What is Peripheral Artery Disease (PAD)?
Peripheral artery disease (PAD), also known as claudication, poor circulation, vascular disease, or hardening of arteries, is a chronic, life-threatening circulatory condition. PAD causes narrowing or blockage of the vessels that carry blood from the heart to the legs. The primary cause of PAD is atherosclerosis, or the buildup of plaque in the arteries. This occurs when arterial inflammation, cholesterol, calcium and scar tissue build up, forming plaque that clogs the arteries and slows blood flow to the legs. The more plaque that builds up on the inside walls of the blood vessels carrying blood from the heart to legs and arms, the more the arteries lose flexibility and narrow, putting patients at greater risk.
Risk factors for PAD, as identified by the Centers for Disease Control and Prevention (CDC), include smoking, high blood pressure, diabetes, high cholesterol, and age over 60. PAD patients are also at greater risk for heart attack and stroke.
Studies have found that the total annual US costs for patients with PAD exceed $21 billion, including nearly $10 billion for hospitalizations. In Medicare alone, one study estimated spending on PAD accounted for more than 2 percent of all Medicare spending.
PAD has been identified by the Institute of Medicine (IOM) as a priority area for comparative effectiveness research. One study suggested that endovascular therapy appears to be the least costly option in the short-run for patients with PAD.
Critical Limb Ischemia
PAD patients are at high risk of developing critical limb ischemia (CLI), a very severe condition of PAD that requires immediate comprehensive treatment by a vascular surgeon or vascular specialist. Without appropriate intervention, CLI will not improve on its own. Complications of CLI can include sores and wounds that won’t heal in the legs and feet. Left untreated, the complications of CLI could result in amputation of the affected limb.
CLI, also referred to as limb threat, is a severe obstruction of the arteries caused by progressive thickening of the arterial lining. It markedly reduces blood flow to the extremities and results in chronic ischaemic rest pain, or ischaemic skin lesions, either ulcers or gangrene.
Treatment for CLI can be complex and individualized, and can include medications, endovascular treatments and arterial surgery. The goals for treating CLI are to relieve ischaemic pain, heal ulcers, prevent limb loss, improve patient function and prolong overall survival.
Amputation is the last recourse, however data estimates it occurs in approximately 25 percent of all CLI patients.
Blockages can restrict blood flow to the muscles, causing muscle cramps, tightness or weakness, especially during activity. In the early stages of PAD, patients may not experience any symptoms. If PAD is not treated, though, blockages may continue to grow and restrict, or even completely block, blood flow. Common symptoms include:
- Leg pain when walking
- Muscle pain or cramping in legs and calf triggered by activity
- Leg numbness or weakness
- Coldness on lower leg or foot
- Sores on toes, legs or feet that won’t heal
- Change in color of legs