Leg Pain while Walking may Signal Clogged Peripheral Arteries
By Michael Lasalandra
Beth Israel Deaconess Medical Center correspondent
Although clogged coronary arteries get most of the publicity, leg arteries can also become blocked, leading to muscle pain and cramping and, occasionally, more serious problems.
The condition is known as Peripheral Artery Disease (PAD) and is a circulation problem in which the arteries in the legs become narrowed or blocked, reducing the amount of oxygen that gets to the limbs.
Leg arteries become blocked in the same way that heart arteries do - by build-up of plaque. Sometimes, people may have both clogged coronary and leg arteries.
PAD is common in people over the age of 50, and is especially problematic in those with diabetes. But most people with the condition don't know they have it, since they don't have symptoms, according to Dr. Allen D. Hamdan, Clinical Director of Vascular and Endovascular Surgery at Beth Israel Deaconess Medical Center's CardioVascular Institute.
"It is estimated that for each patient with symptoms of PAD, there are six more who have no symptoms," he said.
The condition can be detected by a test known as the Ankle-Brachial Index, which compares the blood pressure in the ankle with that of the arm. However, most with the condition don't get such a test unless they are suffering symptoms such as leg or calf pain or muscle cramps when walking or performing other exercise. The pain, which can be debilitating, usually does not occur at rest. In severe cases, ulcers or even gangrene may develop in the legs or feet.
Risk factors for PAD include smoking, high blood pressure, obesity, diabetes, high cholesterol, heart disease or family history. The condition can be treated in the same manner as coronary artery disease - with lifestyle modifications such as quitting smoking, losing weight, increasing exercise, improving diet and keeping blood sugar under control if diabetes is present, according to Dr. Hamdan.
In addition, cholesterol-lowering drugs or blood thinners, such as aspirin, may be prescribed, he says. These medications can help reduce the risk of stroke or heart attack.
"Anything you do for one type of clogged artery is good for any other type," he says.
There is one medication, called cilostazol, that can help patients walk a little further. It inhibits platelet aggregation and is a direct arterial vasodilator. Its main effects are dilation of the arteries supplying blood to the legs and decreasing platelet coagulation. On average, it helps patients walk about 50 to 100 yards further without experiencing pain.
If lifestyle changes, including a structured exercise program, or medications don't reduce the pain, and the pain is so bad that it interferes with a person's daily life, then interventions similar to those used to treat clogged coronary arteries may be used.
One option is angioplasty, with or without a stent. In this procedure, the doctor inserts a long, thin tube or catheter into a small puncture over an artery in the arm or groin. The catheter, which has a balloon at its tip, is guided through the artery to the blocked area. Once in place, the balloon is inflated and pushes the plaque against the artery walls, widening the passageway. Sometimes, a tiny mesh-like tube, called a stent, is inserted into the narrowed area of the artery, keeping it open. Similar to advances in heart artery stents, there are new leg stents that have drugs attached that can improve their results
In severe cases, bypass surgery may be needed. Just like with coronary artery bypass surgery, the surgeon takes a vein from another area of the body and grafts it to the blocked artery, making a new passageway.
But Dr. Hamdan says such interventions — angioplasty, stenting and bypass surgery — are not required for the majority of those with PAD.
"Just because you have a leg artery blockage does not mean you have to get an angioplasty, stent or surgery," he says. "Such procedures are usually done for those with pain so severe they have trouble walking and have not gotten symptom relief through lifestyle modifications or medications."
And those who develop muscle pain and cramping rarely progress to more serious problems such as ulcers or gangrene, Dr. Hamdan says. Still, the condition is not something that should be ignored and may indicate blockages in other arteries to the heart and the brain.
"Someone who is getting reproducible daily pain or muscle cramps while walking should not shrug it off," he says. "People are used to being stoic and think they can simply push through the pain. But there are things we can do to help them. We can reduce the pain and potentially protect other problems such as heart attacks and strokes."
Above content provided by the CardioVascular Institute at Beth Israel Deaconess Medical Center. for advice about your medical care, consult your doctor.
Posted January 2014