Peripheral Artery Disease (PAD)

PAD is common, especially after age 65 and in people who smoke or have diabetes. Many people with PAD have no symptoms, so it often goes unnoticed.

• PAD without symptoms: found on an exam or test before you notice anything.
• Claudication: leg pain, cramping or tiredness when walking that goes away within minutes of rest.
• Chronic limb-threatening ischemia: very poor blood flow causing foot pain at rest, sores that won't heal, or dark tissue. This needs prompt care.
• Acute limb ischemia: a sudden blockage, causing a cold, pale, painful leg. This is an emergency.

• Smoking or vaping nicotine (the biggest risk factor)
• Diabetes
• High blood pressure
• High cholesterol
• Age over 65, or over 50 with other risk factors
• Kidney disease
• Heart disease or a past stroke
• Family history of PAD, heart disease or stroke

• Pain, cramping, aching or tiredness in the calf, thigh or buttock when walking or climbing stairs, that eases with rest
• Foot or toe pain at rest, often at night, that feels better when the leg hangs down
• Sores on the toes, feet or legs that heal slowly or not at all
• A cold foot or leg, or one foot colder than the other
• Shiny skin, hair loss on the legs or feet, or slow-growing toenails
• Weak or no pulse in the feet
• Erectile dysfunction in men
• At your visit, your provider checks the pulses in your legs and feet, looks at skin color, temperature and hair, checks for sores between and under the toes, and may listen over the arteries for a whooshing sound.

The main screening test is the ankle-brachial index (ABI). It compares blood pressure at your ankle with blood pressure in your arm. We do the ABI and a screening Doppler (a handheld device that listens to blood flow) in our office.

If the screening shows PAD, or if a procedure might be needed, we refer you to a vascular clinic for confirmation and mapping with a duplex ultrasound or other imaging. We review the results with you.

Lab tests your provider may order include a cholesterol (lipid) panel, an A1C for diabetes, and kidney function tests.

Treatment aims to ease symptoms, protect your legs and lower your risk of heart attack and stroke. Your plan may include:

• Quitting smoking. This is the single most helpful step. We offer quit-smoking medicines and counseling.
• A walking program: walk until the pain is moderate, rest until it fades, then walk again. Over weeks, many people can walk farther with less pain. Supervised exercise programs work best.
• Medicines to lower the risk of clots, such as aspirin or Plavix (clopidogrel).
• A statin to lower cholesterol and stabilize plaque.
• Controlling blood pressure and blood sugar.
• Pletal (cilostazol), which may help some people walk farther.
• Daily foot care: check your feet every day, keep them clean and moisturized, and wear well-fitting shoes.
• Procedures by a vascular specialist, such as angioplasty, stents or bypass surgery, for severe symptoms or poor blood flow.

PAD is long-term, but many people feel better and walk farther with exercise, quitting smoking and medicines.

Treating PAD also lowers the chance of heart attack and stroke. Daily foot care helps prevent serious problems. Results vary.

Your primary care team at Moaddel Medical screens for PAD with an ABI and screening Doppler in our office, treats risk factors like smoking, diabetes, blood pressure and cholesterol, and refers you to a vascular clinic for confirmation, mapping and procedures when needed.

For foot and leg wounds that are slow to heal, Royal Wound Care, part of Moaddel Medical, specializes in chronic, non-healing wounds.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.