When we define Peripheral Artery Disease or PAD, it is not a one-size-fits-all diagnosis. In fact, there are varying levels of severity of PAD, ranging from asymptomatic to complete blockage. Each stage presents with different severity of symptoms (or no symptoms at all), so in this blog, we will discuss what each stage of PAD means. While some classifications, such as the Fontaine system, further delineate the four steps of PAD, this is typically used for clinical purposes and less for discussions with our patients.
Stage 1: Asymptomatic PAD
As the name suggests, patients in this stage have not yet begun to experience symptoms associated with the occlusion of their peripheral arteries. However, whether incidentally or as part of a cardiovascular checkup, atherosclerosis (blockage within the artery) in the extremities has been found. This first stage would be considered catching PAD early and gives us the greatest opportunity to slow or stop the condition’s progression through risk reduction factors such as improved diet and exercise, quitting smoking, and other lifestyle improvements.
Stage 2: Claudication
During stage two, patients will begin to feel discomfort and pain in their lower extremities – most often in their calves. Unlike transient muscle pain or injury, the pain or discomfort can be reproduced every time the patient exercises, and the discomfort typically goes away after rest. This is brought about by a greater degree of occlusion in the peripheral arteries, and it is during this time we may begin to explore potential treatment options. Of course, improvement in lifestyle choices will make a big difference in minimizing the pain and discomfort associated with this stage.
Stage 3: Critical Limb Ischemia
Ischemia is the medical definition of the reduction of blood flow to an area of the body or an organ. During the critical limb ischemia stage, PAD produces pain at rest and even through the night. Skin sores may begin to appear as a result of blood not reaching the extremities, thus not allowing for proper healing. This is a critical stage in the development of PAD and requires urgent care by a cardiologist like Dr. Farrugia, who specializes in peripheral artery diseases. Typically, at this point, if the patient is healthy enough, a minimally invasive procedure known as balloon angioplasty with stenting is almost always performed. A bypass will be required if the occlusion cannot be opened with this minimally invasive procedure.
Stage 4: Acute Limb Ischemia
Acute limb ischemia or ALI involves the sudden loss of blood flow to the extremities causing the limb’s rapid deterioration and ultimately death. Patients who experience ALI will have significant pain along with tingling sensations, loss of pulse, cold in the extremities, the extremity turning pale, and ultimately paralysis. PAD has become an emergency at this point, and without immediate care, there is a significant chance that the limb will require amputation. Even if we can avoid amputation, the lack of blood flow often causes irreparable muscular and nerve damage.
Of course, we hope that patients recognize the symptoms of severe PAD sooner and never reach this level.
Importantly, PAD is very treatable, and any pain in your legs or extremities brought about by exercise or other activity and going away with rest should be evaluated by a qualified PAD specialist. Fortunately, advances in modern cardiology have allowed us to make the treatment for PAD far less invasive than it has ever been.