chronic limb-threatening ischemia CLTI” (formerly called critical limb ischemia), which has a limb loss rate of 50-75% in five years. CLTI consists of pain in the foot or toes even when not walking (at rest), gangrene, wounds, or ulcers. CLTI needs treatment to restore “in-line” blood flow to the foot urgently.

Diagnosis is usually made by a physical examination by your vascular surgeon combined with ankle-brachial indices, a non-invasive vascular lab test consisting mostly of ultrasound or, in very select cases, a CT scan with contrast.

Treatment consists of risk-factor modification and changing your lifestyle along with medications for claudication. Recommended changes to your lifestyle would include stopping smoking, losing weight, maintaining optimum sugar levels (if diabetic), good control of blood pressure, watching what you eat to keep cholesterol under control and getting some exercise in the form of walking for 30 minutes at least three times a week. 

This column is sponsored by KSC Cardiology, and the opinions expressed herein may not reflect those of CFHN or its advertisers.

BIO: Dr. Aparajita is a fellowship-trained vascular and endovascular surgeon. She is a co-author of 20-plus journal articles and publications and was recently nominated for an Inspiration Award by the American Medical Association.

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