Peripheral Artery Disease

Peripheral artery disease (PAD) occurs when leg arteries become narrow or clogged by plaque, a condition that raises the risk of heart attack, stroke, leg amputation and death. The condition affects about 12 million Americans, making it more prevalent than all cancers combined.¹ With only about 25 percent of PAD patients receiving treatment², it is a disease that is largely under-diagnosed and under-treated by the medical community.

PAD is characterized by a reduction in blood flow to the lower extremities due to plaque build-up in the leg arteries (also known as atherosclerosis). Plaque is made up of deposits of fats, cholesterol and other substances. Plaque formations can grow large enough to significantly reduce the blood's flow through an artery.

When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. If the blockage remains in the peripheral arteries, it can cause pain, changes in skin color and temperature, sores or ulcers and difficulty walking. Total loss of circulation to the legs and feet can cause gangrene and lead to loss of a limb.

Risk Factors

Researchers have identified several risk factors that can be attributed to the development of PAD. These include:

• Diabetes
  • The prevalence of PAD is 20% higher in the diabetic population³
  • It is estimated that more than 23% of patients with diabetes between ages 55-74 have PAD⁴
  • 4.4 million diabetics (both diagnosed and undiagnosed), age 35 and older, have PAD⁵
• Age
  • The incidence of PAD increases with age, and affects approximately 20% of the U.S. population over 70⁶
  • Due to an aging population, the estimated number of people with PAD is expected to grow to more than 17 million in 2010 and more than 22 million in 2020⁷
• Smoking
  • Smokers have 3 times the rate of PAD as non-smokers and are diagnosed on average 10 years earlier⁸
• Coronary artery disease (CAD)
  • An estimated 40% of patients with CAD have PAD⁹

Signs and Symptoms

The leg pain associated with PAD can be so extreme that patients may have difficulty walking short distances. The most common symptoms of PAD include:

• Cramps, tiredness or pain in the legs, thighs or buttocks that occurs while walking and subsides during rest
• Foot or toe pain at rest that often disturbs sleep
• Foot or toe wounds that will not heal or heal very slowly
• A marked decrease in the lower leg/foot temperature, particularly compared to the other leg or rest of the body

Self-Assessment Test

The following questionnaire may help illustrate your level of risk of PAD. Answering “yes” to any of the questions below may signal the presence of, or the risk factors that contribute to the onset of peripheral artery disease. Talk to your doctor about PAD and an ABI (ankle-brachial index) or other diagnostic screening tests if you think you are at risk.

Do you have …
	Aching, cramping or pain in your legs when you walk or exercise, but then the pain goes away when you rest?
	Pain in your toes or feet at night?
	Any ulcers or sores on your feet or legs that are slow in healing?
	An inactive lifestyle?
	Do you smoke?
	Have you ever smoked?
	Are you more than 25 pounds overweight?
	Do you eat fried or fatty foods three times a week or more?
	Heart problems such as high blood pressure, heart attack, stroke?
	A family history of diabetes or heart problems?
	Are of African American or Hispanic ethnicity?

Diagnosis

If a patient has symptoms associated with PAD, several tests can be performed to make a diagnosis. An ankle brachial index (ABI) is used to measure the rate of blood pressure in the ankle compared to that in the arm. A lower pressure in the ankle may indicate PAD. This is a simple, non-invasive test, which can be done in the doctor’s office.

To make a final assessment, the patient undergoes angiography. This minimally invasive procedure involves injecting a dye into the arteries and reviewing the area by X-ray. Typically, the physician can see the blockage on the angiogram images.

Treatments

Like other diseases related to the arteries, PAD can be treated through lifestyle changes, medication, and surgical or minimally invasive procedures, if needed. Traditional treatment options for PAD include angioplasty and open bypass surgery, which is an invasive procedure involving a large incision and a hospital stay. Angioplasty clears a channel in the artery for blood flow by pushing plaque up against the artery walls with a balloon. Plaque excision is a new, minimally invasive approach that removes the plaque from the body. Specifically, the SilverHawk^® Plaque Excision System is an FDA-cleared device that uses a tiny rotating blade the size of a grain of rice to shave away large quantities of plaque from inside the artery. As it is excised, the plaque collects in the tip of the device and then is removed from the patient.

Talking to Your Doctor

If you suspect that you may have peripheral artery disease, you should talk to your doctor.

In preparation for your appointment, you may want to write out your questions in advance and bring them with you. You also may want to bring a family member or friend who can take notes, help with asking questions and listen for important information.

QUESTIONS TO ASK YOUR DOCTOR:

• I have been experiencing the following [list your symptoms], which sound like the symptoms of peripheral artery disease (PAD), what do you think?
• Given my medical history, am I at risk for this disease?
• If so, how do we confirm that PAD is present and to what extent?
• Can you perform an ABI test on me?
• If I do have PAD, what are some of my treatment options?
• What are the risks and benefits of each of these treatment options?
• Can you provide me with referrals to a couple of specialists, so I can learn more about my treatment options and hear different opinions on these?
• In the meantime, is there anything that I can do to modify my lifestyle, such as diet and exercise, to help improve some of my symptoms?

Risk Factors Signs and Symptoms Self-Assessment Test Diagnosis Treatments Talking to Your Doctor