Show #428 Airing Sunday, 4/6/08
You’ve probably heard of coronary artery disease, which is a major killer. But most Americans have never heard of peripheral artery disease, which can also be terribly dangerous. Here to explain is Dr. E. Dean Nukta, director of interventional cardiology of the Cleveland Clinic’s western region, at Fairview Hospital.
Question: What is peripheral artery disease?
Answer: Peripheral Artery Disease, or PAD, is a form of atherosclerosis—the hardening and narrowing of the arteries—caused by the gradual buildup of fatty deposits and other substances. It includes all disorders that affect the arteries outside the heart; however, the most common form of PAD is when the flow of blood is restricted mainly in the arteries that lead to the legs or to the brain (the carotid artery).
Question: What are the signs and symptoms?
Answer: Common symptoms in people with early-stage PAD are cramping, fatigue, heaviness, pain or discomfort in the thighs, calves or hips during activity. Signs of severe PAD include foot pain at rest, non-healing foot or toe wounds, and gangrene.
However, many people with the disease have no symptoms at all, and only about a third have any leg symptoms. The disease often goes undiagnosed because of a lack of symptoms, especially in the early stages, or because people think the symptoms are either arthritis or a normal part of aging.
Question: What if PAD goes untreated?
Answer: If untreated, the space through which blood can flow becomes smaller and smaller. Over time, this could lead to losing one’s leg.
Also, a person with PAD has a five times greater chance of a stroke or of dying from a heart attack. It is likely that they have coronary artery disease as well as PAD.
Question: Can you be screened? How is PAD diagnosed?
Answer: Three types of patients should be screened.
- 50 and over who is a smoker or has diabetes;
- Over the age of 70, or
- Any patient with high risk: smoker, diabetes, high blood pressure, high cholesterol, a family history of PAD, or is complaining of leg pain.
The last is important—it’s often mistaken for arthritis.
PAD is diagnosed through a simple procedure called an ankle-brachial index, or ABI. The blood pressure in a patient’s arm is measured and compared to the blood pressure in the leg. If the percentage is considered abnormal, PAD is suspected and more sophisticated testing (such as an ultrasound) can be used to find the blockage and treat it.
Question: What is the treatment for PAD?
Answer: Treatment is like that for coronary artery disease—smoking cessation, losing weight, and lowering high blood pressure and cholesterol.
Patients are told to walk as much as they can to enhance circulation to the leg.
Other medications that may be prescribed include those to reduce the risk of heart attack and stroke, or clotting in the leg, like aspirin or Plavix.
If these measures were not working, then we’d turn to endovascular procedures.
Question: What are these procedures?
Answer: 90% of the time, we are talking about a stent or a special device called a driller.
In an angioplasty, a catheter with a balloon on the tip is inserted through the skin into the blocked artery, and the balloon is inflated to reopen the artery. A tiny wire mesh cylinder, called a stent, acts like scaffolding, holding the artery open.
A driller is a special device that cleans out the artery.
At Fairview Hospital, we have a new endovascular suite, allowing us to safely practice these procedures with the latest techniques and equipment available.
Peripheral Artery Disease is dangerous, but treatable. Take a step towards pain-free walking by calling Dr. Nukta at the number that’s next.
