Peripheral Artery Disease
Peripheral artery disease (PAD) affects an estimated eight to 12 million Americans. PAD, a circulation problem in which narrowed arteries reduce blood flow to your limbs, can increase the risk of stroke and heart attack. PAD may cause pain and sores, and potentially lead to loss of limb(s).
Peripheral Artery Disease Symptoms and Diagnosis
The most common cause of PAD is atherosclerosis (hardening of the arteries), which occurs when plaque builds up in your artery walls and reduces blood flow. PAD increases your risk of coronary artery disease, heart attack and stroke.
Peripheral artery disease can affect the arteries of the:
- Legs (PAD of the legs)
- Neck (carotid artery disease)
- Kidneys (renal artery disease)
- Large and small intestines (mesenteric artery disease)
Other forms of PAD can affect the veins, causing varicose veins, and the aorta, which may lead to development of abdominal aortic aneurysm.
You may not notice any symptoms from PAD initially. The most common symptom is leg pain while walking, known as intermittent claudication (IC):
- Muscle pain, heaviness, tightness or cramping in your legs brought on by walking and relieved by stopping
- Typically occurs after walking a certain distance
- Location of the pain or discomfort depends on the location of the clogged or narrowed artery
- Calf pain is very common
- When IC is severe, walking may be difficult even at short distances
If PAD progresses, pain may even occur when you are at rest (rest pain) and may be intense enough to disrupt sleep. Typically rest pain occurs in the feet, especially the toes. You may find that you need to dangle your feet down to relieve the pain.
Other signs and symptoms of peripheral artery disease include:
- Leg numbness or weakness
- Coldness in your lower leg or foot, with one leg or foot colder than the other
- Sores on your toes, feet or legs that won't heal
- A pale or blue color to your legs
- Weak or absent pulses in the legs
- Hair loss on your feet and legs
- Change in your toenails
- Erectile dysfunction in men
The major risk factors for PAD include:
- Smoking: the greatest risk factor for PAD. If you smoke or have a history of smoking, your risk of PAD is at least four times higher than a non-smoker. Additionally, smokers who develop PAD also start showing symptoms much sooner than non-smokers with PAD.
- Age: an estimated 12 to 20 percent of those over age 65 have PAD
Other risk factors for PAD include:
- High blood pressure
- High cholesterol
- Heart disease
- Family history of PAD
- Race: African Americans are also more than twice as likely as Caucasians to have PAD
If you have leg pain, difficulty walking, foot numbness or other symptoms, don't dismiss these as normal signs of aging: call your doctor. Early diagnosis and treatment of PAD is important to not only preserve the health of your legs, but also to reduce your risk of heart disease and stroke.
Your doctor can diagnose peripheral artery disease through a physical exam and one or more of these tests:
- Ankle-brachial index, which compares your blood pressure in your arm and your ankle.
- A treadmill test, which helps compare blood flow in your limbs before and after exercise.
- Doppler ultrasound, which can detect blockages in your blood vessels.
- Magnetic resonance angiogram (MRA)
- Angiography and/or CT angiography
- Blood tests to check your cholesterol, homocysteine and C-reactive protein levels.
Peripheral Artery Disease Treatment at BIDMC
The main goals of treating PAD are to:
- Reduce your symptoms
- Improve your quality of life
- Prevent further complications
Lifestyle changes that can help manage symptoms of PAD include:
- Quitting smoking
- Lowering blood pressure and cholesterol
- Treating diabetes
- Exercising regularly (check with your doctor before beginning an exercise program)
- Eating a healthy diet
Your doctor may also prescribe medication to treat conditions that worsen or complicate PAD, including:
- Cholesterol-lowering drugs
- Blood pressure medications
- Medications to control blood sugar if you have diabetes
- Aspirin to reduce the possibility of blood clots
- Drugs to help relieve symptoms may also be prescribed, such as medication to increase blood flow to the limbs
If you have PAD, and particularly if you have diabetes, you may be at risk for developing sores on your lower legs and feet. Poor blood circulation can interfere with proper healing, increasing the risk of infection. To prevent this, you should:
- Shower to wash your feet daily
- Moisturize your feet daily to prevent cracks that can lead to infection
- Wear shoes that fit well and socks that are thick and dry
- Promptly treat fungal infections, such as athlete's foot
- Avoid walking barefoot and soaking your feet
If lifestyle changes and/or medications aren't enough to improve more severe PAD symptoms, your doctor may recommend angioplasty, or angioplasty with stenting, a minimally invasive procedure that uses a catheter to push plaque away from your artery walls and possibly insert a stent to keep an artery open.
Bypass surgery, or revascularization, may be recommended, depending on the severity of the blockage in your artery. During bypass surgery, a vein from another part of your body is used to create a bypass around the blocked area.
Endarterectomy is another surgical procedure option, in which diseased material is removed from the inside of the artery to restore normal blood flow to the leg or arm.