Peripheral arterial disease, or PAD, is defined as the blockage of the peripheral arteries, excluding the arteries in the heart, aortic arch or brain.
It is characterized by the hardening of the arteries (atherosclerosis) and the subsequent blockage of the arteries in the extremities, and is a marker for systemic vascular disease involving the heart, brain and kidney arteries.
PAD affects over 12 million people in the U.S. Half of those people have no symptoms and one-third have symptoms of intermittent claudication, defined as pain, cramping or aching in the calves, thighs or buttocks that occurs with walking and is relieved by rest. The remaining people have more severe forms of the disease, including pain at rest, ulcers and gangrene.
The two strongest risk factors for PAD are diabetes and smoking. Other risk factors include advanced age, high blood pressure and high lipid levels. Cigarette smoking is the single most modifiable risk factor that can lead to PAD, which directly increases the risk for amputation.
The American Diabetes Association Consensus Panel on Peripheral Arterial Disease recommends a screening test called an Ankle Brachial Index (ABI). This ABI screening should be performed on diabetic patients who are 50 years of age or older. If normal, it should be repeated every five years.
Diabetic patients who meet the following criteria should also be screened every five years, if the results are normal: those who are younger than 50, but who have other PAD risk factors including smoking, high blood pressure, high lipids or who have had diabetes for 10 years or greater.