September is PAD Awareness Month – So What?

By Robert Crawford, M.D.
Assistant Professor of Surgery

Everyone asks, “what is PAD?” September is as good a time as any to explain.

PAD stands for Peripheral Arterial Disease — sort of a mouthful, so we stick with PAD. It is a condition that affects the arteries that bring blood to your lower extremities. These arteries become blocked with plaque (cholesterol) and become hardened, and this reduces blood flow to the legs. PAD produces pain in the legs caused by poor circulation, and in more severe cases it can lead to gangrene and loss of the limb. Depending on the stage of the disease at presentation, the most devastating consequence, if left untreated, is amputation.

It’s worth knowing about because PAD is quite common and can cause you to lose your legs, but yet it’s often preventable through lifestyle changes. Close to 10 million Americans are affected, including one-third of the population over age 70.

Consider this: the five year risk of death of patients with PAD is greater than that of a patient with breast cancer. Additionally, having PAD places patients at increased risk of having other serious problems, such as heart attacks.

Significant risk factors include smoking, hypertension, high cholesterol and diabetes. In fact, the prevalence of PAD is in some cases double that of non-diabetics. PAD is more common in aging populations and African Americans.

Sounds very dramatic –- loss of limbs? –- and it is. But there’s hope. PAD is a chronic progressive disease, which means it gets worse over time. But depending on the  stage at presentation, PAD can be treated to reduce your chances of losing a limb to amputation. Here are the most common treatments we deploy to treat PAD:

  1. Stopping smoking
  2. Better diet and nutrition
  3. Effective management of diabetes, hypertension and high cholesterol
  4. Working with your doctor to establish a prescription intervention plan with aspirin or
    anti-cholesterol medications
  5. A regimented exercise program
  6. Minimally invasive surgical intervention
  7. Open surgical intervention

And that’s where I come in. Surgery should be a last stop for the treatment of PAD, but if it has to happen, it’s important to come to the experts who are skilled in treating the most severe cases of this disease every day.

The Division of Vascular Surgery at the University of Maryland Medical Center is made up of a team of physicians who specialize in the treatment of PAD. Because of our role as a premier academic institution, our patients get the benefit of having an entire top-notch team, not just an individual doctor, caring for you. The vascular doctors at UMMC received quality training in open and endovascular
surgical techniques. Our involvement in clinical trials grants us access to the latest technology used for PAD therapy. Most importantly, we take great pride in providing the best care for you from the moment you walk through our doors.

As a final note, understand that at least half of the patients with PAD don’t have any obvious symptoms. If you have any of the risk factors listed above, call our Vascular team or your physician and ask for a PAD screening

If you’re like the other half of patients with PAD, you will likely experience some of the following symptoms:

    1. Claudication: This refers to pain in the calves when walking. It is commonly described as a cramping pain that starts after a variable distance (“Doc…my legs hurt after I walk for about one block”). This pain will get better when patients stop walking. Some patients can have a more atypical type of pain, such as pain in the hips or thighs (“Doc…when I walk my legs just so get very tired…I have to stop”). This too will get better when walking stops.
    2. Rest pain: This symptom typically represents a more severe form of the disease. Patients will get pain in the legs, typically the top part of the foot at night. This pain can be so bad that it can wake patients up from sleep and gets better with movement or dangling the leg from the side of the bed.
    3.  Ulceration: Patients can develop sores in their feet. Sometimes this happens after minor trauma, such as a simple scrape or clipping of toe nails. These ulcers tend to not heal, a clear sign that blood flow is impaired.
    4. Gangrene: This is a consequence of severe PAD. Essentially the tissues die because of a lack of blood flow and oxygen. This can lead to surgical amputation if left untreated..

If we can be of any help, call 410-328-5840 for our Vascular team or e-mail us at


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