This September, ALPS is recognizing peripheral arterial disease (PAD) awareness month by showing support for the PAD patient community and helping the public better understand the risks and treatment options for PAD and chronic limb ischemia (CLI). With this, we aim to prevent unnecessary limb amputations and instead secure a longer and better quality of life for PAD patients.
It is estimated that PAD affects between 8.5 and 12 million Americans[1],[2]. By saving the limbs of patients living with PAD through increased awareness and access to care, we can improve life quality of countless patients and even save lives.
What is PAD?
PAD is a chronic and life-threatening circulatory condition. PAD is often caused by a buildup of fatty plaque in the arteries[3]. A buildup of arterial inflammation, cholesterol, calcium, and scar tissue forms plaque, that can clog the arteries, and prevent blood flow to the legs or the arms. A larger amount of buildup will put patients at a greater risk. The disease is also known as poor circulation, hardening of arteries, and claudication. PAD is most common in the legs, but it can happen in any blood vessel[4]. Both men and woman are affected by PAD, but African Americans have an increased risk of PAD. Furthermore, Hispanics may have similar to or slightly higher rates of PAD compared with non-Hispanic white people[5].
PAD related amputations
About 54% of all surgical amputations result from complications of vascular diseases and other conditions that affect blood flow, such as diabetes and PAD. Of patients undergoing amputation for complications of these diseases, nearly half will die within five years of the amputation procedure[6].
Chronic vascular problems can lead to tissue death in toes, feet and legs. The most severe form of PAD is called critical limb ischemia (CLI) or critical limb-threatening ischemia (CLTI). This diagnosis is defined as PAD in patients with rest pain, nonhealing wounds, or tissue loss. It has been reported that up to 20% of people living with CLI/CLTI undergo an amputation or die within a 1-year follow-up[7].
Symptoms of PAD
One of the most common symptoms of PAD is a pain in the legs activated by physical activity. Other symptoms of PAD are muscle pain or cramping in the legs and calf. However, 4 out of 10 people with PAD have no pain in their legs.
You can look for physical signs of PAD in the leg. These include:
- Weakness
- Hair loss
- Smooth and shiny skin
- Cool skin
- Decreased or absent pulses in the feet
- Cold or numb toes
- Wounds on the legs and feet that do not heal[8]
Risk factors for PAD
Risk factors for PAD include high blood pressure, atherosclerosis, diabetes, high cholesterol, and age above 60 years, but the most important risk factor is smoking[9]. Patients with PAD are at risk of developing coronary artery disease and cerebrovascular disease, which can then possibly lead to a heart attack or stroke[10].
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[1] Allison MA, Ho E, Denenberg JO, Langer RD, Newman AB, Fabsitz RR, Criqui MH. Ethnic-specific prevalence of peripheral arterial disease in the United States. Am J Prev Med. 2007; 32:328–333. doi: 10.1016/j.amepre.2006.12.010. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0749379706005587
[2] Thiruvoipati T, Kielhorn CE, Armstrong EJ. Peripheral artery disease in patients with diabetes: epidemiology, mechanisms, and outcomes. World J Diabetes. 2015; 6:961–969. doi: 10.4239/wjd.v6.i7.961. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499529/
[3] CDC. Peripheral Arterial Disease (PAD) | cdc.gov [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Aug 23]. Available from: https://www.cdc.gov/heartdisease/PAD.htm
[4] Peripheral Artery Disease (PAD) [Internet]. CardioVascular Coalition. [cited 2022 Aug 23]. Available from: https://cardiovascularcoalition.com/cardiovascular-care/peripheral-artery-disease-pad/
[5] CDC. Peripheral Arterial Disease (PAD) | cdc.gov [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Aug 23]. Available from: https://www.cdc.gov/heartdisease/PAD.htm
[6] Johns Hopkins Medicine, Amputation [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System 2022 [cited 2022 Sep 5]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/amputation#:~:text=Amputation%2C%20Diabetes%20and%20Vascular%20Disease,in%20toes%2C%20feet%20and%20legs.
[7] Abu Dabrh AM, Steffen MW, Undavalli C, Asi N, Wang Z, Elamin MB, Conte MS, Murad MH. The natural history of untreated severe or critical limb ischemia. J Vasc Surg. 2015; 62:1642–1651.e3. doi: 10.1016/j.jvs.2015.07.065. Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001005#R18.
[8] CDC. Peripheral Arterial Disease (PAD) | cdc.gov [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Aug 23]. Available from: https://www.cdc.gov/heartdisease/PAD.htm
[9] Olin JW, Sealove BA. Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management. Mayo Clinic Proceedings. 2010 Jul;85(7):678–92. Available from: https://www.mayoclinicproceedings.org/article/S0025-6196(11)60174-2/fulltext
[10] CDC. Peripheral Arterial Disease (PAD) | cdc.gov [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2022 Aug 23]. Available from: https://www.cdc.gov/heartdisease/PAD.htm