Peripheral Arterial Disease (P.A.D.)


November 1, 2018 | View PDF

What is P.A.D.?

P.A.D. is short for Peripheral Arterial Disease. The term PAD encompasses a large series of disorders that affect arterial beds exclusive of the coronary arteries. People have P.A.D. when the arteries in their legs become narrowed or clogged with fatty deposits, or plaque . The buildup of plaque causes the arteries to harden and narrow, which is called atherosclerosis . When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced. Some people call this poor circulation. P.A.D. occurs most often in the arteries in the legs, but it also can affect other arteries that carry blood outside the heart. This includes arteries that go to the aorta, the brain, the arms, the kidneys and the stomach. When arteries that supply the heart are hardened or narrowed, it is called coronary artery disease or cardiovascular disease. The good news is that like other diseases related to the arteries, P.A.D. can be treated by making lifestyle changes, by taking medicines, or by undergoing leg artery angioplasty or other endovascular intervention type procedure ( laser, stents, atherectomy, rotational atherectomy etc) or traditional vascular surgery, if needed. And you can live well with P.A.D.

Is P.A.D. serious?

P.A.D. is a serious disease commonly affecting 1/3 Americans over the age of 50. The hardened arteries found in people with P.A.D. are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain. That is why people with P.A.D. have a two- to six-times greater chance of death from a heart attack or a stroke with or without symptoms. Patient with symptoms from PAD have a higher risk of death than patient with P.A.D but no symptoms. P.A.D has higher risk of death than certain well known cancer such as breast cancer, prostate cancer and Hodgkin's disease. When the blood flow to the legs is greatly (or severely) reduced, people with P.A.D. may have pain when walking. P.A.D. may cause other problems that can lead to amputation of a toe, foot or a leg. People with P.A.D. may become disabled and not be able to go to work. As time goes on, they may have a very poor quality of life.

Who is at risk for P.A.D.?

The chance of having P.A.D. increases as you get older. People over age 50 have a higher risk for P.A.D., but the risk is increased if you:

• Smoke, or used to smoke

• Have diabetes

• Have high blood pressure

• Have abnormal blood cholesterol levels

• Are of African American ethnicity

• Have had heart disease, a heart attack or a stroke

• Have a family history of P.A.D., heart attack or stroke.

What are the warning signs or symptoms of P.A.D.?

P.A.D. develops slowly over many years. In the early stages, most people with P.A.D. have no symptoms. Only about one out of four people with P.A.D. actually feel typical symptoms of P.A.D. in their leg muscles (known as "claudication", defined below). By that time, their arteries may be so clogged hardened that they are not getting enough oxygen to supply their leg muscles. The most common signs of P.A.D. include one or more of these problems:

• Cramps, tiredness or pain in your legs, thighs or buttocks that always happens when you walk but that goes away when you rest. This is called claudication.

• Foot or toe pain at rest that often disturbs your sleep.

• Skin wounds or ulcers on your feet or toes that are slow to heal, or that do not heal. Sometimes, people ignore their leg pain and think it is just a sign that they are getting older. As a result, many people with P.A.D. do not know they have it and do not get treatment. It is important to discuss any leg or thigh pain you may be having with your health care provider since it may be a warning sign of a serious disease such as P.A.D. Ulcers can be on the hands or legs. Ischemic ulcers from arterial disease should be differentiated from non P.A.D ulcers.

How do I find out if I have P.A.D.?

If you think you have P.A.D., see your health care provider and talk about any symptoms you are having and go over your medical history and your risk factors for P.A.D. Your provider will examine the pulses in your feet and legs. If your provider finds those pulses are weak and thinks you may have P.A.D., your provider may order a test called the ABI, which stands for ankle-brachial index . The ABI is the best test for finding out if you have P.A.D. It uses sound waves to find out if there is reduced blood flow in the arteries. It also compares the blood pressure in your ankles with the blood pressure in your arms. P.A.D. also can be diagnosed by other tests that measure blood pressures in the leg (segmental pressure), toe pressures (toe-brachial index or TBI) or artery blood flow (with ultrasound). Other more sophisticated tests can be performed such as PVR (pulse volume recordings), CTA ( Cat scan), magnetic resonance angiography (MRA) or catheterization or angiography.

How is P.A.D. treated?

P.A.D. can be treated with lifestyle changes, medicines and surgery, if needed. Since people with P.A.D. are at high risk for heart attacks and stroke, they must take charge of controlling their risk factors related to cardiovascular disease. These life-saving steps will help to prevent and control P.A.D.:

• Get help to quit smoking and set a quit date now.

• Lower your blood pressure to less than 140/90 mmHg or less than 130/80 mmHg if you have diabetes or chronic kidney disease.

• Lower your LDL (bad) cholesterol to less than 100 mg/dl or to less than 70 mg/dl if you are at very high risk for a heart attack or stroke (if you smoke, have diabetes or have chronic kidney disease).

• Manage your blood glucose to reach an A1C level of less than 7 and practice proper foot care if you have diabetes.

• Talk to your doctor about taking antiplatelet medicines such as aspirin or clopidogrel (Plavix) to prevent clotting. Other meds are approved for PAD and vascular disease such as Pletal and Zontivity.

• Follow a healthy eating plan to control your blood pressure, cholesterol and blood glucose (for diabetes).

• Get regular exercise such as walking for 30 minutes at least 3 or 4 times per week.

• If you have pain or cramps in your legs, ask your health care provider about an exercise program that will help improve your symptoms. If possible, get a referral to a specialist.

P.A.D. exercise program.

For most people with P.A.D., these life-saving steps may be enough to slow down the disease and even improve any symptoms. If needed, your health care provider can refer you to a specialist for procedures or surgery to treat arteries that are severely blocked. These procedures often help people with P.A.D. to improve symptoms and to avoid losing a foot or leg.

Remember: Finding and treating P.A.D. early can help keep your legs healthy, lower your risk for heart attack or stroke, and save your life and limbs.

Our board certified interventional cardiologist and vascular specialist, Dr. Majdi Ashchi has an extensive experience with interventions to treat simple to complex vascular blockages in any vascular bed or organ including carotids ( neck arteries), arms, kidney arteries, stomach or intestinal arteries, leg arteries as well as heart arteries. Our experts use simple balloon angioplasty or medicated balloon angioplasty, bare metal to medicated stents to more complex atherectomy devices, laser catheters, and clot buster catheters to remove clots or cholesterol plaques. If you wish to make an appointment with our doctors, please contact us at (904)-222-6656 or visit our web site ( for our locations or phone numbers in three counties.

Majdi Ashchi, DO, FACC, FSCAI, FSVM, FABVM, is the president & medical director of Ashchi Heart & Vascular Center, PA. After graduating from the College of Osteopathic Medicine at Nova-Southeastern University of The Health Sciences 1989, and the University of South Florida for his bachelor's degree 1985, he was recruited to the prestigious Cleveland Clinic Foundation for his internal medicine residency. Dr. Ashchi completed his Cardiology fellowship from Case Western Reserve University (1996) and an interventional cardiology fellowship from the University of Connecticut in 1997. Dr. Ashchi has become a pioneer in the diagnosis and treatment of vascular disease (arterial, aneurysm, vein disease) as well as carotid and coronary disease. Dr. Ashchi is currently assistant professor of internal medicine at the University of Central Florida College of Medicine as well as adjunct clinical assistant professor of internal medicine at Lake Erie College of Osteopathic Medicine.


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