September is Peripheral Arterial Disease (PAD) awareness month
Peripheral Arterial Disease (PAD) can be silent until a person exerts themselves. After walking a short distance a person may start to experience tightness, pain and/or fatigue in their calves, thighs or buttock. As PAD in a person worsens they may notice their feet feeling cold and bluish in color, hair loss on the legs and thickening toenails. As the disease becomes severe a person may develop non-healing wounds around the ankle and experience pain at night that is relieved with the legs in a dependent position.
Those at highest risk of developing PAD are diabetics, elderly, smokers and individuals with high cholesterol. Approximately 25% of patients with intermittent claudication will become ischemic (critical PAD) within five years of their initial onset of claudication.
An ankle brachial index (ABI) is commonly used to establish the presence or absence of PAD. The downfall to using this method alone is that the effectiveness is decreased in diabetic and elderly patients because of a higher incidence of arterial calcification and collateral arterial flow. ABIs are limited by arterial calcification in 20% of the patient population.
Doppler waveform analysis should be performed in conjunction with ABIs to increase the accuracy of the results. If a patient has calcified or non compressible vessels, ABIs could be falsely elevated making it appear as though the testing is normal. An ABI greater than 1.2 or 120% should be considered positive for calcified vessels, especially in elderly and diabetic patients.
Another important diagnostic tool is exercise testing. Patients with claudication symptoms will have normal “resting” ABIs with normal waveform analysis. However, with exercise testing there will be exercise induced ischemia or “true claudication.”
The Vascular Lab at Muskegon Surgical Associates can easily diagnose PAD. There are no needles or dyes injected into the body. We use noninvasive ultrasound Doppler to identify blockages in the arteries. The results of the Doppler study will provide valuable information, which can ultimately lead to the repairs necessary to improve the circulation of blood to the legs.