Peripheral Arterial Disease

What you need to know about

MARQUETTE — “Peripheral Arterial Disease (PAD) is common in the Upper Peninsula,” said Dr. Yazan Khouri, Interventional Cardiologist at UP Health Systems-Marquette.

PAD is a common circulatory condition that occurs when blood vessels become narrowed or blocked with fatty deposits, called plaque, over time. UPHS-Marquette offers lifesaving treatments for PAD but also strives to educate patients about the risk factors they can control to prevent its development.

PAD causes narrowing of the arteries and subsequently a decrease in blood flow to the areas affected, like legs and feet,” Dr. Khouri said.

“PAD can indicate a widespread problem that other arteries, including those in the heart and brain, may also be blocked, which in turn increases a person’s risk of a heart attack or stroke. Also, because PAD decreases blood flow, it can lead to amputation if left untreated” The same risk factors that cause PAD can also cause Coronary Artery Disease (CAD).

So for anyone who has been diagnosed with PAD, getting the disease under control early is important, he said.

Closeup side view of female doctor massaging legs and calves of a senior female patient with visible varicose veins.

“Improving PAD can help better cardiovascular outcomes and prevent heart attacks,” Dr. Khouri said.

Some of the PAD risk factors cannot be controlled such as being male or being age 70 or older.

“What people can control is keeping their cholesterol, blood pressure, diabetes and weight under control,” he said. Indisputably the most important factor people can do to prevent PAD is to quit smoking.

“Smokers have two to 10 times the risk for developing PAD as compared to someone who does not smoke,” Dr. Khouri said. “At least 80 percent of our PAD cases are smokers or former smokers.”

Dr. Khouri tells his patients to “know your numbers,” namely cholesterol, blood pressure, diabetes (blood glucose) and weight.

Because most cases of PAD are asymptomatic — meaning the disease hasn’t progressed enough to spur a diagnosis — people do not realize they have the disease.

“In a typical case, the symptoms may be intermittent,” Dr. Khouri said. “For instance, the person might say they can walk 100 feet but then their legs get really tired and they have to sit down for 5 or 10 minutes, then they can walk again.”

Other potential signs include numbness in the legs or feet, color changes in the skin on the legs or feet and cold legs or feet.

“If anyone has any of the symptoms, the first thing to do is talk to your primary care physician about these symptoms,” Dr. Khouri explained.

If PAD is suspected, an ultrasound or scan of legs might be a next step.

“If the patient is asymptomatic or the symptoms are mild, the treatment may start with lifestyles changes,” he said. “That would involve eating better, becoming more active, and giving up smoking “

Medications like aspirin or statins can help decrease the risk of progression of the disease and improve overall cardiovascular outcomes.

In cases that are severe, more aggressive treatment is recommended, including some endovascular procedures offered at UPHS-Marquette.

Dr. Khouri said those procedures include taking “a picture” of the artery to get a good look at where the problem is; angioplasty, in which a catheter brings a tiny balloon into the artery and inflates it to remove deposits on the vessel’s wall; or stenting, in which a mesh device is used to keep the artery open.

Other even more advanced techniques are available in more severe cases, including a device that shaves inside the artery to improve circulation or a coated balloon which will help with longterm outcomes with blockage.

Dr. Khouri said if endovascular treatment isn’t a reasonable option, there are surgical procedures available, such as bypasses.

“In the U.P., we could do a better job with prevention and earlier diagnosis,” he said. In many cases patients have advanced PAD by the time they seek medical attention.

“Amputation might be an option in these stages, but that changes a patient’s life drastically,” Dr. Khouri said, adding that depression can become commonplace for amputees.

“We urge patients with any symptoms to see their primary physicians as soon as possible,” Dr. Khouri said. “Please stop smoking as soon as possible, and if you are having trouble quitting, please ask your doctor about treatment options to help you quit”

In hopes of increasing public awareness of the disease, its symptoms and its treatments, Dr. Khouri will be giving several community presentations on PAD in 2019, including January 29th at the Ramada Inn of Marquette. The event is free to the public and reservations can be made by calling toll free 844-411-8747.

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