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Peripheral artery disease (PAD) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.
When you have peripheral artery disease (PAD), the blood flow to your legs or arms — usually your legs — is insufficient to keep up with demand. This may result in symptoms such as leg pain while walking (claudication).
Peripheral artery disease is also a sign of fatty deposit buildup in your arteries (atherosclerosis). This condition can cause artery narrowing and reduce blood flow to your legs and, in rare cases, your arms.
Exercise, a healthy diet, and quitting tobacco in any form are often effective ways to treat peripheral artery disease.
WHAT ARE THE SYMPTOMS OF PAD?
While many people with peripheral artery disease have no or only mild symptoms, some experience leg pain while walking (claudication).
Claudication symptoms include muscle pain or cramping in your legs or arms that is triggered by activity but goes away after a few minutes of rest. The location of the pain is determined by the clogged or narrowed artery. The most common location is calf pain.
The severity of claudication ranges from mild discomfort to incapacitating pain. Severe claudication can make it difficult to walk or engage in other forms of physical activity.
The following are signs and symptoms of peripheral artery disease:
- Cramping in one or both hips, thighs, or calf muscles after performing certain activities, such as walking or climbing stairs
- Numbness or weakness in the legs
- Coldness in your lower leg or foot, particularly when compared to the opposite side
- Slower growth of your toes
- Legs with gleaming skin
- Your legs or feet have no or a weak pulse.
- Unhealing wounds on your toes, feet, or legs
- A difference in the color of your legs
- On your feet and legs, you may experience hair loss or slower hair growth.
- Male erectile dysfunction
- Aching and cramping in your arms when knitting, writing, or performing other manual tasks
Pain may occur even when you are at rest or lying down if peripheral artery disease progresses. It may be intense enough to interfere with sleep. Walking around your room or hanging your legs over the edge of your bed may provide temporary relief.
WHAT ARE THE CAUSES OF PAD?
Atherosclerosis is a common cause of peripheral artery disease. Fatty deposits on your artery walls cause atherosclerosis, which reduces blood flow.
Although most discussions of atherosclerosis center on the heart, the disease can and often does affect arteries throughout the body. It causes peripheral artery disease when it occurs in the arteries that supply blood to your limbs.
Peripheral artery disease can also be caused by blood vessel inflammation, limb injury, unusual ligament or muscle anatomy, or radiation exposure.
WHAT ARE THE RISK FACTORS FOR PAD?
The following factors increase your chances of developing peripheral artery disease:
- Smoking
- Diabetes
- Obesity (a body mass index over 30)
- Hypertension
- High cholesterol levels
- Growing older, especially after the age of 65 or 50 if you have atherosclerosis risk factors
- A history of peripheral artery disease, heart disease, or stroke in the family
- Homocysteine levels are high, which is an amino acid that helps your body make protein and build and maintain tissue.
People who smoke or have diabetes are more likely to develop peripheral artery disease due to decreased blood flow.
WHAT ARE THE COMPLICATIONS OF PAD?
If your peripheral artery disease is caused by plaque buildup in your blood vessels, you may also develop:
- Critical limb ischemia: This condition starts with open wounds that don't heal, an injury, or an infection in your feet or legs. When injuries or infections progress and cause tissue death, critical limb ischemia occurs, sometimes necessitating amputation of the affected limb.
- Heart attack and stroke: The atherosclerosis that causes peripheral artery disease symptoms is not limited to your legs. Fat deposits can also form in the arteries that supply blood to your heart and brain.
HOW IS PAD DIAGNOSED?
Your doctor may use the following tests to diagnose peripheral artery disease:
- Physical exam: During a physical exam, your doctor may detect signs of PAD such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and low blood pressure in your affected limb.
- ABI (ankle-brachial index): This is a common test for determining PAD. It compares your ankle blood pressure to your arm blood pressure.
Your doctor will use a standard blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow to obtain a blood pressure reading.
You can walk on a treadmill and have readings taken before and after exercise to determine the severity of the narrowed arteries.
- Blood tests: A blood sample can be used to measure your cholesterol and triglycerides as well as to screen for diabetes.
- Ultrasound: Doppler ultrasound, for example, can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
- Angiography: This test, which uses a dye injected into your blood vessels, allows your doctor to see blood flow through your arteries as it happens. Your doctor can use imaging techniques such as X-rays, magnetic resonance angiography (MRA), or computerized tomography angiography to track the dye's flow.
Catheter angiography is an invasive procedure that involves inserting a small hollow tube (catheter) into an artery in your groin and injecting dye into the affected area. This type of angiography enables your doctor to treat a blocked blood vessel while it is still being diagnosed. Once your doctor has identified the narrowed area of a blood vessel, he or she can widen it by inserting and expanding a tiny balloon or by administering medication that improves blood flow.
WHAT ARE THE TREATMENTS FOR PAD?
The treatment of peripheral artery disease has two major objectives:
- Manage symptoms like leg pain so you can return to physical activities.
- Reduce your risk of heart attack and stroke by halting the progression of atherosclerosis throughout your body.
These objectives may be achievable through lifestyle changes, particularly early in the course of peripheral artery disease. If you smoke, quitting is the single most important thing you can do to lower your risk of complications. Walking or doing other exercise on a regular basis according to a schedule, known as supervised exercise training, can significantly improve your symptoms.
If you have signs or symptoms of peripheral artery disease, you will almost certainly require additional medical attention. Your doctor may advise you to take medication to prevent blood clots, lower blood pressure and cholesterol, and manage pain and other symptoms.
Medications
- Medication for lowering cholesterol: To reduce your risk of heart attack and stroke, you may take a cholesterol-lowering medication known as a statin.
Lowering low-density lipoprotein (LDL) cholesterol, or "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL) or 2.6 millimoles per liter (mmol/L) is the goal for people with peripheral artery disease. If you have additional major risk factors for heart attack and stroke, such as diabetes or continued smoking, the goal is even lower.
- Medications to prevent blood clots: Because peripheral artery disease is associated with decreased blood flow to your limbs, it is critical to increase that flow.
Your doctor may advise you to take aspirin every day or to take another medication, such as clopidogrel (Plavix).
- Medications for symptom relief: Cilostazol boosts blood flow to the limbs by keeping the blood thin and widening the blood vessels. It is especially useful in treating leg pain in people with peripheral artery disease. Headache and diarrhea are common side effects of this medication.
Pentoxifylline is an alternative to cilostazol (Pentoxil). This medication has few side effects, but it does not work as well as cilostazol.
- Medication for high blood pressure: If you have high blood pressure, your doctor may prescribe medication to help you control it.
Your treatment goal for blood pressure should be less than 130/80 millimeters of mercury (mm Hg). This is the recommendation for anyone suffering from coronary artery disease, diabetes, or chronic kidney disease. Aiming for 130/80 mm Hg is also the goal for healthy adults 65 and older, as well as healthy adults younger than 65 who have a 10% or higher risk of developing cardiovascular disease in the next ten years.
- Blood sugar control medication: Controlling your blood sugar levels becomes even more important if you have diabetes. Discuss your blood sugar goals with your doctor, as well as the steps you need to take to achieve them.
Surgery and angioplasty
In some cases, angioplasty or surgery may be required to treat claudication caused by peripheral artery disease:
- Angioplasty: A catheter is threaded through a blood vessel to the affected artery during this procedure. A small balloon at the catheter's tip is inflated to flatten the plaque into the artery wall and reopen the artery while stretching the artery open to increase blood flow.
In order to keep the artery open, your doctor may place a mesh tube (stent) in it. This is the same technique used by doctors to open heart arteries.
- Bypass surgery: Your doctor may use a blood vessel from another part of your body or a synthetic vessel to create a path around the blocked artery. Blood is able to bypass the blocked or narrowed artery using this technique.
- Thrombolytic treatment: If a blood clot is blocking an artery, your doctor may inject a clot-dissolving drug into the artery at the clot's location to break it up.
Supervised exercise program
To increase the distance you can walk pain-free, your doctor will most likely prescribe a supervised exercise training program. Regular exercise improves PAD symptoms in a variety of ways, including assisting your body in using oxygen more efficiently.
HOME REMEDIES FOR PAD
Many people can manage the symptoms of peripheral artery disease and halt its progression by making lifestyle changes, particularly quitting smoking. To maintain or improve PAD:
- Maintain a healthy diet: A heart-healthy, low-saturated-fat diet can help control your blood pressure and cholesterol levels, lowering your risk of atherosclerosis.
- Quit smoking: Smoking causes artery constriction and damage and is a significant risk factor for the development and worsening of PAD. If you smoke, the most important thing you can do to reduce your risk of complications is to quit.
If you're having trouble quitting on your own, talk to your doctor about smoking cessation options, such as medications.
- Exercise: This is a critical component. How far you can walk without pain is often used to measure success in the treatment of PAD. Exercise prepares your muscles to use oxygen more efficiently.
Your doctor can assist you in developing an appropriate exercise program. He or she may recommend a claudication exercise rehabilitation program to you.
- Certain cold medications should be avoided: Cold medications containing pseudoephedrine (Advil Cold & Sinus, Aleve-D Sinus & Cold, and others) constrict your blood vessels and may worsen your PAD symptoms.
Careful foot care
In addition to the lifestyle changes mentioned above, take good care of your feet. People with PAD, particularly those who also have diabetes, are at risk of having sores and injuries on their lower legs and feet heal slowly.
Poor blood flow can delay or prevent proper healing while also increasing the risk of infection. To care for your feet, follow this advice:
- Wash your feet daily, thoroughly dry them, and moisturize frequently to avoid cracks that can lead to infection. However, do not moisturize between the toes as this can promote fungal growth.
- Wear comfortable shoes and thick, dry socks.
- Treat any fungal infections of the feet, such as athlete's foot, as soon as possible.
- When trimming your nails, use caution.
- Inspect your feet for injuries on a daily basis.
- Allow a foot doctor to treat bunions, corns, and calluses.
- Consult your doctor at the first sign of a skin sore or injury.