The pain of PAD usually goes away when you stop exercising, although this may take a few minutes. When muscles are being used, they need more blood flow. That means if there’s a blockage due to plaque build-up, the muscles won’t get enough blood during exercise to meet their needs. That’s what causes the pain, which is called ‘intermittent claudication’. The term comes from the Latin word meaning ‘to limp’.

Research has shown that nearly 75 per cent of people with PAD do not experience symptoms (silent disease). Women are less likely to have symptoms than men.

Symptoms of severe PAD include:

• Foot pain that does not go away when you stop exercising 
• Foot or toe wounds or ulcers that will not heal or heal very slowly 
• Pain and darkening of skin of toes and/or foot that is called gangrene. Sometimes this process can proceed higher into the leg.
• A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body. 

'Katradhu Tamizh' Ram's next Diwali in Suburbs Rajini Still In A Dilemma! அஜீத் பேட்டி? ராம் இயக்கத்தில் சேரன்? கமல் பாராட்டிய டைட்டில்்

Many people dismiss leg pain as a normal sign of ageing. You may think it’s arthritis or just ‘stiffness’ from getting older. PAD leg pain occurs in the muscles, not the joints.

PAD diagnosis begins with a physical examination. Your doctor will check for weak pulses in the legs. The ankle-brachial index (ABI) test helps in identifying the presence of consequential blockages. This test is done by measuring the blood pressure in the arm and around the ankle of the leg and comparing with the normal relationship between the two values. It’s a painless exam to determine how well your blood is flowing to the leg muscles. This inexpensive test takes only a few minutes and can be performed by your doctor as part of a routine exam. Normally, the ankle pressure is at least 90 per cent of the arm pressure, but with severe narrowing it may be less than 50 per cent. If an ABI reveals an abnormal ratio between the blood pressure of the ankle and arm, you may need further testing.

Your doctor may then recommend one of these other tests:

• Doppler and ultrasound (Duplex) imaging: a non-invasive method that visualises the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.

• Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.

• Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without the use of X-rays.

• Angiography can also be done. During this test, a contrast agent is injected into the artery and X-rays are taken to show arteries of the legs and any blockages that may be present. This test is usually combined with procedures to deploy stents or perform balloon angioplasty in order to relieve the blockages.

PAD risk factors you can control

Certain risk factors for PAD cannot be controlled, such as ageing or having a personal or family history of PAD, cardiovascular disease or stroke. However, there are many risk factors that you can control including:

Cigarette smoking

Smoking is a major risk factor for PAD and the condition occurs about 10 years earlier in smokers compared to non-smokers.

Physical inactivity

Exercise increases the distance that individuals with PAD can walk without pain and also helps to decrease the risk of heart attack or stroke. Supervised exercise programs are one of the treatments for PAD patients.

Exercise

The most effective treatment for PAD is regular exercise. Supervised exercise programs may be prescribed for appropriate patients. You may have to begin slowly, but simple walking regimens, leg exercise and treadmill exercise program 3-4 times a week will result in decrease of symptoms in as few as three months. Exercise for intermittent claudication takes into account the fact that walking causes pain. The program consists of alternating exercise and rest in intervals in order to build up the amount of time you can walk before the pain sets in. It is best if this exercise program is undertaken in a rehabilitation centre on a treadmill and monitored.

Diet

Many PAD patients have elevated cholesterol levels. A diet low in saturated fat and cholesterol can help lower blood cholesterol levels, but medication may be necessary to maintain the proper cholesterol levels. 

Medication

It is important to be compliant with medications prescribed for high blood pressure, high cholesterol, etc.

Your doctor may prescribe medications that would improve blood flow through the narrowed arteries.

Your doctor may also prescribe medications to make your blood less sticky that would reduce the chances of blood clot formation.

Procedures

For a minority of patients the above recommendations and treatments are not 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). They are non-surgical 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. If there is a long portion of artery in your leg that is completely blocked and you are experiencing severe symptoms, surgical procedures may be necessary. A vein from another part of the body can be used to ‘bypass’ and reroute blood around the closed artery.

The best choice of therapy in a given situation is decided in consultation with your doctor.

Dr G Balachander
Cardiologist
Illinois, USA