The Two Stages of PAD
Peripheral Artery Disease (PAD) is a common disease that affects 10 percent of the population over 60 years of age. PAD occurs when cholesterol-based plaque builds up and causes problems with blood vessels carrying blood away from the heart.
Often PAD can be categorized into two stages. The first stage, known as claudication, occurs when there is pain upon exertion due to a lack of blood flow in the legs. In this phase of PAD, there is only enough blood supply for the legs when there is no movement or at complete rest. Once a person starts to move, the blood supply becomes restricted and results in pain. The individual needs to then repose to regain sufficient blood flow and alleviate discomfort. If a person is used to an active lifestyle, this can negatively affect his or her quality of life.
The second stage, known as critical limb ischemia, manifests as leg pain symptoms even when an individual is resting. This “rest pain” is due to the deterioration of blood flow, which can no longer adequately support the mere act of lying down in bed. Stage 2 is clinically defined as ischemic rest pain that lasts longer than two weeks, wounds, infections like gangrene, and an ABPI (Ankle-Brachial Pressure Index) below 0.5.
PAD patients will describe this ischemic rest pain as the feeling of having the front half of their foot dunked in ice coupled with extreme pain. The agony will awaken them from their nightly slumber. Many try to remedy the torment by either dangling their afflicted foot off the end of the bed or walking it out. This action is an attempt to use gravity to pull the blood flow down, back to the leg. At this stage, it is critical to see a vascular surgeon for a consultation as soon as possible to prevent any dire outcomes.
As the critical limb ischemia progresses, there may be the development of wounds or ulcerations, as well as a predisposition to serious infections. Wounds that do not heal or infections that are not quickly identified may lead to devastating complications, such as gangrene or the loss of limbs.
Progression from Stage 1 to Stage 2 is fortunately slow, but it is essential to work with an experienced vascular surgeon, like Dr. David Nabi, who can identify PAD and rule out other diseases that may mimic PAD symptoms.
Some diseases, such as neuropathy or spinal stenosis, can overlap with PAD, so expertise is key to providing the best clinical outcome for your situation.
Getting assessed at Stage 1 is vital in preventing PAD from deteriorating into the Stage 2 disease process. Working with your doctor to manage and improve your systems of PAD before it progresses is one of your best tools to advocate for your health, so the sooner you can start, the better. Prevention, education, and working with an expert in PAD is the best course of action to keep your symptoms under control. Don’t let PAD control your life!
For a PAD assessment, please contact Dr. David Nabi at NewportVascular.com.