Lewis Gale Physicians October 19, 2017

Peripheral artery disease (PAD) is defined as damage or disease of the arteries outside of the heart and brain. According to the American Heart Association (AHA), PAD affects more than 8.5 million Americans every year, and many are unaware that they have it.

Blood delivers oxygen and nutrients to hardworking organs and tissues through all of the body's arteries. Narrowing of these arteries can interrupt this blood flow, and impair delivery of essential nutrients and oxygen. Impaired blood flow can affect the health of tissue in the arms, legs, and body core. Severe interruptions in blood flow can cause functional problems, such as cramping or fatigue with minor activity. Prolonged, untreated PAD can lead to serious complications such as death of affected tissue, serious infection, and amputation.

Causes

PAD is usually caused by a gradual buildup of plaque called atherosclerosis, also described as deposits of fatty material in the arteries of the legs. Other causes include:

  • Blood clots or embolisms.
  • Congenital heart disease.
  • Inflammation of the blood vessels (vasculitis).

PAD can be hereditary. You also may get PAD if you are overweight or obese, or have hypertension, diabetes, or high cholesterol. Unhealthy lifestyle choices such as smoking, eating a high-fat diet, and not getting enough exercise can lead to PAD.

Risk Factors

PAD is more common in men and in people over 50 years old. Other factors that increase your chance of developing PAD include:

  • Family history.
  • Diabetes.
  • Smoking.
  • High blood pressure or family history of high blood pressure.
  • Stroke or family history of stroke.
  • High cholesterol or family history of high cholesterol.

Symptoms

Symptoms of PAD are related to the organ or part of the body deprived of blood, including:

  • Pain, fatigue, aching, tightness, weakness, cramping or tingling in the leg(s) brought on by exercise that goes away when resting.
  • Numbness and pain of the legs or feet at rest.
  • Cold hands, legs, or feet.
  • Loss of hair on the legs and/or feet.
  • Paleness or blueness of the legs and/or feet.
  • Weak or absent pulse in the leg.
  • Sores, ulcer, or infection of the feet and legs that heal slowly.
  • Erectile dysfunction.
  • Swelling in lower extremities.
  • Muscle atrophy.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam and testing will be done to measure the strength of the pulse in the leg arteries, listen for a whooshing sound in the leg arteries or abdomen, and to check blood pressure. Related tests may include:

  • Ankle-brachial index (ABI): a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. Normally, ankle pressure is at least 90 percent of arm pressure, but with severe narrowing it may be less than 50 percent. 
  • Doppler and Ultrasound (Duplex) imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage. 
     
  • Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.  
     
  • Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays. 
     
  • Angiography:  During an angiogram, also called an arteriogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present.

Treatment Options

Early treatment can slow or stop the disease and include:

Lifestyle Changes

  • Smoking cessation.
  • Diabetes control.
  • Blood pressure control.
  • Increased physical activity—such as a walking program.
  • Weight loss, if overweight.
  • Low-saturated fat, low-cholesterol diet.
  • Foot care, which is especially important for people with diabetes:
    • Shoes that fit properly.
    • Proper treatment of all foot injuries—healing is slowed when circulation is poor, so the risk of infection is higher.

Medication

The following medications may be prescribed:

  • Blood thinners to reduce blood clots.
  • Pain medication.
  • Statins to lower cholesterol.
  • Vasodilators to widen arteries.

Invasive Procedures

  • Balloon angioplasty — a balloon is inflated in the artery to stretch it.
  • Stent implant— a wire mesh tube is placed in the artery; the stent expands and stays in place, keeping the artery open.
  • Laser treatment.
  • Atherectomy — a tube called a catheter is used to remove plaque inside a blood vessel.

Surgery

Surgery to open up narrowed arteries is performed in severe cases:

  • Endarterectomy—the lining of the artery is removed, along with plaque build up.
  • Bypass surgery—a vein from another part of the body or a synthetic graft replaces the vessel.

Prevention

General guidelines to prevent PAD include lifestyle changes, smoking cessation, and adhering to any treatment plans for other health conditions. If PAD goes untreated, it can lead to an increased risk of coronary artery disease, stroke, heart attack, or loss of a leg. Early diagnosis is key to achieving the most successful outcome. Because people with PAD are at increased risk for heart attack and stroke, the American Heart Association encourages people at risk to discuss PAD with their healthcare professional to ensure early diagnosis and treatment.

Sources:

American Heart Association: www.heart.org

National Institutes of Health: www.nhlbi.nih.gov