Peripheral Arterial Disease
What is Peripheral (leg) Artery Disease?
PAD is a disease of the arteries of the legs. It is common, affecting 20% of people over the age of 65. When blood vessels in the legs become narrowed or blocked with fatty deposits (atherosclerosis or hardening of the arteries) circulation to the legs and feet is obstructed.
Decreased blood flow can cause pain, numbness and cramping. Many people may have symptoms, but fail to appreciate that they have PAD. When the blockage is severe, it can cause tissue death or gangrene, which can lead to amputation of the affected limbs. If you experience cramping in your buttocks, thighs or calves after a short walk, this is a good indication that you have PAD.
Atherosclerosis affects the entire body. People with PAD are 3 times more likely to die of heart attacks and strokes than people without PAD. Slow or blocked blood flow may also cause blood clots and raise the risk of poor healing and infection. One out of three people with diabetes older than age 50, has PAD.
What are the symptoms of PAD?
Many people have no symptoms. The primary symptom of PAD is intermittent claudication. This is leg pain, fatigue or cramping when walking and/or climbing stairs that recedes after a short rest. Claudication is leg pain including numbness, aching or heaviness in leg muscles, and cramping in the legs, buttocks, thighs, calves and feet, and cold feet or lower legs. Intermittent means the pain goes away when you rest. You may also develop sores on your feet and legs that won’t heal. Pain in your toes or feet while you are resting may signal an advanced case of PAD.
- Poor toenail growth and decreased hair growth on the legs
- Erectile dysfunction
- Toes and feet have a bluish color indicating a loss of blood flow
Risk factors for PAD
- Diabetes and smoking together create the highest risk for PAD complications
- High blood pressure, high blood cholesterol, heart disease, stroke and metabolic syndrome – the name for a group of risk factors that raise the risk of heart disease and other health problems, are all risk factors for PAD.
What Causes PAD?
The primary cause is atherosclerosis or hardening of the arteries. Smoking, high blood pressure, diabetes, kidney failure, obesity and high cholesterol can damage the lining of the arteries. When the body senses damage, it attempts to heal the damage by causing plaque to build up and eventually rupture, causing a blood clot to form at the site. The buildup of plaque and blood clots narrows the arteries and limits blood flow.
Who is at risk?
- Age is a significant risk factor. If you are aged 70, or 50 with a history of smoking and diabetes you are at high risk.
A test called ankle brachial index (ABI) is a test that compares the blood pressure in your ankle with the blood pressure in your arm. If the pressure in your ankle is lower than in your arm, you may have PAD. You may also be tested for diabetes. Other tests like ultrasound and MRI will reveal blockages and confirm the diagnosis.
The goal of treatment is to slow or stop the progression of the disease, and reduce the risk of complications. PAD is commonly treated with aggressive management of risk factors with lifestyle changes and medication. If that fails to improve PAD, surgery must be considered.
1. Pain medications to reduce leg pain
- Medications for high cholesterol and high blood pressure
- Anti-clotting medications, like aspirin, inhibit blood clots and can increase your walking distance
2. Lifestyle changes to control PAD
- Controlling your risk factors can prevent or delay PAD and its complications. Studies have shown that walking and other routine physical activity can treat and prevent PAD. Quitting smoking, losing weight and eating healthy can improve the symptoms of PAD.
- Angioplasty with a stent: This procedure helps to widen the artery and keep it open to prevent blockages in the artery.
- Atherectomy: This procedure removes the plaque buildup.
- Artery bypass graft: When blood flow is nearly or completely blocked to your legs, bypass surgery with a graft, allows blood to bypass the blockage and restore blood flow to affected limb.
Treatment of the underlying disease, atherosclerosis, can slow or stop the progress of the disease and reduce the risk of complications. When lifestyle changes fail or PAD symptoms get worse, minimally invasive procedures can improve your quality of life and reduce the risk for related diseases.
The board certified vascular specialists at South Valley Vascular in Visalia, Porterville and Hanford, California specialize in diseases of the arteries and veins. When facing blood vessels problems, you can trust us with your care or that of a loved one. Give us a call to schedule a consultation, meet our experts, get your questions answered, be sure you have a correct diagnosis and receive top quality care.
Need more information on Peripheral Arterial Disease? Visit the Society for Vascular Surgery’s Patient Resources section here.