Peripheral Artery Disease

Peripheral artery disease (PAD), also called peripheral arterial disease, is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs. When someone develops PAD, the extremities – usually your legs – don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits (plaque) in your arteries called atherosclerosis. This condition may be reducing blood flow to your heart and brain, as well as your legs. Often, you can successfully treat peripheral artery disease by exercising, eating a healthy diet and quitting smoking.

 

Symptoms of Peripheral Artery Disease
While many people with PAD have mild or no symptoms, some have leg pain when walking (intermittent claudication). This includes muscle pain or cramping in the legs or arms triggered by activity, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location.

The severity of intermittent claudication varies widely, from mild discomfort to debilitating pain that can make it hard to walk or do other types of physical activity. PAD symptoms include:

  • Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared with the other side
  • Sores on your toes, feet or legs that won't heal
  • A change in the color of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet
  • Erectile dysfunction in men

If peripheral artery disease progresses, pain may even occur when you're at rest or when lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around may temporarily relieve the pain.

 

Causes of Peripheral Artery Disease
Peripheral artery disease is often caused by atherosclerosis; this occurs when fatty deposits (plaques) build up in your artery walls and reduce blood flow.

Although the heart is typically the subject when talking atherosclerosis, this disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease. Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles or radiation exposure.

People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow. Other factors that increase your risk of developing PAD include:

  • Obesity (a body mass index over 30)
  • High blood pressure
  • High cholesterol
  • Increasing age, especially people age 50 or older
  • A family history of peripheral artery disease, heart disease or stroke
  • High levels of homocysteine, a protein that helps build and maintain tissue


Diagnosis of Peripheral Artery Disease

  • Some of the tests and procedures your doctor may use to diagnose PAD include:
  • Physical exam: Your doctor may find signs of PAD such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds (bruits) over your arteries heard with a stethoscope, poor wound healing where your blood flow is restricted and decreased blood pressure in the affected limb.
  • Ankle-brachial index (ABI): This is a common test that compares the blood pressure in your ankle with that in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
  • Ultrasound: Special ultrasound imaging techniques can help your doctor evaluate blood flow and identify blocked or narrowed arteries.
  • Angiography: By injecting a dye into your blood vessels, this test allows your doctor to view blood flow and trace flow of the dye using imaging techniques, such as X-rays, a magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).
  • Catheter angiography (CTA): CTA is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area, then injecting dye. This allows for simultaneous diagnosis and treatment, finding the narrowed area of a blood vessel, then widening it with an angioplasty procedure or using medication to improve blood flow.
  • Blood tests: A blood sample can be used to measure cholesterol, triglycerides and check for diabetes.

 

Treatment of Peripheral Artery Disease
The kind of treatment(s) you may receive depends on the severity of your condition. Possible treatments include:

  • Medical management
  • Peripheral Angioplasty/Catheterization
  • Bypass surgery
  • Thrombolytic therapy


Frequently Asked Questions

 

When should I see a doctor?
If you have leg pain, numbness or other symptoms, don't dismiss them as a normal part of aging. Call your doctor. Even if you don't have symptoms of PAD, you may need to be screened if you are:

  • Over age 70
  • Over age 50, with a history of diabetes or smoking
  • Under age 50, with diabetes and other risk factors, such as obesity or high blood pressure


Is peripheral artery disease serious?
Yes. If the peripheral arteries are narrowed, it’s very likely the arteries leading to the heart and brain are also narrowed. This increases the risk for heart attack and stroke. If blood flow to the legs is severely impacted, complications can arise that eventually lead to amputation.


What can I do to control my Peripheral Artery Disease(PAD)?
Several lifestyle changes can positively impact PAD. One of the best is to embark on a structured walking program. There has also been a link made between smoking and PAD, so if you smoke, quit. Smoking harms your blood vessels and speeds plaque buildup in them. Keep blood pressure and cholesterol under control. High blood pressure can damage the vessel walls and increase plaque buildup, which narrows the opening.


Who is at risk for peripheral artery disease?
The risk for PAD is increased for people over the age of 50 and African Americans . Your risk also increases if you smoke, have diabetes, high blood pressure or high cholesterol, heart disease, have had a heart attack or a stroke.


Why am I at risk if I have diabetes?
Many diabetics may not have feeling in their legs or feet due to nerve disease, so they might not feel pain associated with PAD until it’s in an advanced stage. Also, sores take longer to heal due to decreased blood flow to your legs, which could lead to amputation. If you have diabetes and PAD, it increases your risk of having a stroke or heart attack.


What diseases affect the veins?
Blood clot formation, known as venous thrombosis, is the most common and most threatening disease of the veins. An inflammation of the veins, also called phlebitis, is a painful condition usually caused by infection or injury. The main danger with phlebitis is an increased risk of blood clots being formed. If part of the clot breaks loose and travels to the lung it can lodge in a pulmonary blood vessel, which can potentially be fatal. Varicose veins are a less dangerous condition caused when blood flow is too slow or valves in the veins are damaged. The veins may swell and twist into varicose veins causing pain.