Peripheral Arterial Disease

Peripheral Arterial Disease

PAD stands for peripheral arterial disease. At our vein clinic we perform PAD screening using simple noninvasive methods. If you have PAD you have a higher risk of having a stroke or a heart attack and death. Call to schedule an appointment.

What is Peripheral Artery Disease?
Maybe you walk less than you used to because of "muscle aches" in your legs. Or you've had a sore on your foot that seemed to take forever to heal. Perhaps you've also heard you have "poor circulation." These are the sneaky symptoms of peripheral artery disease, or PAD, affecting 8 million Americans. Peripheral artery disease narrows arteries in the legs, limiting blood flow to your muscles.

How common is Peripheral Artery Disease?
PAD affects 10-15 % of the community population, 25 percent of primary care clinic population older than 50 and much higher in the assisted living facilities and nursing homes. Only 10-30 % of patients have classical intermittent claudication, up to 60 % of patients are asymptomatic according to Cardiovascular Health Study.

Why should you worry about Peripheral Artery Disease?
30% of patients who went for elective revascularization for PAD had severe 3 vessel CAD requiring stents surgery or was inoperable. Patients with PAD have a 25% increase risk of mortality, 75% of that mortality is from cardiovascular death. PAD is highly associated with CAD and Carotid disease thus leading to the high risk of Stroke and Myocardial infarction. In patients' with PAD all-cause mortality is increased 3 fold and cardiac mortality is increased 6 fold.

What are the risk factors and what is the GOAL?
1. DM (3×4 time increase in risk of PAD) each 1 % increase in Hb A 1 c is associated with 26% risk of PAD. Aggressive BS control will prevent microvascular complications like retinopathy but not decrease macrovascular disease like coronary artery disease.
Goal: HbA1c of less than 7% .

2. Smoking (3×4 time increase in risk of PAD).
Goal: Smoking cessation has led to increase walking distances.

3. Hypertension Increased risk of cardiovascular events.
Goal: BP goal is 130/80. Preferred meds are B Blockers and ACE inhibitors.

4. High Cholesterol HPS (heath protective study) Statins were of benefit regardless of cholesterol value. Statins were associated with a decrease in total mortality of 12%, vascular mortality of 17%, Coronary events 24%, strokes 27%, non coronary revascularization 16%.
Goal: Start on statins if patient tolerates them and LDL goal less than 100.

How is Peripheral Artery Disease Treated?
• Talk to the primary care doctor about risk factor modification goals as described above
• Ask for Plavix instead of aspirin
• Ask for referral to an Exercise rehabilitation program.
• Consider discussing CILOSTAZOL for symptoms (Not for Heart Failure patients ).
• If all else fails consider referral to a Vascular surgeon for revascularization.