Peripheral Arterial Disease: A Patient Guide

The ABI is a measurement performed with an electronic stethoscope and a simple office blood pressure cuff. This test measures the blood pressure at the ankle and at the arm, and the physician can easily compare the pressure at these two sites. A blood pressure that is lower in the ankle than the arm implies a blockage in the artery between the heart and the leg. Such a blockage represents peripheral arterial disease.

Several other examinations may be required to diagnose and determine the extent of the disease:

• Medical history and physical exam
• Ankle-brachial test
• Treadmill exercise test
• Reactive hyperemia test
• Segmental pressure measurements
• Pulse volume waveform analysis
• Duplex arterial imaging or ultrasound imaging
• Magnetic resonance angiography
• Computerized tomographic angiography
• Arteriogram

How can PAD be prevented?

Strategies to prevent PAD are similar to those that prevent coronary artery disease. They include:

• Eat a heart-healthy diet. While certain vitamins and minerals have been shown to be helpful to heart health, fats and oils such as saturated fat and tropical oils (palm and coconut oil) have been shown to be particularly harmful, because they can speed up the development of PAD, atherosclerosis, and obesity.
• Improve cholesterol level. This is especially important if you have a family history of vascular disease. A person's total cholesterol level should be no more than 200 milligrams per deciliter and no more than five times the HDL level (HDL is the “good cholesterol”). The LDL cholesterol (the “bad” cholesterol) should be no more than 130. For people that already have PAD we now recommend that the target LDL cholesterol should be around 70. Key strategies to improve cholesterol ratios include a heart-healthy diet, regular exercise, limited alcohol use, and prescription cholesterol-reducing drugs (if needed, almost all people that already have PAD documented will benefit from cholesterol lowering medications).
• Exercise regularly. Exercise is an excellent tool in the prevention of vascular complications of PAD. It can slow or even reverse the process of atherosclerosis, as well as lower blood pressure and reduce cholesterol levels (consult with your physician before beginning any exercise program).
• Control diabetes. Persons with diabetes are more likely to develop the complications of vascular disease. Diabetes is the leading cause of amputation as well as a need for renal replacement therapy in the US. Inadequacy of diabetes control is the leading cause of complications among diabetic patients.
• Control high blood pressure (hypertension). Individuals with high blood pressure are at greater risk of developing vascular problems. Hypertension can be controlled through blood pressure-lowering medications, self-monitoring, eating a heart-healthy and low-salt diet, and engaging in regular exercise. Certain blood pressure medications are particularly helpful in increasing walking distance of patients with PAD. Likewise, some blood pressure medications may aggravate this condition.
• Control weight. Obesity and being overweight are major risk factors for a host of serious health conditions, including PAD, high blood pressure, diabetes, heart attack, and stroke.
• Quit smoking (or don’t start to smoke). Tobacco smoking is a major cause of PAD and stroke. Tobacco causes vasoconstriction to the peripheral arterial vessels. Since these vessels are the ones affected by PAD, there is further decrease in flow to the areas that need it most. The vasoconstrictor effects of tobacco can still be measured 24 hours after even one cigarette.