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List of All Topics
Peripheral Arterial Disease
Introduction
Peripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce the blood flow to your limbs.
When you develop peripheral arterial disease, your extremities — usually your legs — don't get enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking — a condition called intermittent claudication.
Of perhaps greater concern is that peripheral arterial disease is likely to be a sign of widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain as well.
Strictly speaking, peripheral arterial disease refers to a problem with any of the arteries outside, or peripheral to, your heart, but the term is commonly used to describe circulatory problems in your limbs or pelvis.
You can often successfully treat peripheral arterial disease with exercise, with a healthy diet and, most important, by quitting smoking if you smoke. Early diagnosis and treatment are important to stop the progression of peripheral arterial disease and give you a leg up on reducing your risk of heart disease and stroke.
Signs And Symptoms
About half of people with peripheral arterial disease have mild or no symptoms. About one-third to one-half develop more severe symptoms, including intermittent claudication.
Intermittent claudication is characterized by muscle pain or cramping in your legs or arms that is triggered by a certain amount of activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common.
The severity of intermittent claudication varies widely. Pain from this condition can range from mildly bothersome to debilitating. Severe intermittent claudication can impair your ability to function and engage in any physical activity.
Other signs and symptoms of peripheral arterial disease include:
- Leg numbness or weakness.
- Cold legs or feet.
- Sores on your toes, feet or legs that won't heal.
- A change in the color of your legs.
- Hair loss on your feet and legs.
- Changes in your nails.
Causes
The most common cause of peripheral arterial disease is atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up in your artery walls and reduce blood flow.
Although the heart is usually the focus of discussion of atherosclerosis, the disease can and usually does affect arteries throughout your body. When it affects the arteries that supply blood to your heart muscle, it can cause chest pain (angina) and sometimes a heart attack. When it occurs in the arteries in your neck and brain, it can cause a stroke. And when it occurs in the arteries supplying blood to your limbs, it causes peripheral arterial disease.
Less commonly, the cause of PAD may be blood clots in your arteries, injury to your limbs, unusual anatomy of your ligaments or muscles, or infection.
Treatment
Treatment for PAD has two major goals. The first is to manage symptoms, such as leg pain, so that you can resume physical activities. The second is to stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke.
You may be able to accomplish these goals with lifestyle changes. If you smoke, quitting is the single most important thing you can do to reduce the progression of the blockage and reduce your risk of complications.
If lifestyle changes are not enough, you need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
Medications
- Cholesterol-lowering medications. You may take a cholesterol-lowering drug called a statin to reduce your risk factor for heart attack and stroke. The goal for people who have peripheral arterial disease is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL). The goal is even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.
- High blood pressure medications. If you also have high blood pressure, your doctor may prescribe medications to lower it such as beta blockers or ACE inhibitors. The goal of this therapy is to reduce your systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mm Hg) and your diastolic blood pressure (the bottom number) to 90 mm Hg or lower. If you have diabetes, the blood pressure targets are even lower.
- Medication to control blood sugar. If you also have diabetes, it becomes even more important to control your blood sugar (glucose) levels.
- Medications to prevent blood clots. Because peripheral arterial disease is related to reduced blood flow to your limbs, it's important to reduce your risk of blood clots. A blood clot can completely block an already narrowed blood vessel and cause tissue death. Your doctor may prescribe daily aspirin therapy or another medication that helps prevent blood clots, such as clopidogrel (Plavix).
- Symptom-relief medications. The drug cilostazol (Pletal) increases blood flow to the limbs both by preventing blood clots and by widening the blood vessels. It specifically helps the symptom of claudication, leg pain, for people who have peripheral arterial disease. An alternative to cilostazol is pentoxifylline; however, it's less effective.
In some cases, angioplasty or surgery may be necessary to treat peripheral arterial disease that is causing intermittent claudication:
- Angioplasty. In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on its tip is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. In some cases, a mesh framework called a stent is deployed and left in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.
- Bypass surgery. Your doctor may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.
- Thrombolytic therapy. If you have a blood clot blocking an artery, your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up.
In addition to, or in place of, medications or surgery, your doctor may prescribe a supervised exercise training program to increase the distance you can walk pain-free.
Regular exercise improves symptoms of PAD by a number of methods, including helping your body use oxygen more efficiently. Studies have shown that exercise therapy improves the ability to walk without pain as well as surgical treatment or angioplasty does. It's the most effective treatment for the symptom of intermittent claudication.
Information obtained from National Institute of Health