Combating Peripheral Arterial Disease (PAD)

with Bradley Mays, M.D., Vascular Surgery, Columbia St. Mary’s

Posted: Sept. 1, 2005

“PAD is a global disease,” says Dr. Bradley Mays. “It involves arteries not only in the legs, but throughout the body. Because it is often has no symptoms, PAD often goes undiscovered until a serious problem arises.” Left untreated, PAD can lead to stroke, heart attack, kidney failure, aneurysm and amputation – all with little to no warning.

To fight PAD early on, Dr. Mays helps his patients execute the following strategies:

Bradley Mays, M.D., Vascular Surgery, Columbia St. Mary’s "Anyone who has high blood pressure, smokes or is over age 50 should be examined for signs of PAD."

Routine screening
“Anyone who has high blood pressure, smokes or is over age 50 should be examined closely for signs of PAD,” says Dr. Mays. He also emphasizes how important it is for a patient with diabetes or a non-healing wound on their feet or legs to seek care in a timely manner. In many cases, early intervention can be key to saving a limb.

The PAD screening includes:

Complete health history
The patient’s health history may provide clues as to the severity and location of PAD. “It’s important to listen to the patient and find out the location of the leg pain and then determine what brings it on and what relieves it,” says Dr. Mays.

Physical exam
“The legs are easy to examine” says Dr. Mays. “If you have arterial disease in your legs, there is a high chance you have it in or near your heart as well. That’s why foot and leg examinations are so important.” Often, a non-healing sore on the foot or toe is the first indication of a serious disease elsewhere in the vascular system.

ABI
An ABI (ankle blood index) is simply a blood pressure reading from the ankle. The ABI will be used along with a blood pressure reading from the arm to determine if a suspected arterial blockage is in the lower or upper half of the body.

Lifestyle changes
“Our first defense against PAD is lifestyle changes that may help eliminate the need for medical intervention,” says Dr. Mays. The most important step is to stop smoking: “One-third of patients who stop smoking experience a reduction in claudication, which is the pain in their leg or calf,” says Dr. Mays.

Good control of blood pressure, cholesterol and diabetes may also help relieve claudication. So might a routine walking program in which the patient begins by walking short distances and building from there. “Unlike pain in your chest, it is okay to walk through the pain in your legs,” says Dr. Mays, “so we encourage patients to build their walking tolerance as long as the pain is not severe.”

Intervention
If the pain is so severe that the patient cannot walk even a half a block, or if the pain is limiting their day-to-day activity, medical treatment may be necessary. “For PAD that causes continuous pain or if the patient has a non-healing sore, we will intervene with angioplasty to remove the blockage plus stenting to hold the artery open. In severe blockages, surgery may be necessary,” says Dr. Mays.

Today, minimally invasive angioplasty and stenting are used roughly twice as often as traditional, open surgery. One reason, says Dr. Mays, is that the short-term results of stents have been proven to be effective in holding arteries open long enough to allow wounds to heal and pain to disappear. Although the long-term effectiveness of stents for PAD has not been tested, the short-term results are promising when combined with post-procedure preventive measures, which include smoking cessation and other lifestyle changes.

Relationships
Treatment of PAD is ongoing and involves an entire care team including a vascular surgeon, interventional radiologists and cardiologists. “Treating a patient with PAD is a life-long relationship,” says Dr. Mays. “It’s not a one-time treatment course. We need to follow the progression of the disease, not only in the artery that has been treated, but also the other arteries at risk.”

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