Peripheral arterial disease (PAD), hardening of the arteries in the leg, is a marker for premature cardiovascular events and vascular-related death. The November issue of the Journal of Vascular and Interventional Radiology includes a comprehensive review of this disease that affects more than 10 million Americans, as well as a comprehensive treatment plan for all types of PAD patients.
PAD develops most commonly as a result of atherosclerosis, or ?hardening of the arteries,? which occurs when cholesterol and scar tissue build up, forming a substance called plaque inside the arteries that narrows and clogs the arteries. Because atherosclerosis is a systemic disease, people with PAD are likely to have blocked arteries in other areas of the body. Thus, people with PAD are at increased risk for heart disease, aortic aneurysms and stroke. PAD is also a marker for diabetes,hypertension and other conditions.
Efforts on a national level to improve the awareness of PAD among patients and caregivers alike are critical to prevent premature death and impaired quality of life among this expanding group of patients.
As baby boomers continue to age, the number of those affected by PAD will continue to increase. Research shows that the prevalence of PAD increases 10-fold from men aged 30-44 to men aged 65-74 and almost 20-fold in women of the same ages.
As patients age, many of them dismiss one of the most common symptoms of PAD, known as claudication, as part of the ?normal? aches and pains of aging. Intermittent claudication is leg painthat occurs when walking or exercising and disappears when the person stops the activity. Other symptoms of PAD include numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don’t heal.
With more than 50 percent of PAD patients asymptomatic or with atypical symptoms, screening is essential for diagnosis. The ankle brachial index (ABI) test is a painless test that compares the blood pressure in the legs to the blood pressure in the arms to determine how well the blood is flowing and whether further tests are needed.
Once PAD is diagnosed, the goals of therapy for patients with PAD are to prevent systemic atherosclerotic disease progression and clinical cardiovascular events, prevent limb loss, and improve functional status of patients with intermittent claudication (pain when walking that stops during rest).
Management of PAD includes:
1. Smoking cessation
2. Physical activity
3. Dietary modification
4. Weight maintenance or reduction with target body mass index and waist circumference
5. Blood pressure control
6. Modification of elevated total and LDL-cholesterol levels
7. Antiplatelet therapy
8. ACE inhibitor therapy
9. Glycemic control in patients with diabetes mellitus
Interventional radiologists are doctors who specialize in minimally invasive, targeted treatments that have less risk, less pain and less recovery time compared to open surgery. They use their expertise in interpreting X-rays, ultrasound, MRI and other diagnostic imaging studies to understand, visualize and diagnose the full scope of the disease’s pathology and to map out the procedure tailored to the individual patient. Then during the procedure, they image as they go to guide tiny instruments, such as catheters, through blood vessels or skin, to treat diseases at the site of the illness nonsurgically. IRs pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease to prevent amputation.
Interventional radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional radiologists are board-certified in diagnostic radiology and fellowship-trained in vascular and interventional radiology. The American Board of Radiology certifies their specialized training.