Peripheral Arterial Disease (PAD) is a disease of the arteries, the blood vessels that carry blood from the heart to the rest of the body. It usually develops when fatty deposits (plaques) build up on the walls of the arteries (this is called atherosclerosis), causing the arteries to become narrowed. This in turn restricts the flow of blood to the muscles in the limbs. The disease typically affects the legs, causing pain on walking, although often there will be no symptoms and sufferers are frequently unaware that they have it. It is however important to detect and treat the disease as it increases the risk of heart attack or stroke and PAD is classed as equivalent to coronary heart disease (CHD). It is a common problem in older people with around 1 in 10 people aged between 60 and 70 suffering from PAD, and this rises to 2 in 10 over the age of 70. It is more common in men than women.
Despite the fact that PAD is so prevalent it is often not diagnosed and even when a diagnosis is made appropriate treatment goals are often not set. This is a missed opportunity to effectively treat a high risk population. The relatively simple ankle –brachial pressure index test (ABPI) can be used to detect PAD and this is something that can easily be done in the GP surgery. It is a test that measures blood pressure at the ankle and in the arms and compares the ratio of the two. Lower blood pressure in the legs compared with the arms is an indication of blocked arteries.
We now have evidence that shows that lowering lipid levels with the use of statins reduces the risk of heart attack and stokes in people suffering from PAD. In addition, there is some evidence that suggests that this treatment also improves symptoms and preserves kidney function. We also have emerging evidence showing that taking statins a few weeks before surgery also helps to reduce any associated risks. Other vascular risk factors also need to be addressed including type-2 diabetes and high blood pressure, both of which are common among people with PAD. Furthermore, PAD is very strongly associated with smoking. People with PAD also benefit from taking antiplatelet medication such as aspirin.
As far back as 1994 the vascular surgery and vascular disease prevention teams at the Royal Free Hospital set up a weekly outpatient clinic that addresses the medical aspects of treating PAD and it would be encouraging to see this model being followed.