While most people understand that a narrowing or blockage of the coronary arteries of the heart can lead to a heart attack, many do not know that the same type of blockage in the arteries elsewhere in the body can also cause serious health problems.
Peripheral artery disease (PAD) occurs when atherosclerosis, or plaque buildup, occurs in the arteries that supply blood to the legs, arms, brain and other organs and tissues away from the heart. This plaque, made up of cholesterol, fat, calcium and other particles, sticks to the inner walls of the arteries and narrows the pathway of or completely blocks oxygen-rich blood from reaching those structures.
Like what happens during a heart attack, a person with PAD may experience pain as a result of that decreased blood flow. The pain with PAD occurs most often in the legs during walking or running. If blood flow isn’t restored, tissues may stop functioning properly and could eventually die.
More than 8.5 million Americans have peripheral artery disease, according to the American Heart Association. Also referred to as peripheral vascular disease, the condition typically shows up in people over the age of 55. It can signal a high risk of coronary artery disease, which can lead to heart attack, or carotid artery disease, which can lead to stroke. But often, peripheral artery disease goes undetected until a person has a heart attack or stroke.
“Peripheral artery disease is a window to the world of cardiovascular health,” said Barry Katzen, M.D., an interventional radiologist who treats patients with PAD and is the founder and chief medical executive of Miami Cardiac & Vascular Institute. “In some people, we discover their heart disease first, but in some, we find the PAD and then, through investigation, we discover they have atherosclerosis in their coronary arteries as well.”
Dr. Katzen says that many people discount leg pain or attribute it to arthritis or some other orthopedic ailment. But, he warns, it’s important to consider the cause of that pain may be vascular in nature.
Symptoms of Peripheral Artery Disease
While peripheral artery disease can show up as pain or weakness in the arms or hands, Dr. Katzen notes that the significant amount of blood vessels in the muscles of the legs means that it often causes pain in the legs first.
“Symptoms include leg pain, called intermittent claudication, or muscle achiness, cramping or burning that subsides with rest,” he said. “Vascular pain is different from pain caused by an orthopedic problem, which often takes longer to relieve. With vascular pain, as soon as you stop walking, the pain stops.”
So, Dr. Katzen sees many patients after an orthopedic evaluation reveals no cause for the pain. When he and other vascular specialists, including vascular surgeons, interventional radiologists and cardiologists, see a patient with leg pain, their evaluation focuses on finding a potential blockage. They also ramp up their assessment of a patient’s heart health to find evidence of coronary artery disease that could lead to a heart attack.
Fortunately, the gold-standard for diagnosing PAD is a non-invasive test called an ankle-brachial index. The test measures the blood pressure in the legs, using blood-pressure cuffs, and compares it to the blood pressure in the arms, which should be about the same. If the blood pressure is weaker in the legs, or the ankle-brachial index is low, it reveals that blood flowing to the ankles may be meeting resistance from a blockage somewhere in the arteries of the legs. An abnormal ankle-brachial index generally triggers use of more sensitive, non-invasive testing for blood flow. These tests include blood flow measurements and ultrasound exams.
A physician may also order a CT or MR angiogram to visualize how the blood is flowing through the arteries of the legs to develop a “roadmap” of the circulation.
Dr. Katzen recommends that anyone over the age of 50 should have an annual ankle-brachial test to diagnose PAD as early as possible and ward off any serious complications from the advancement of the disease.
To underscore the serious nature of PAD, Dr. Katzen explains that untreated blockages can lead to amputations and a condition known as critical limb ischemia, which can be fatal. Fortunately, though, if PAD is diagnosed early, treatments have high success rates, up to 90 percent, according to Dr. Katzen.
For most patients in the early stages of PAD, Dr. Katzen recommends exercise and other lifestyle changes, such as quitting smoking, maintaining a healthy body weight and eating right to reduce cholesterol levels in the blood, which can lead to the buildup of plaque in the arteries.
“With exercise, the body creates new blood vessels to supply more blood to the muscles,” Dr. Katzen said. “This collateral flow helps relieve the pain and get the necessary blood to the legs and feet.”
If a patient has high cholesterol and evidence of atherosclerosis elsewhere, Dr. Katzen may prescribe statin therapy to lower the cholesterol and anti-platelet therapy to help stop the progression of plaque in the blood vessels. He may also use medications to relieve claudication.
Treatments for more advanced PAD include angioplasty, where a balloon is deployed via a catheter inserted through the wrist or groin into the blocked blood vessel. When that balloon is inflated, it pushes the plaque against the walls of the artery to restore blood flow. Additionally, a stent – or small metal tube that may have medicine coating it – may be deployed through the catheter to keep the vessel propped open. For some patients, scraping the inside of the blood vessel to remove the plaque may be necessary. This procedure is called an atherectomy.
If the PAD has advanced enough to where the above treatments cannot adequately restore the blood flow, a bypass procedure may be necessary. Miami Cardiac & Vascular Institute is participating in the DETOUR2 trial, which is testing whether a non-surgical approach to bypassing long blockages in the legs using a catheter and stents can be an effective treatment option.
Regardless of the treatment option, Dr. Katzen assures his patients that the goal is to prevent the need for amputation and to address the higher risk for a cardiac or neurological event that PAD patients have been shown to have.
“With our 30-plus year history of treating patients with PAD at the Institute, we strive to find the least invasive ways to successfully diagnose and treat PAD, and we take a collaborative approach to reduce these patients’ risk of cardiovascular disease, heart attack and stroke,” Dr. Katzen said.