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ANNOUNCER: Aging is inevitable. And as you
age, your risk for serious health complications increases.
One of the most common but least familiar condition is
Peripheral Arterial Disease. With an estimated 8-12 million cases in the
United States alone. The disease occurs when fatty build-ups restrict blood
flow to the legs.
ALAN HIRSCH, MD: Peripheral arterial disease, or
PAD, is the same type of blockage that occurs in the leg arteries as occurs
in some individuals in the heart arteries or the brain arteries.
ANNOUNCER: This blockage in the leg arteries can lead
to debilitating pain.
DIANE TREAT-JACOBSON, PhD, RN: Many patients with PAD
have that classically described claudication where it’s in the muscle in
the leg. It’s often a cramping but can sometimes be just a fatigue or an
aching, sometimes a numbness. It can also happen in the thigh or in the
buttock. It can happen most typically in the calf. But it’s in the muscles
of the legs not the joints.
ALAN HIRSCH, MD: There are many reasons why individuals
as they age might find themselves unable to walk pain-free. I don't
believe it's the responsibility of each individual to make their own diagnosis.
They might have arthritis. They might have claudication or some other
impairment to pain-free walking. I would ask any elderly American
who has difficulty with walking to describe their symptoms to their physician
so that an examination can be performed to clearly establish the reason
for their walking impairment.
ANNOUNCER: Leg pain is a serious issue, but a greater
concern is that PAD patients have an increased risk of suffering from a
heart attack or stroke-even if they have no pain symptoms.
ALAN HIRSCH, MD: Because of this increased risk
of heart attack and stroke in patients with PAD who don't have symptoms,
I believe it's important to establish the PAD diagnosis in all patients
at risk.
ANNOUNCER: An early PAD diagnosis means early prevention
of stroke and heart attack. Fortunately, PAD can be diagnosed with a simple
test at your doctor’s office.
ALAN HIRSCH, MD: The standard definition of peripheral
arterial disease is created by an abnormal value of the ankle-brachial
index. The ankle-brachial index, or 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.
DIANE TREAT-JACOBSON, PhD, RN: “So I’m going to take the
blood pressure on your arm and then the blood pressure on your ankles and
then come around and take the blood pressure on your other arm.
I’m going to use the Doppler which as you remember is
the machine that you can hear the pulse beating while we’re doing it.”
RON GORKE: It’s very simple. It’s no different than taking
the blood pressure in your arm. The only difference is that they move down
to your ankle. And it’s very easy. It only takes ten minutes. No complications,
no pain, nothing.
DIANE TREAT-JACOBSON, PhD, RN: “Now I’m going to inflate
the cuff until I can’t hear the sound and then I carefully lower it down.
Very slowly. That was 124.”
ANNOUNCER: In addition to the ABI, your doctor may also
perform some blood tests to optimize your treatment.
ALAN HIRSCH, MD: There are no blood tests required to
establish the diagnosis of PAD, but there are blood tests that should be
considered in the patient who's either at risk or who has PAD. These
include measurement of the blood sugar or hemoglobin AIc value, measurement
of the blood cholesterol, and certainly other measurements may be indicated
based on the patient's overall well-being.
ANNOUNCER: But it’s the ABI test that helps doctors catch
PAD early on. And a recent study shows that the ABI test is not performed
as often as it should be.
DIANE TREAT-JACOBSON, PhD, RN: The PARTNERS Study was
a national study where we had 27 regional vascular centers who recruited
each 15-20 primary care clinics and we asked each of those clinics to evaluate
a number of patients who came into their offices for routine office visits.
And we asked them to do an ABI on all of those individuals who were either
over the age of seventy or over the age of fifty with the risk factor of
diabetes or smoking. We screened almost 7000 patients in this study and
about 29% of them were found to have Peripheral Arterial Disease.
And half of the patients that were diagnosed with PAD
did not know they had the disease and their physicians didn’t know they
had the disease. So you have people who are at significant risk of having
a heart attack or a stroke who don’t know they have peripheral arterial
disease.
DIANE TREAT-JACOBSON, PhD, RN: “So now I’m going to move
over and do the other ankle. Start with the pulse right behind your inside
bone.”
DIANE TREAT-JACOBSON, PhD, RN: A well informed patient
can go to their physician and clearly state the symptoms that they’re having
and say that they’ve heard about the ABI and that they would like to have
one done. And this will help trigger the primary care clinician to also
make a diagnosis in the primary care setting so if patients need to be
referred to a specialist or if aggressive risk factor management needs
to be initiated that can happen right at the primary care level.
Early intervention is very important. If patients stop
smoking, if their diabetes is well controlled, if their blood pressure
is normalized with either diet or medication, if their cholesterol is normalized
with diet or medication these things can help change the progression of
the disease and also change the likelihood that someone will have a heart
attack or a stroke.
ALAN HIRSCH, MD: Additionally, recognition of PAD permits
some patients to understand why they may have limitations with walking,
why they might experience claudication or the muscular discomfort that
occurs as a symptom of PAD. So establishing the PAD diagnosis provides
two opportunities. One is to feel better and be able to maintain
their functional independence, and the other is to prevent heart attack
and stroke and to prolong their lives.
ANNOUNCER: ABI testing is especially important for people
at high risk of developing PAD.
ALAN HIRSCH, MD: Individuals who I consider to be at risk
of PAD are anybody over the age of 70 or individuals 50 years of age old
who either smoke or have a history of smoking or who have diabetes mellitus.
ANNOUNCER: So if you think you are at risk, or are just
concerned about the dangers of Peripheral Arterial Disease, make sure to
talk to your doctor about the ABI test. It’s easy, painless, and fast—and
it can save your life.
For more information on PAD, log on to the Vascular Disease
Foundation at www.VDF.org or visit UnderstandingPAD at www.UnderstandingPAD.com
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SUMMARY
