What is P.A.D.?

P.A.D stands for peripheral arterial disease. This is the disease of aorta and its branches including the arteries that supply blood to legs, arms, kidneys and brain.

Why is it important?

The importance of P.A.D is in two contexts: general and local. The presence of P.A.D warns us about the presence of arterial disease in other organs. The people with P.A.D are at a higher risk for having heart attack and stroke.

In local context, disease of carotid arteries (the two arteries that travel up the neck into the brain on either side of Adam’s apple) is responsible for one in every five strokes. The presence of blockages in the leg arteries can be responsible for leg pains and in some cases, loss of limb. Blockage of kidney arteries can in certain cases be responsible for resistant hypertension (high blood pressure)

How to diagnose P.A.D.?

The P.A.D. in legs can be diagnosed by good physical examination by a provider and a simple test called ABI (ankle brachial index). An ultrasound can diagnose disease of carotid arteries.

The diagnosis is also sometimes based on symptoms. The typical symptom of blockages in leg arteries is cramping pain in the calves or hip that is predictably brought on by exertion and goes away at rest.

Should I have the test for P.A.D. done even if I do not have any symptoms?

In case of disease of carotid arteries, the trick is to make the diagnosis before a stroke. The diagnosis can sometime be made if your provider hears a bruit (an abnormal sound) over your carotids with a stethoscope. Research shows that persons with a bruit may not have significant blockage of carotid arteries and someone may have severe disease without any audible bruit.

Some authorities are making a case for routine ultrasound of the abdomen for early diagnosis of aneurysm of the abdominal aorta.

The presence of P.A.D. can also alert us to the presence of disease in the heart and brain arteries.

How do you treat P.A.D.?

All blockages do not necessarily always demand surgical correction. The treatment includes management of risk factors including stopping smoking, treating diabetes, high blood pressure, high cholesterol and regular exercise. Aspirin and Clopidogrel (marketed as Plavix) are two blood thinners that have been found to be useful in patients with P.A.D. The medicines like Cilostazol and Pentoxifylline can help relieve exertional cramping. Exercise plays a vital role in treatment of disease of leg arteries. In certain cases, surgery is the best option. This can be in the form of an open surgical procedure or stents or balloon angioplasty.

Can we prevent P.A.D.?

The preventive measures include management of risk factors including stopping smoking, treating diabetes, high blood pressure, high cholesterol and regular exercise.

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