Lancaster Physician Spring 2020 - 26

L A N C A S T E R M E D I C A L S O C I E T Y.O R G

Healthy Communities

survey published in the journal Circulation
found that fewer than one in four adults with
risk factors and walking impairment have any
awareness of PAD. Of those who were aware
of PAD, less than one in seven were aware
that PAD is the single most important cause
of leg amputation.
Physicians, other health care providers, and
patients may mistake the symptoms of PAD
for other conditions. Common symptoms
of lower extremity PAD include leg pain,
claudication, or non-healing wounds.
There is a litany of other diagnoses providers must consider when these symptoms
present-from spinal stenosis to foot and
ankle arthritis.
WHAT CAN BE DONE TO IMPROVE
PAD STATISTICS?
First, focus on prevention. Lifestyle modifications to improve risk are the same for
cardiovascular disease and PAD. The most
important lifestyle changes to highlight are
following a heart-healthy diet, avoiding
tobacco (smoking or vaping), getting regular
exercise, and maintaining a healthy weight.
Lifestyle changes can also help with other
risk factors, which include a diagnosis of
hypertension and diabetes. Gaining control
of blood pressure and glycemic levels will go
a long way toward preventing PAD.
Increase awareness of the disease. The
AHA provides a webinar on how to talk to
your patients about PAD, fact sheets, and
handouts for patients regarding PAD online
at heart.org/PADtoolkit. Tell your patients
how lifestyle modification can help them
prevent a number of cardiovascular-related
diseases. Educate them about the disease
and risk factors, and empower them to
make heart-healthy choices with your help.
Encourage patients to attend lectures in the
community from those who treat the disease.
Improve detection. Patients may present
with no symptoms to the opposite spectrum with critical limb ischemia (CLI).
That's why taking a health history, reviewing symptoms, and performing a physical
examination are key. Non-invasive testing
through ankle-brachial index (ABI) is the
primary test performed to diagnose PAD.

ABI compares blood pressure readings in
the ankles to those readings in your arms.
Normal ABI ranges from 1.0-1.4. Values
below 0.9 are considered diagnostic of PAD,
and values less than 0.5 suggest severe PAD.

stroke. Smokers have four times the risk of
developing PAD than non-smokers. Quitting
smoking helps slow the progression of PAD
and heart disease.

OTHER TESTS THAT CAN
BE HELPFUL IN
DIAGNOSING PAD ARE:

Medications - Careful selection of medications can help manage PAD, its symptoms,
and possible complications. Medications
may include:

*Exercise treadmill testing helps measure
functional limitations of a patient with PAD.

* A
 ntiplatelet therapy to reduce the risk
of myocardial infarction, stroke, or death

* Doppler ultrasound imaging is ordered
to measure blood flow in the arteries by
using sound waves.
* Computed Tomographic (CT) Angiography and Magnetic Resonance Imaging
(MRI) can also reveal blockages in the
lower extremities.

* Statin medications to lower cholesterol
* Angiotensin-converting enzyme inhibitor
or angiotensin-receptor blocker to reduce
the risk of myocardial infarction, stroke,
heart failure, or death

* Angiography records blood flow in the
arteries and pinpoints the location of
any blockages.

* Cilostazol to improve symptoms and
increase walking distance in patients with
claudication (however, it is contraindicated
for patients with heart failure).

Encourage early treatment. Treatment for
PAD, which may vary from one individual
to the next, is directed to improve function
and reduce the potential of related events.
Options include:

Interventional Procedural Treatment - In
some more severe cases, vascular specialists
may recommend treatment. Fortunately,
vascular procedures have become much less
invasive than in the past.

Lifestyle Changes
Regular physical activity - In some cases,
the pain that comes from walking is what
requires management. Once the pain is
managed, the patient can resume their
physical activities, which helps to decrease
plaque buildup and the risk of PAD. Simple
walking regimens, leg exercises, and treadmill
exercise programs at least three days a week
can be beneficial. Introducing regular exercise
can help decrease symptoms of PAD within
four to eight weeks.
Nutrition - Recommend a heart-healthy
diet that focuses on vegetables, fruits,
whole grains rich in dietary fiber, low-fat or
fat-free dairy, and lean meats (poultry and
fish). Remind your patients to limit sweets,
salty or highly processed foods, and fatty or
processed meats.
Smoking cessation - Tobacco use greatly
increases the risk of PAD, heart attack, and

LANCASTER

26

PHYSICIAN

THESE PROCEDURES
INCLUDE:
Abdominal and thoracic aortic
repair or replacement
Angioplasty
Bypass surgery
Carotid artery stenting
Carotid endarterectomy
Peripheral vascular ablation
Popliteal aneurysm repair
Pulmonary embolism treatment
Thrombolytic therapy

Raising awareness of PAD is the crucial first
step in its detection and treatment. Talk to
your at-risk patients and make sure they
know the early warning signs as well as the
steps to prevent PAD.


http://www.heart.org/PADtoolkit

Lancaster Physician Spring 2020

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