April 4, 2020

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Getting a leg up on PAD critical

Peripheral artery disease can lead to heart attacks

Leg fatigue is a classic symptom of peripheral artery disease or PAD. Up to 80 per cent of those with PAD may have no symptoms at all.

ELLEN M. BANNER / SEATTLE TIMES / MCT FILES

Leg fatigue is a classic symptom of peripheral artery disease or PAD. Up to 80 per cent of those with PAD may have no symptoms at all.

Hey there, time traveller!
This article was published 22/5/2015 (1779 days ago), so information in it may no longer be current.

Are your legs getting a little more tired from walking than they used to? If so, then perhaps it is time to talk to your health-care provider.

Leg fatigue is a classic symptom of peripheral artery disease (PAD), which is a narrowing and hardening of arteries (atherosclerosis) other than those that supply the heart or brain.

Generally speaking, PAD affects about 12 to 14 per cent of Canadians, and up to 20 per cent of those over the age of 70. Men are more at risk than women, and an estimated one in three people with diabetes over the age of 50 is affected by PAD.

Determining whether you have this condition is critical, because those who do have it are four to five times at greater risk for heart attack and stroke.

PAD generally strikes one or both legs, resulting in decreased blood flow and oxygen to the affected limbs. The most common symptom of PAD is leg pain or leg fatigue when walking (intermittent limping) that resolves with rest. It can also cause pain, burning or numbness in the buttock, hip, thigh, shins or feet. Other symptoms can include leg ulcers that don't heal, bluish or pale skin, cool skin, fainter pulse, shiny skin and poor hair or nail growth on the affected leg(s). Interestingly, about 50 per cent to 80 per cent of people with PAD may have no symptoms at all.

The most common causes and risk factors for PAD include smoking, diabetes, high cholesterol, high blood pressure, stroke, obesity, inactivity, being over the age of 50 or a family history of heart disease. It is important to treat PAD, not only because it may place you at a greater risk for having a heart attack or stroke, but because it can also lead to the loss of the affected leg.

The initial test for PAD is with the ankle-brachial index (ABI), which is a ratio of the blood pressure in your legs and arms. If the pressure in the leg is lower than the pressure in the arm, then blockages in the leg are suspected. If the ratio is less than or equal to 0.9, then PAD is diagnosed. If the ABI is abnormal, then a leg ultrasound is done to determine the severity of the blockage.

Other tests may include catheter angiography (a look inside the artery with a catheter), or computerized tomography angiography (CTA) or magnetic resonance angiography (MRA), which can replace catheter angiography which is more invasive. Once diagnosed, PAD severity can range from asymptomatic to severe tissue loss with gangrene.

Treatment of PAD involves lifestyle changes, medication and surgery. Lifestyle changes include smoking cessation, dietary changes, controlling diabetes, blood pressure and cholesterol, losing weight and continuing to exercise regularly. Walking at least 30 minutes three times a week may help improve your symptoms.

Lifestyle changes will also help prevent PAD from developing. Medications include anti-platelet medications such as clopidogrel, aspirin and cilostazol or pentoxifylline, which help control symptoms such as leg pain and prevent clots.

Surgery (which is usually done in severe cases of PAD) may include angioplasty, atherectomy, vascular bypass, thrombectomy, or amputation. Angioplasty involves expanding the size of the artery with a balloon or placing a stent in the artery to keep it open. Atherectomy involves scraping the plaque off the inside of the artery wall, but it is no more effective than angioplasty. Vascular bypass is circumventing a diseased artery by using a large vein to move blood to the leg. Thrombectomy involves removing a clot that has settled in an artery that is causing the blockage. As a last resort and only in extreme cases, if gangrene has set in, amputation may be needed to prevent an infection called sepsis.

Recognizing the symptoms and ways to prevent PAD are critical. If you are concerned you may have PAD or any of the risk factors for it, talk to your health-care provider. Early intervention can help prevent PAD and complications.

 

Donna Alden-Bugden is a family nurse practitioner at the McGregor Quick Care Clinic in Winnipeg.

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