Advancing age does not have to hurt, though it’s a common misperception that can lead many older Americans to overlook health issues that need to be treated.
One of the most serious is peripheral arterial disease, or PAD, which is also referred to as peripheral vascular disease.
Dr. Richard S. Downey, cardiac, endovascular and chest surgeon at Northern Michigan Regional Hospital, said anyone who has feelings of pain or tiredness in their legs or who can no longer walk as far as they once were able should be evaluated for arterial blockages that can have serious consequences.
“If you’ve got pain in your legs, something is causing it,” said Downey. “Pain is not a normal part of the aging process.”
PAD is caused by narrowing of the arteries that lead from the heart and branch off to supply the body with blood; it is most often noticed in the legs and arms. Once the arteries are narrowed from a build-up of plaque-causing cholesterol, blood flow is reduced, thereby reducing use and causing pain.
Downey explained that typically if there’s obstruction in the arteries leading to the legs, there are blockages elsewhere that could cause life-threatening heart attack and stroke, and the carotid artery to the brain can also be affected. Those with PAD are four or five times more likely to suffer a heart attack, the doctor noted, and often the heart attacks are more damaging and fatal.
Therefore, it’s important to heed the warning signs and be evaluated by a physician if there is: cramping in the legs; a heavy feeling in the limbs; the inability to perform regular daily tasks (such as work-related duties, kneading bread or other repetitive motions when the arms are affected); and relief from leg pain upon resting.
While PAD is often a disease that afflicts those over the age of 70 — up to 12 million Americans have one form of PAD — it can affect any age, and both genders equally. The most prevalent risk factors include high cholesterol and blood pressure, diabetes and smoking.
“It’s very unusual for me to treat somebody with this problem who is a nonsmoker,” Downey said.
Diagnosis and treatment
It’s not uncommon for signs of PAD to be mistaken as part of the aging process or other ailments. To diagnose blockages properly, Downey said first the pulse in the legs and arms are measured; difference in pressure is typically one of the first signs of a blockage.
A CT angiogram and other non-invasive ultrasounds and monitoring tests are performed. A dye injection test via catheter may be performed to allow doctors to view the arteries on a monitor.
Patients are first put on an exercise regimen that calls for 30 minutes of brisk walking per day, at least three times a week. Regular exercise helps encourage new vessel growth around blocked arteries, thereby improving circulation, Downey explained.
A low-fat, low-cholesterol diet is prescribed, along with controlling blood pressure and cholesterol with medications.
Smoking should be ceased, not merely cut back, he added.
If the patient’s symptoms aren’t markedly improved with those lifestyle changes, a balloon angioplasty procedure is typically performed. Downey said in the vast majority of cases, this treatment opens up the blocked artery; then, a stent is usually inserted to hold the artery open and a surgical bypass is not necessary. A surgical bypass is performed if the blockage is more severe.
If PAD is left untreated, it can lead to gangrene and loss of toes and limbs and other health effects. It’s also important to remember that once the disease is treated, a person needs to begin living a healthier lifestyle and not revert to past habits, Downey said, especially smoking.
Early warning signs
Peripheral vascular disease (PVD) refers to diseases of blood vessels outside the heart and brain. It involves a narrowing of vessels that carry blood to the legs, arms, stomach or kidneys. Peripheral arterial disease (PAD) is a type of PVD.
The most common symptoms of PAD are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.
Source: American Heart Association