Peripheral Arterial Disease Can Be as Serious as a Heart Attack

If you are having trouble walking, don’t be too quick to dismiss your problem as a normal sign of aging. You could be experiencing symptoms of peripheral arterial disease, a serious but treatable condition.

While most people understand that a narrowing or blockage of the coronary arteries can lead to a heart attack, many do not realize that the same type of blockage in the other arteries of the body can result in life-changing consequences.

An estimated 10 million U.S. adults have peripheral arterial disease, or PAD. The condition is characterized by reduced blood flow due to a narrowing of the arteries that carry blood from the heart to the rest of the body. It often affects the legs and feet, causing symptoms during walking such as weakness, fatigue, aching, pain or cramping that fade within 10 minutes after resting.

Vascular surgeon Aidan Hamm, M.D., a member of the fellowship-trained team of vascular surgeons at Bethesda Hospital East and Bethesda Hospital West, part of Baptist Health.

“We see a lot of people who say, ‘Oh, I thought I just had arthritis.’ Or, ‘I thought I was getting old and my legs were tired.’ Some say, ‘I thought I was having trouble because I put on some weight.’ They negate the problem and don’t mention it in visits with their doctor until more serious symptoms arise,” says vascular surgeon Aidan Hamm, M.D., a member of the fellowship-trained team of vascular surgeons at Bethesda Hospital East and Bethesda Hospital West, part of Baptist Health.

“The legs are asking for more blood, but you can’t give it to them because there are blockages in the arteries,” Dr. Hamm explains.

Dr. Hamm notes that peripheral arterial disease is progressive. If not addressed, it can cause widespread vascular damage and other health problems. In the United States, PAD leads to an estimated 150,000 leg amputations per year.

“The degree of severity ranges from people who have the disease but are not experiencing symptoms, to people who come in with limb-threatening emergencies that you have to take to the operating room right away,” Dr. Hamm says. As with most conditions, the sooner PAD is addressed, the more successful treatment will be, he adds.

What Causes PAD?

PAD occurs when a buildup of fatty deposits called plaque cause blood vessels narrow and stiffen, a condition known as atherosclerosis. The plaque sticks to the artery walls and can eventually block blood from reaching organs and the rest of the body. It is a common cause of heart disease.

“Atherosclerosis can present anywhere in the body — not only in the arteries of the heart, but also in the legs, the arms, in the arteries of the kidneys, intestines and the brain. Everywhere,” Dr. Hamm says. “The treatment can range from conservative medical therapy to minimally invasive or complex surgical interventions.”

Anyone can get peripheral arterial disease, but some risk factors can make you more prone, including smoking, high blood pressure, high cholesterol and being 60 or older. Diabetics and Blacks also have a higher rate of PAD.

How Is PAD Treated?

“This is a serious disease,” says Ian Del Conde, M.D., a cardiologist and vascular medicine specialist who treats PAD patients at Miami Cardiac & Vascular Institute, also part of Baptist Health. “Everyone with PAD has a high risk of a heart event. Aggressive prevention measures are necessary.”

If you are diagnosed with PAD, your treatment will depend on its severity, location and your general health. Physicians first want to ensure that your disease does not progress, so patients are often put on medications to lower blood pressure and cholesterol. You may also be given medications to prevent the formation of a blood clot, which can occur when a blood vessel narrows.

In more advanced cases, options for intervention include a minimally invasive procedure called angioplasty, in which a small catheter is threaded through an artery in the wrist or groin to the blockage and a balloon is inflated, pushing the plaque against the artery walls. Some patients may need an atherectomy, in which plaque is removed from the artery. Others may undergo a bypass procedure, using a blood vessel from another part of the body or a synthetic vessel.

Why PAD is a Concern

Because PAD is so widespread and can have dire consequences, medical organizations throughout the country have banded together to raise awareness. September is Peripheral Arterial Disease Awareness Month, although the condition is a concern all year long.

“When people show up with advanced conditions, it’s a lot harder to salvage things, particularly if we talk about limb salvage,” Dr. Hamm says. “If they had come in a little bit sooner, we could have done something — either minimally invasive or aggressive, such as open revascularizations — to save limbs, prevent strokes or prevent aneurysms.”

People diagnosed with heart disease should be especially vigilant, Dr. Hamm says.

“If you start to get buildup of plaque and atherosclerosis in the heart, it’s a harbinger that it’s elsewhere,” he says.  “Getting screened and followed early is a good way to prevent complications.”

What You Can Do

Since the hardened arteries that cause problems in your legs can also affect the blood vessels in your heart and brain, it’s important to discuss your risk with your physician. Also, you can improve your health profile by maintaining a healthy weight, increasing physical activity, controlling blood sugar levels if you have diabetes, stopping smoking and avoiding all types of tobacco or nicotine.

Even if walking is difficult for you, don’t give up. Avoiding exercise might be a natural response for those who experience claudication, the technical name for pain when you walk. However, a recent study suggests that people with restricted blood flow to the legs and feet may be able to improve their long-term walking ability by pushing themselves a little. 

The study, published in the Journal of the American Heart Association, found people with PAD who walked at a speed that caused painful symptoms increased their leg function over time more than those who walked at a more comfortable pace. However, this “no pain, no gain” approach should be approached with caution, supervision and in consultation with your physician.

“If you notice walking is becoming more difficult, if you have a hard time keeping up with others or if you have pain when you walk, talk with a doctor,” Dr. Hamm advises. “People with PAD can lead active and long lives, but they should monitor their condition and consult with a healthcare professional.”