By Marcy Rushford
Peripheral Artery Disease (P.A.D.) is a condition that frequently goes undiagnosed until it is in the advanced stages of the illness. But there is a fairly simple test that can help detect P.A.D. during the early stages and hopefully prevent some of the potentially fatal consequences.
P.A.D. stems from a build-up of plaque along the arterial walls of the body. The plaque reduces blood flow, especially when a person is exerting themselves physically. A person with P.A.D. may feel pain or numbness in her arms and legs, especially the legs. But the larger concern is that P.A.D. also restricts blood flow in the arteries around the heart and brain, increasing a person’s risk for a heart attack or stroke.
Part of the reason P.A.D. is under-diagnosed is because leg pain is such a general symptom and may not be a sign of anything other than overuse. Here in New England, as well as other cold-weather climates, the pain and numbness of P.A.D. tends to be more pronounced during winter months, just like if a person had arthritis.
If a person who is a diabetic or has high blood pressure or high cholesterol is feeling leg pain while walking stairs, it may be an indication of P.A.D. Lifestyle choices are what primarily contribute to the plaque build-up in the arteries. Smokers are also at particular risk. Most people only think about the risk of cancer associated with smoking, but tobacco use has a serious effect on the circulatory system as well.
The test we run for P.A.D. is called an ankle-brachial index test (ABI). An ABI can take up to an hour but it’s not at all intensive. We wrap sensors that look like blood pressure cuffs on the upper and lower thigh of both legs, as well as one sensor just below each knee and ankle. A radiologist will look at the results for indications of diminished blood pressure in these different areas of the leg to determine if there is plaque build-up.
The ABI test is an entry point for evaluating a patient where P.A.D. is a concern.
Based on the results and the patient’s medical history, the physician may request additional testing, like a treadmill stress test, echocardiogram or nuclear cardiac test, to further evaluate the extent of the disease.
The goal of the ABI test is early detection. If diagnosed during the early stages, P.A.D. can be managed through lifestyle changes and possibly medication. Over time, the pain and numbness can be alleviated, although the condition is not cured. People who don’t have P.A.D. detected until it reaches advanced stages may require stenting or other types of surgical intervention. Some people have had to have a limb amputated in order to control the disease.
The National Institute of Health says that people begin to be at risk for P.A.D when they reach age 50 and above; but here at BMH we have seen patients with the condition who are in their mid-30s. Typically, these younger people are heavy smokers or have a poor diet. People should talk to their primary care provider or cardiologist if they’re having leg pain. A short series of screening questions can help determine if an ABI test is appropriate. Like a silent heart attack, P.A.D. can manifest with no outward symptoms. It’s a very gradual disease with pretty serious effects. Don’t wait for it to worsen before getting it checked.
Marcy Rushford, CRA, MBA, RDMS, RT(R,M) is the Director of the Radiology and Cardiology Unit at Brattleboro Memorial Hospital.