Peripheral Artery Disease
What is peripheral artery disease?
Peripheral artery disease (PAD) is a circulatory condition. Peripheral arterial disease is another name for PAD. Arterial means relating to an artery or arteries. Arteries carry oxygenated blood to the body’s tissues. Peripheral means it affects the arteries outside the aorta, most commonly the vessels supplying the legs. However, it can also involve arteries that supply the arms, abdomen, kidneys, and other vital organs. Peripheral artery disease causes narrowing or blockages in the peripheral arteries.
Atherosclerosis is the most common cause of PAD. Atherosclerosis is a buildup of plaque on the walls of the arteries. Plaque is a waxy material containing cholesterol and other substances. As it grows on the artery walls, it stiffens the artery and narrows the passage through the artery. This limits blood flow. Without adequate blood flow, tissues can’t get the oxygen and nutrients they need. Atherosclerosis is also the cause of coronary artery disease (CAD), which affects even smaller arteries supplying the heart muscle.
PAD is a fairly common problem. More than 8 million Americans over age 40 have the disease, but many don’t know it. That’s because the disease is often mild, causing few or no symptoms in the beginning. As the disease progresses, the tissues struggle to work without enough oxygenated blood. This causes symptoms, including claudication—pain or burning in the calf, thigh, hip or buttock with walking. Other lower limb symptoms can include weakness, coolness, cramping and sores that don’t heal.
Like CAD, lifestyle factors play a role in the development of PAD, which affects men and women equally. Smoking and having diabetes are major risk factors for PAD.
Peripheral artery disease treatment focuses on managing symptoms and preventing atherosclerosis from getting worse. Early on, lifestyle changes may be all that is necessary to reach these goals. As the disease progresses, it may require medications to relieve symptoms and prevent complications. In some cases, doctors may recommend surgery.
If you have PAD, it’s important to follow all of your doctor’s recommendations. Without proper treatment, PAD can have limb- or life-threatening consequences. This includes limb ischemia leading to gangrene and heart attack or stroke. Seek immediate medical care (call 911) for potentially serious symptoms, such as chest pain, difficulty breathing, a cold limb, or sudden paralysis, difficulty speaking, or one-sided face drooping.
What are the symptoms of peripheral artery disease?
Peripheral artery disease of the legs is the most common form of PAD. However, many people with the disease may not realize they have it because symptoms are mild or absent. As PAD progresses, symptoms tend to become more noticeable and problematic. Symptoms are the result of a lack of oxygenated blood perfusing the tissues of the leg.
Common symptoms of peripheral artery disease
The classic symptom of PAD is claudication, which is pain, cramping or burning in the calf, thigh, hip or buttock with walking or climbing stairs. However, up to 40% of people with PAD do not have this symptom. When it occurs, claudication pain typically starts after walking a certain distance, as muscles demand more oxygen. The pain improves with rest, as the muscles require less oxygen.
Claudication can range from mild to severe. Some people describe mild cases as a heaviness in the legs or feeling like the legs are about to give out. In severe cases, the pain can occur with little to no activity. You may hear it called intermittent claudication because the pain comes and goes.
Other common PAD symptoms in the legs include:
- Hair loss and slowed hair and toenail growth
- Pale or cool lower leg or foot
- Smooth, shiny, discolored or mottled skin
- Ulcers or sores on the toes, feet or legs that don’t heal
- Weak or absent pulses in the feet or legs
- Weakness or numbness
Men with PAD may also experience ED (erectile dysfunction).
Serious symptoms that might indicate a life-threatening condition
In some cases, PAD can lead to serious complications that threaten life or limb. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms including:
- Claudication at rest, which could indicate critical limb ischemia and lead to gangrene
- Sudden loss of feeling, paralysis, coldness or blueness in one foot, which could indicate acute limb ischemia
- Symptoms of a heart attack, including chest pain and difficulty breathing, along with dizziness, sweating, anxiety or fainting
- Symptoms of a stroke, including sudden vision changes, confusion, disorientation, trouble speaking or understanding speech, or one-sided numbness, weakness, paralysis, or face drooping
Reaching a peripheral artery disease diagnosis can be difficult. People often mistake early symptoms for other things or ignore mild symptoms. Regular medical care can help identify people at risk of the disease and screen them for potential problems. Screening may assist doctors in finding the condition before symptoms develop.
What causes peripheral artery disease?
The most common cause of PAD is atherosclerosis—or hardening of the arteries. It occurs when plaque deposits and accumulates on the walls of arteries, causing stiffness and narrowing. Plaque contains cholesterol and other substances, such as calcium.
The result of plaque buildup is decreased blood flow through the arteries, which deprives tissues of oxygen and nutrients. PAD symptoms are the result of this inadequate blood flow to the muscles and tissues in the legs.
Less common causes of PAD include injury, inflammation, abnormal anatomy, and radiation exposure.
What are the risk factors for peripheral artery disease?
The main risk factor for PAD is being a current or former smoker. Smoking introduces toxins that damage the lining of arteries, causing inflammation. This inflammation makes the artery walls more prone to plaque buildup. The other major risk factor is having diabetes. Even borderline high blood sugar can cause damage to artery walls, leading to plaque formation. Most people with PAD have one or both of these risk factors.
Other risk factors for PAD include:
- African American
- Age older than 60 years
- Family history of PAD, heart disease, or stroke
- High blood pressure or high cholesterol
Reducing your risk of peripheral artery disease
Controlling risk factors is the key to reducing your risk of PAD. Although not all risk factors are modifiable, many are under your control. You may be able to lower your risk of peripheral artery disease by:
- Eating a heart-healthy diet, including foods low in saturated fats
- Getting regular physical exercise several times a week
- Keeping your blood sugar in the recommended range if you have diabetes
- Lowering your blood pressure and cholesterol levels if necessary
- Maintaining a healthy body weight
- Stopping smoking
Talk with your doctor about your risk of PAD. Even without symptoms, your doctor may recommend screening if you are 65 years or older. If you have risk factors, screening may be necessary at age 50 or even younger.
How is peripheral artery disease treated?
The two PAD treatment goals are managing symptoms and stopping the progression of atherosclerosis. When PAD is mild, you may be able to accomplish these goals with lifestyle changes. These are the same recommendations for preventing PAD, including stopping smoking, leading a heart-healthy lifestyle, and controlling chronic diseases like diabetes.
If you have claudication or other symptoms, your doctor may recommend medications to reach the treatment goals. This may include:
- Anticoagulants or antiplatelet drugs to prevent blood clots, such as a daily aspirin or prescription medicine, such as clopidogrel (Plavix)
- Cholesterol-lowering medicines, such as statins
- Diabetes medicines to lower blood sugar levels
- High blood pressure medicines, such as ACE (angiotensin converting enzyme) inhibitors
- Medicines to increase blood flow in the limbs, such as cilostazol (Pletal) or pentoxifylline (Trental)
In some cases, surgery is necessary to relieve severe claudication symptoms. This may include:
- Angioplasty and stenting, which is a catheter-based procedure to open the narrowed artery and hold it open with a mesh device
- Bypass surgery using a graft to create a new path around the blockage for blood to flow
If a clot develops in a leg with PAD, thrombolytic therapy may be necessary to dissolve it. This involves using a clot-busting drug.
What are the potential complications of peripheral artery disease?
PAD can lead to serious complications that can threaten your limb and your life. This includes:
- Acute limb ischemia, which is a sudden drop in blood supply to a limb requiring emergency medical treatment to avoid amputation
- Critical limb ischemia, which is a chronic lack of blood flow leading to gangrene and possibly amputation of the limb
- Heart attack or stroke
The risk of complications increases if you continue to smoke or have uncontrolled blood sugar levels. Following your treatment plan is the best way to prevent future problems. If you have PAD, talk with your doctor and learn about the warning signs of complications and what to do about them.