Doctor's Insights: Peripheral Artery Disease (PAD)
What your legs can reveal about your heart
Peripheral Artery Disease (PAD) affects millions of Americans, yet it often goes undiagnosed until it’s advanced. PAD happens when plaque builds up in the arteries that supply blood to your limbs — most commonly the legs — leading to reduced circulation. Early detection and treatment can prevent serious complications including amputation. Additionally, detecting PAD identifies patients who would benefit from cardiovascular risk reduction therapies that can reduce heart attack risk.
We connected with Sonal Pruthi, MD, an interventional cardiologist, who explains what she finds most interesting in her cases, who’s at risk, what symptoms to look for, and what patients can do to protect their vascular health.
Who should be screened for PAD?
People don’t usually get screened for PAD, but they should. Anyone who has coronary artery disease (CAD) needs to be screened for PAD — Upwards of 42 percent of patients with CAD also have peripheral artery disease (PAD). People with diabetes, hypertension, smoking especially those 50 and older, should also be screened.
If you’re younger than 50 but have diabetes plus another risk factor like high cholesterol or high blood pressure, you should also be screened. And if you smoke, screening is important after 50 - or earlier if you have symptoms. Any one with non healing foot wounds should definitely be screened for peripheral vascular disease.
The risk factors are basically the same as for heart disease: diabetes, high blood pressure, smoking, and high cholesterol.
I often tell my patients it’s like the plumbing in a house — if there’s rust in one pipe, there’s probably rust in others. If you have “rust in the pipes” of the heart, there may be rust elsewhere — in the legs, the neck (carotid arteries), or the kidneys. It’s all one connected system of blood vessels, so if one part has disease, it’s worth checking the others.
Why do we actually care about PAD?
We care about PAD because it often indicates coexisting heart disease, and that has major implications for your health. Therapies for managing PAD overlap with those for treating heart disease and timely initiation helps us decrease the risk of heart attack and stroke, slow disease progression, and most importantly, reduce the risk of amputation and limb loss.
What are the symptoms?
The most common symptom is fatigue, heaviness, or an aching pain in the legs, especially when walking — more so when walking uphill or climbing stairs. It’s very similar to angina in the heart. When your muscles need more blood and they don’t get it, that’s when you feel discomfort.
The pain can appear anywhere from the buttocks to the calves, and usually goes away when you stop walking — that’s a hallmark sign.
Another major sign is wounds or sores on the feet or toes that aren’t healing. If a wound isn’t healing, it’s often because there isn’t enough blood flow to bring nutrients for healing. Same goes for discoloration or bluish discoloration of the toes - and this is a big point for me: no one should get an amputation without being evaluated for vascular disease first.
Many amputations can be prevented or at least limited by restoring blood flow. Even if a full prevention isn’t possible, restoring blood flow can mean the difference between losing toes versus losing a leg — and that can preserve a person’s ability to walk and function.
How is PAD diagnosed?
Screening for PAD is simple and noninvasive. It starts with your doctor feeling for pulses in your legs. Then comes a test called an Ankle-Brachial index (ABI), which measures the blood pressure difference between the arm and legs.
Ultrasound of the leg arteries is often next. If needed, more advanced imaging like CT or MRA can be done. But most of it is low-risk and straightforward.
How is PAD Treated?
Most patients don’t need surgery. The majority of people with PAD can manage it with medications and lifestyle changes alone.
Lifestyle changes are key:
- Quitting smoking: This is critical, as smoking accelerates progression of PAD.
- Medication management: Low-dose aspirin, cholesterol-lowering drugs, and blood pressure or diabetes medications protect arteries and slow disease progression.
- Exercise: Structured walking programs improve circulation, increase walking distance, and reduce the risk of amputation. Patients often don’t realize that structured exercise programs can make such a difference.
For patients experiencing more significant symptoms, such as pain that limits daily activity or non-healing ulcers, procedures may become necessary. Fortunately, most interventions are minimally invasive. Comparative to techniques for heart procedures: We use special balloons and stents to restore blood flow, similar to what we do in the heart. Only in select cases is bypass surgery required. The goal is always to preserve function and limit invasiveness whenever possible.
How can patients prevent progression or improve symptoms?
Patients can take active steps to manage PAD and maintain quality of life. Structured walking programs are especially effective. Patients are encouraged to walk at a pace that brings on moderate leg fatigue in three to five minutes, rest until it eases, and then resume. Over time, the total walking duration should reach 30–60 minutes.
With structured walking, circulation improves, symptoms decrease, and the risk of complications goes down. It’s about giving patients control over their disease. With lifestyle changes and medical therapy, most patients do not require procedures at all.
Key Takeaway
I often tell patients that PAD is like the heart’s plumbing system - problems in one area can reflect disease elsewhere. Recognizing this early is key to protecting your health. I want patients to know that PAD is more than a leg problem - it often signals disease in other blood vessels, including the heart and carotid arteries.
Early screening is critical, especially if you have heart disease, diabetes, smoking or other risk factors. Most people can manage PAD with structured exercise, lifestyle changes, and medications, which not only improve circulation and reduce symptoms but can actually decrease the risk of amputation.
It’s important to remember: no amputation should happen without a full vascular evaluation. Even when we can’t prevent all amputations, restoring blood flow can often limit the extent and preserve function. PAD is a condition you can take control of, and with the right care and monitoring, you can maintain your quality of life.
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