Peripheral Arterial Disease

The cause of PAD is atherosclerosis. This happens when plaque builds up on the walls of the arteries that supply blood to the arms and legs. Plaque is a substance made up of fat and cholesterol. It causes the arteries to narrow or become blocked. This can reduce or stop blood flow, usually to the legs. If severe enough, blocked blood flow can cause tissue death and can sometimes lead to amputation of the foot or leg.

The main risk factor for PAD is smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, heart disease, and stroke.

Many people who have PAD don’t have any symptoms.

IF YOU HAVE SYMPTOMS, THEY MAY INCLUDE

• Pain, numbness, achiness, or heaviness in the leg muscles. This happens when walking or climbing stairs.
• Weak or absent pulses in the legs or feet
• Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all
• A pale or bluish color to the skin
• A lower temperature in one leg than the other leg
• Poor nail growth on the toes and decreased hair growth on the legs
• Erectile dysfunction, especially among men who have diabetes

PAD can increase your risk of heart attack, stroke, and transient ischemic attack.

Doctors diagnose PAD with a physical exam and heart and imaging tests. Treatments include lifestyle changes, medicines, and sometimes surgery. Lifestyle changes include dietary changes, exercise, and efforts to lower high cholesterol levels and high blood pressure.

Prevention

Taking action to control your risk factors can help prevent or delay peripheral artery disease (PAD) and its complications. Know your family history of health problems related to PAD. If you or someone in your family has the disease, be sure to tell your doctor.

CONTROLLING RISK FACTORS INCLUDES THE FOLLOWING

• Be physically active.
• Be screened for PAD. A simple office test, called an ankle-brachial index or ABI, can help determine whether you have PAD
• Follow heart-healthy eating.
• If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
• If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.

The lifestyle changes described above can reduce your risk of developing PAD. These changes also can help prevent and control conditions that can be associated with PAD. such as coronary heart disease, diabetes, high blood pressure, high blood cholesterol, and stroke.

Risk Factors

Peripheral artery disease (PAD) affects millions of people in the United States. The disease is more common in blacks than any other racial or ethnic group. The major risk factors for PAD are smoking, older age, and having certain diseases or conditions.

SMOKING

Smoking is the main risk factor for PAD and your risk increases if you smoke or have a history of smoking. Quitting smoking slows the progress of PAD. People who smoke and people who have diabetes are at highest risk for PAD complications, such as gangrene, or tissue death, in the leg from decreased blood flow.

OLDER AGE

Older age also is a risk factor for PAD. Plaque builds up in your arteries as you age. Older age combined with other risk factors, such as smoking or diabetes, also puts you at higher risk for PAD.

DISEASES AND CONDITIONS

MANY DISEASES AND CONDITIONS CAN RAISE YOUR RISK OF PAD, INCLUDING:

• Diabetes
• High blood pressure
• High blood cholesterol
• Coronary heart disease
• Stroke
• Metabolic syndrome

Causes

The most common cause of peripheral artery disease (PAD) is atherosclerosis. Atherosclerosis is a disease in which plaque builds up in your arteries. The exact cause of atherosclerosis isn’t known.

The disease may start if certain factors damage the inner layers of the arteries.

THESE FACTORS INCLUDE:

• Smoking
• High amounts of certain fats and cholesterol in the blood
• High blood pressure
• High amounts of sugar in the blood due to insulin resistance or diabetes

When damage occurs, your body starts a healing process. The healing may cause plaque to build up where the arteries are damaged.

Eventually, a section of plaque can rupture, causing a blood clot to form at the site. The buildup of plaque or blood clots can severely narrow or block the arteries and limit the flow of oxygen-rich blood to your body.

Symptoms

Many people who have peripheral artery disease (PAD) don’t have any signs or symptoms.

Even if you don’t have signs or symptoms, ask your doctor whether you should get checked for PAD if you’re:

• Aged 70 or older
• Aged 50 or older and have a history of smoking or diabetes
• Younger than 50 and have diabetes and one or more risk factors for atherosclerosis

INTERMITTENT CLAUDICATION

People who have PAD may have symptoms when walking or climbing stairs, which may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms also may include cramping in the affected leg(s) and in the buttocks, thighs, calves, and feet. Symptoms may ease after resting. These symptoms are called intermittent claudication.

During physical activity, your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won’t get enough blood, which will lead to symptoms. When resting, the muscles need less blood flow, so the symptoms will go away.

OTHER SIGNS AND SYMPTOMS OF PAD INCLUDE:

• Weak or absent pulses in the legs or feet
• Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all
• A pale or bluish color to the skin
• A lower temperature in one leg compared to the other leg
• Poor nail growth on the toes and decreased hair growth on the legs
• Erectile dysfunction, especially among men who have diabetes

Diagnosis

Peripheral artery disease (PAD) is diagnosed based on your medical and family histories, a physical exam, and test results.

PAD often is diagnosed after symptoms are reported. A correct diagnosis is important because people who have PAD. are at higher risk for coronary heart disease (CHD), heart attack, stroke, and transient ischemic attack. If you have PAD, your doctor also may want to check for signs of these diseases and conditions.

MEDICAL AND FAMILY HISTORIES

Your doctor may ask:

• Whether you have any risk factors for PAD For example, he or she may ask whether you smoke or have diabetes.
• About your symptoms, including any symptoms that occur when walking, exercising, sitting, standing, or climbing.
• About your diet.
• About any medicines you take, including prescription and over-the-counter medicines.
• Whether anyone in your family has a history of heart or blood vessel diseases.

PHYSICAL EXAM

During the physical exam, your doctor will look for signs of PAD. He or she may check the blood flow in your legs or feet to see whether you have weak or absent pulses.

Your doctor also may check the pulses in your leg arteries for an abnormal whooshing sound called a bruit. He or she can hear this sound with a stethoscope. A bruit may be a warning sign of a narrowed or blocked artery.

Your doctor may compare blood pressure between your limbs to see whether the pressure is lower in the affected limb. He or she also may check for poor wound healing or any changes in your hair, skin, or nails that may be signs of PAD.

DIAGNOSTIC TESTS

A simple test called an ankle-brachial index (ABI) often is used to diagnose PAD. The ABI compares blood pressure in your ankle to blood pressure in your arm. This test shows how well blood is flowing in your limbs.

A treadmill test can show the severity of symptoms and the level of exercise that brings them on. You’ll walk on a treadmill for this test. This shows whether you have any problems during normal walking.

You may have an ABI test before and after the treadmill test. This will help compare blood flow in your arms and legs before and after exercise.

Your doctor may recommend blood tests to check for PAD risk factors. For example, blood tests can help diagnose conditions such as diabetes and high blood cholesterol.

Treatment

Treatments for peripheral artery disease (PAD) include lifestyle changes, medicines, and surgery or procedures.

Treatment may slow or stop the progression of the disease and reduce the risk of complications. Without treatment, PAD may progress, resulting in serious tissue damage in the form of sores or gangrene, tissue death. due to inadequate blood flow. In extreme cases of PAD, also referred to as critical limb ischemia (CLI), removal (amputation) of part of the leg or foot may be necessary.

TREATMENT OFTEN INCLUDES MAKING LONG-LASTING LIFESTYLE CHANGES, SUCH AS:

• Physical activity
• Quitting smoking
• Heart-healthy eating

PHYSICAL ACTIVITY

Routine physical activity can improve PAD symptoms and lower many risk factors for atherosclerosis, including LDL (“bad”) cholesterol, high blood pressure, and excess weight. Exercise can improve the distances you can comfortably walk.

QUITTING SMOKING

If you smoke, quit. Smoking raises your risk for PAD. Smoking also raises your risk for other diseases, such as coronary heart disease and heart attack, and worsens other coronary heart disease risk factors.

HEART-HEALTHY EATING

Your doctor may recommend heart-healthy eating to treat atherosclerosis, the most common cause of PAD. Following heart-healthy eating can help control blood pressure and cholesterol levels, which can lead to atherosclerosis.

MEDICINES

Your doctor may prescribe medicines to:

• Prevent blood clots from forming due to low blood flow with anticlotting medicines, such as aspirin.
• Treat unhealthy cholesterol levels with statins. Statins control or lower blood cholesterol. By lowering your blood cholesterol level, you can decrease your chance of developing complications from PAD.
• Treat high blood pressure with one of many high blood pressure medicines.
• Help ease leg pain that occurs when you walk or climb stairs.
• Reduce the symptoms of intermittent claudication, measured by increased walking distance with certain platelet-aggregation inhibitors.

SURGERY OR PROCEDURES

Your doctor may recommend bypass-grafting surgery if blood flow in your limb is blocked or nearly blocked.

Your doctor may recommend angioplasty to restore blood flow through a narrowed or blocked artery.

Atherectomy is a procedure that removes plaque buildup from an artery. During the procedure, a catheter is used to insert a small cutting device into the blocked artery. The device is used to shave or cut off plaque.

Recovery

If you have peripheral artery disease (PAD), you’re more likely to also have coronary heart disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”). However, you can take steps to treat and control PAD and lower your risk for these other conditions.

LIVING WITH PERIPHERAL ARTERY DISEASE SYMPTOMS

If you have PAD, you may feel pain in your calf or thigh muscles after walking. Try to take a break and allow the pain to ease before walking again. Over time, this may increase the distance that you can walk without pain.

Talk with your doctor about taking part in a supervised exercise program. This type of program has been shown to reduce PAD symptoms.

Check your feet and toes regularly for sores or possible infections. Wear comfortable shoes that fit well. Maintain good foot hygiene and have professional medical treatment for corns, bunions, or calluses.