Why is peripheral artery disease difficult to diagnose?

Anthony G. Smeglin, MD

Peripheral artery disease can be difficult to diagnose and is underdiagnosed because people don’t know what to look for, and doctors often don’t focus on it.

The majority of people with peripheral artery disease either don’t experience symptoms or they attribute their symptoms to other causes.

Typically, peripheral artery disease can lead to symptoms such as pain in the legs with walking (known as claudication), achiness and heaviness. Sometimes, if it progresses, it can lead to ulcers or gangrene.

Some four out of five people experience atypical symptoms. That can be that when they are walking they may just get a cramp and continue walking. They may have some numbness or some heaviness. These are the sort of symptoms that people will often just attribute to their other ailments. It can often be confused for spine issues, arthritis issues, and neuropathic issues. One of the most common causes of these types of symptoms is venous disease. That’s one of the things that needs to be teased out.


How do peripheral arterial and peripheral vascular disease differ?

Anthony G. Smeglin, MD 

Peripheral arterial disease and peripheral vascular disease are not the same thing. Peripheral arterial disease, or peripheral artery disease, is a process that affects the arterial blood vessels in the body. Peripheral vascular disease encompasses peripheral artery disease but also includes other things like venous disease or disease processes that affect the organs. Peripheral artery disease refers to arteries that lead to all areas of the body.


How is peripheral artery disease (PAD) treated?

Anthony G. Smeglin, MD 

Peripheral artery disease (PAD) is usually treated with lifestyle modifications to modifying risk factors.

Exercise is one of the most important treatment modalities for people with PAD. Too often people complain of pain when they walk and as a result they walk less or exercise less. People should walk more and exercise more. What that does is help the body develop and grow ‘collaterals’ or small blood vessels to help feed the muscle with more blood supply.

Other lifestyle modifications for PAD include:

• eating healthy
• quitting smoking
• controlling blood pressure
• controlling cholesterol


How is peripheral artery disease (PAD) diagnosed? 

Anthony G. Smeglin, MD

Peripheral artery disease (PAD) may be diagnosed through the following:

• A thorough medical history is taken and discussed. This will help delineate whether the symptom is coming from a blockage in the arteries or that it’s more likely due to a nerve, musculoskeletal or spine problem.

• A diagnostic procedure called an ankle brachial index (ABI) will be done. This is recommended for all people over 65 with risk factors, and anyone over 50 who has a history of smoking or diabetes. The ABI is very sensitive and specific when done properly for picking up or screening for peripheral artery disease. If the ABI alone is not enough, the person would exercise (walk slowly) on a treadmill while an ABI is performed.

• More advanced tests called pulse volume recording or an ultrasound of the legs may be performed.


What are the potential complications of peripheral arterial disease (PAD)?

Anthony G. Smeglin, MD

Potential complications of peripheral arterial disease (PAD) include an increased risk of cardiovascular morbidity and mortality. What that translates into is that once someone has the diagnosis of peripheral arterial disease, they have a five year elevated risk of a cardiovascular problem. As such, risk factors and therapies are directed not only at peripheral arterial disease but also at the cardiovascular system in general.


How common is peripheral artery disease (PAD)?

Anthony G. Smeglin, MD

Peripheral artery disease affects anywhere from 15 to 20 percent of the population. It’s often underrecognized. If people feel like they have symptoms that may be concerning for peripheral artery disease, they should talk to their doctor.


Do people with peripheral artery disease need a monitored exercise program? 

Anthony G. Smeglin, MD 

People with peripheral artery disease (PAD) don’t have to have a monitored exercise program, but they may prefer it, and it works better. Most insurance companies will approve at least a 12-week or so monitored exercise therapy program.

People can exercise on their own if they prefer. They can go outside and walk around the block, ride a bicycle or swim. In the winter they can walk around a mall. There are a whole host of exercises that can help get that heart rate up and circulation improved.