The technological advances in Peripheral Artery Disease treatment that save limbs and lives every day are truly a culmination of science and art where highly trained vascular specialists apply knowledge, a caring heart, and skillful hands. Unfortunately, PAD is still very much so a silent killer making Modern Vascular’s endeavors to drive awareness, education, and tailored treatment options that much more important. Early detection is integral for intervention and amputation prevention.
How to know when to refer?
As clinicians, the focus is on our responsibility to heal our patients, through observation, analysis, and care plans. Knowing when it is time to refer a patient to other providers who specialize in PAD treatment can be a judgment call. Many patients have high-risk factors but there are no showing symptoms. Risk factors include diabetes, hypertension, age, and early detection is vital for treatment. It is customary for patients with diabetes to get their feet checked every time they see their doctor, but more patients should be checked for discoloration on the foot, and also take a pulse of the foot. By carefully examining the foot, PCPs, Podiatrists, Endocrinologists and others can more definitely know which patients would benefit from consulting with a PAD specialist.
Here are 5 Symptoms that should be referred immediately:
PAD with Neuropathic Pain
Neuropathy, otherwise known as peripheral neuropathy, is a result of damage to the peripheral nerves located outside of the brain and spinal cord. This damage causes weakness, numbness and pain, usually in the hands and feet, also affecting other areas and body functions including digestion, urination and circulation.
Both Neuropathy and PAD affect the lower extremities, which sometimes results in mistaking one for the other. They can both be present at the time there are a few outlying symptoms that set them apart; they include1:
Cramps in the thigh, calf, ankle, buttocks, or foot
- Difficulty climbing stairs
- Fatigue in the legs or achiness
- Slow or non-healing wounds on the leg, angle, or foot
- Temperature of one leg is cooler than the other
- Leg hair loss or poor toenail growth
- Numbness or weakness in the legs
- Pain that stops at rest
- Paleness or blueness in one or both legs
Neuropathy can occur when there are vascular disorders, in other words, when blood flow to the arms and legs is decreased or slowed by inflammation, blood clots, or other blood vessel disorders. Decreased blood flow deprives the nerve cells of oxygen, causing nerve damage or nerve cell death. Vascular problems can be caused by vasculitis, smoking and diabetes.
PAD with Claudication
Claudication is pain in the thigh, calf, or buttocks that happens when you walk may be a symptom of peripheral artery disease (PAD).2
At first, claudication pain occurs when you walk a certain distance and goes away when you rest. But as PAD gets worse, the pain can occur when you walk shorter distances. Over time, you may no longer be able to walk because the pain is so severe.
Claudication is linked to health conditions that also increase your risk for heart attack or stroke, PAD with claudication should be checked for and then treated for by a vascular specialist who can address the artery disease in other parts of the body.
PAD with Rest Pain
More serious than Claudication is a symptom of PAD known as rest pain. When the arterial blockages are so severe that muscles aren’t getting enough oxygen while at rest. Foot pain is the most common signal. At first, it’s most troublesome when the leg is elevated, particularly in bed at night.
The earliest and most common symptom is called intermittent claudication followed by Rest Pain. Patients usually experience it as a cramp-like muscular discomfort, but PAD can also produce numbness, tingling, weakness, or fatigue.3
People with mild blockages can walk substantial distances before the symptoms set in, but patients with severe PAD may experience distress in just a few yards. Whether mild or severe it is recommended to refer to a vascular specialist to for a guided walking program or a endovascular intervention.
PAD with Gangrene
Gangrene happens when blood supply to certain tissues is stopped. This can happen due to4:
- Injury (burns, infected dog bite, or combat wound)
Diabetes, PAD, or other chronic diseases that harm the circulatory system such as Raynaud disease, can lead to gangrene if they are severe and not under control.
If the patient’s gangrene is caused by poor blood flow, it may time to recommend your patient for vascular surgery to improve circulation. For instance, when gangrene is a result of a blocked artery, the patient may have bypass surgery or an angioplasty to address the condition.
Wounds that Won’t Heal
Chronic or nonhealing wounds and ulcers are caused by blockages in the arteries (arterial ulcers) and the result of a loss of sensation, often seen in patients with diabetes (neuropathic foot ulcers). Patients with underlying PAD and chronic wounds are at a higher rate of amputation. Referring to a PAD Specialist will help prevent serious complications in the early stages, helping to identify and treat both the PAD as well as other factors which may be impacting wound healing. Patients with underlying PAD are at increased risk of developing non-healing wounds and ulcers and have a higher rate of amputation. Therefore, it is important for people that have PAD to seek out wound care. Here are some common wounds that occur in patients with Peripheral Artery Disease.
Modern Vascular is not only diligent in early detection and treatment of PAD, but focused on amputation prevention. Consider referring your patients to us for minimally invasive vascular solutions.
We return your patients ready to heal.
To learn more about Modern Vascular to answer your PAD-related problems, or to find a clinic near you to refer to a refer a patient you can call (888) 853-1278 or use the online form at modernvascular.com/referring-doctors to request a consultation with a Patient Advocate.
Is it peripheral neuropathy or pad? Is it Peripheral Neuropathy or PAD?: Vein and Vascular Solutions NYC: Board Certified Vascular and Interventional Radiologists. (n.d.). Retrieved April 19, 2022, from https://www.vascularsolutionsnyc.com/blog/is-it-peripheral-neuropathy-or-pad
Mayo Foundation for Medical Education and Research. (2022, March 2). Claudication. Mayo Clinic. Retrieved March 24, 2022, from https://www.mayoclinic.org/diseases-conditions/claudication/symptoms-causes/syc-20370952
Rest pain. Coastal Vascular Center. (2022, January 31). Retrieved March 24, 2022, from https://coastalvascular.net/peripheral-arterial-disease-pad/rest-pain/
Gangrene is a symptom of pad – stand against amputation. Take a Stand Against Amputation. (2021, December 30). Retrieved April 19, 2022, from https://standagainstamputation.com/symptoms-of-pad/gangrene/
Pad awareness month: Take off your socks at your next doctor’s appointment! PAD Awareness Month: Take Off Your Socks at Your Next Doctor’s Appointment! | Iredell Health System – Statesville, NC. (2021, September 27). Retrieved March 24, 2022, from https://www.iredellhealth.org/news/releases/pad-awareness-month-take-off-your-socks-at-your-next-doctor-s-appointment/
Treatment strategies for patients with peripheral artery disease (PAD). Treatment Strategies for Patients With Peripheral Artery Disease (PAD) | Effective Health Care (EHC) Program. (n.d.). Retrieved April 15, 2022, from https://effectivehealthcare.ahrq.gov/products/peripheral-artery-disease-treatment/research-protocol