PAD is a process that can affect every artery in the body. Arteries bring nutrient-rich, oxygenated blood to individual organs. The result of PAD is that plaque builds up in the arteries and restricts flow. Think of this as sediment blocking a pipe. Eventually, the entire pipe is stopped up. The same thing occurs in the arteries. Once the plaque reaches a critical level, the patient will develop symptoms. If this process affects the arteries in the heart, patients may develop chest pain of angina. When the circulation to the legs is impacted, the patient will complain of pain and cramps in the legs with minimal exercise. Blockages that restrict blood flow to the brain can result in a stroke. PAD can be progressive, but with treatment, the potential risks can be reduced.
Another name for PAD, peripheral arterial disease, is arteriosclerosis, or hardening of the arteries. There are known risk factors associated with this disease process, which include Diabetes Mellitus, or elevated blood sugars; high blood pressure; elevated cholesterol levels; smoking; and inherited or familial risks. These risk factors appear to be related to the aggressiveness of plaque production. When patients have multiple risk factors, the PAD becomes more complex to treat, for the pattern of distribution affects multiple organs and arteries simultaneously. This disease process progresses over a long time frame, so if treatment is instituted early on, the patient will benefit. However, once PAD becomes progressive, there is no cure, so the goal is to interrupt and retard the disease process. The risk factors are associated with damage to the lining of the artery, and it is this area of injury that is the site of the initial plaque formation. Over time, this plaque is deposited layer upon layer, again similar to sediment in a pipe.
Since complications occur because of blocked arteries, early treatments are designed to identify and treat the risk factors. Patients may present with certain complaints that are associated with PAD, but once the clinician recognizes certain risk factors, diagnostic tests and medical treatments can be started. The goal of treatment is to modify patients’ risk factors. It is very important for the health care consumer to be involved in this process and to assume responsibility for their health. This may include the willingness to undergo multiple tests to determine the extent of PAD and the compliance to take multiple medications. The beneficial impact of smoking cessation and exercise are very important.
If the PAD is longstanding, medication alone may be insufficient treatment, and invasive treatments may be necessary. The goal of these treatments is to improve blood flow to the affected area. Options for treatment can range from minimally invasive outpatient treatments to very involved bypass procedures with a prolonged hospital stay. Innovation and technology continue to improve healthcare delivery, so that the majority of treatments can be performed in a minimally invasive fashion. This needle stick approach allows a therapeutic intervention with minimal risk as an outpatient.
The combination of medical and surgical treatments has resulted in prolonged and improved quality of life for PAD patients. As a physician, I urge patients to take an active role in their care so that they understand the goals of treatment and become the necessary piece of the puzzle that allows for successful outcomes.