Fighting for Your Legs: Peripheral Arterial Disease
on Rise for Senior Citizens
‘Silent killer’ bringing grave results that can
include gangrene, amputation, or death
By Dr. Gary M. Ansel
July
10, 2008 - Peripheral Arterial Disease (PAD), a condition synonymous
with the clogging of arteries in the body’s lower extremities, is often
referred to as a “silent killer” that can bring with it potentially
grave results that include gangrene, amputation, or death.
Data shows that PAD currently affects approximately
eight million men and women over the age of 40 in the United States.
What’s more, the risk of developing PAD increases dramatically as people
grow older, with as many as one in 20 Americans over the age of 50
developing the disease.
Although PAD is prevalent among the senior
population, current statistics shows public awareness about the disease
is low. In fact, only 25 percent of those afflicted receive treatment ,
in large part due to frequent misdiagnosis of commonly mistaken
symptoms. In many instances, especially among the senior community, PAD
is mistaken for arthritis or aging pains, allowing the disease to remain
undiagnosed, untreated, and left to intensify.
PAD develops when arteries in the legs become
clogged with plaque comprised of fatty deposits, calcium, and
cholesterol and blood flow to the legs becomes limited or blocked. In
severe cases, the arterial blockages can cause circulation problems that
reduce blood flow to the brain and heart, which then elevate the risk
for stroke and heart attack.
PAD is broken down into two stages that worsen as
blood flow to the legs decreases: Claudication and Critical Limb
Ischemia (CLI).
About Peripheral Vascular Diseases
Also
called: PAD, Peripheral arterial disease
Peripheral
vascular disease (PVD) happens when there is a narrowing of the
blood vessels outside of your heart. A substance made up of fat
and cholesterol, called plaque, builds up on the walls of the
arteries that supply blood to the arms and legs. The plaque
causes the arteries to narrow or become blocked. This can reduce
or stop blood flow, usually to the legs, causing them to hurt or
feel numb. If severe enough, blocked blood flow can cause tissue
death. If this condition is left untreated, the foot or leg may
need to be amputated.
A person
with PVD also has an increased risk of heart attack, stroke and
transient ischemic attack. You can often stop or reverse the
buildup of plaque in the arteries with dietary changes,
exercise, and efforts to lower high
cholesterol levels and
high blood pressure.
Claudication, the first stage, begins with a
feeling of fatigue or heaviness in the lower extremities or buttocks and
progresses to significant discomfort during activity. Patients with
buttock claudication will frequently stop walking until the pain goes
away, a condition know as “window shopper’s disease.”
The second stage, CLI, starts off with pain
while resting or sitting and, if left untreated, may lead to gangrene.
Within the CLI population alone, at least 200,000 amputations are
performed each year.
In addition to the correlation between PAD and the
aging population, diabetics are also especially susceptible to PAD
because they have difficulty properly processing the sugar they ingest.
Also, smoking and heritage, such as African Americans, Hispanic
Americans and Native Americans, are heightened risks for developing
severe PAD that results in amputation.
Knowing the Difference
For senior citizens, it’s not out of the ordinary
to have some leg pain after a long and vigorous walk. However, when pain
and cramping exist after short walks or mild activity, it could be an
indication that there are blockages within the peripheral arteries.
Early detection of PAD is essential to maintaining
a high quality of life for those afflicted with PAD. Below is a list of
warning signs and symptoms that should be monitored closely:
● Fatigue or cramping in the leg muscles (known
as claudication) when walking
● Pain in the legs, buttocks and/or feet that
disturbs sleep
● Wounds on toes, feet or legs that heal slowly,
poorly, or not at all
● Color changes in the skin of the feet
(paleness or blueness)
● A lower temperature in one leg when compared
to the other leg
● Poor nail growth and decreased hair growth on
toes and legs
Seeing Your Doctor
Two of the most common methods used to test
patients for PAD are the ankle-brachial index (ABI) and the Doppler
ultrasound test. The ABI is a noninvasive, painless, and reliable test
that works by comparing blood pressure in the ankles and arms. An ABI
test is useful in determining if someone has PAD, but cannot locate the
blocked artery. The Doppler test, which is also noninvasive, manipulates
sound waves to evaluate blood flow in lower extremities, often locating
the blockage.
Getting Treated
Treatment for mild PAD is largely behavioral, as
the condition can be mitigated with a regimen of walking, a low
cholesterol diet for diabetics, cessation of smoking and, in some cases,
medication. For severe PAD, however, treatment may require an invasive
bypass surgery or angioplasty.
Lower extremity bypass surgery involves harvesting
a healthy vein from another region of the body for insertion into the
damaged limb, an effort to reroute blood away from the blocked artery.
Angioplasty is a minimally invasive procedure used to widen arteries
with constricted or blocked blood flow. During the procedure, a catheter
with a balloon on its tip is inserted into the narrowed artery and
inflated. Once the artery widens, the balloon is deflated and the
catheter is withdrawn, often restoring blood flow.
Another option in specific arteries (such as the
iliac) is to have a stent (a tubular wire-mesh tube) inserted into the
artery, where it is expanded to act as a “scaffold” to hold the artery
open and allow blood flow to resume. The procedure is minimally
invasive, as the stent is guided into the restricted artery with a
catheter inserted through a small opening in the artery located in the
groin.
What’s Next
Drug-eluting stents, which are coated with medicine
that is slowly released into the artery, were created to prevent the
recurent disease from growing through the stent and forming scar tissue,
a process called restenosis. These devices have shown clinical
effectiveness in treating coronary artery disease, and are currently
being studied in the leg arteries.
In the United States and other parts of the world,
clinical trials are currently underway to determine the effectiveness of
using drug-eluting stents to treat PAD. The trial process is similar to
the procedure used to treat coronary artery disease, and involves
inserting a drug-eluting stent into the affected leg.
Zilver PTX Drug-Eluting Stent Trial
One particular investigational device involved in
these recent trials is the Zilver PTX Drug-Eluting Stent (www.zilverptxtrial.com)
from Cook Medical. The Zilver PTX stent is coated with paclitaxel, a
drug approved for use as an anti-cancer agent and used successfully with
coronary stents to reduce the recurrence of narrowing in the arteries
following stenting. The amount of paclitaxel used is minimal compared to
the amount used to treat cancer. It was created with the intention of
staving off relapse in the nearly 40 percent of patients who now must
endure repeat procedures when arteries renarrow. The Zilver PTX Trial is
currently enrolling patients in clinical trial locations across the U.S.
and Japan.
In the meantime, doctors across the country are
working to increase general awareness and help identify the early
warning signs of the disease. It is their hope that this heightened
awareness, paired with the acceptance of innovative new treatment
methods, will help eradicate PAD completely.
For more information on clinical trials, please
visit the
Zilver PTX Website.
Dr. Gary M. Ansel is Director of the Center
for Critical Limb Care and Clinical Director of the Peripheral Vascular
Intervention-Division of Cardiology at Riverside Methodist Hospital.
More information
July
10, 2008 - Peripheral Arterial Disease (PAD), a condition synonymous
with the clogging of arteries in the body’s lower extremities, is often
referred to as a “silent killer” that can bring with it potentially
grave results that include gangrene, amputation, or death.
