Peripheral arterial disease (P.A.D.) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.
When plaque builds up in the body's arteries, the condition is called atherosclerosis. Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.
P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This post focuses on P.A.D. that affects blood flow to the legs.If severe enough, blocked blood flow can cause tissue death. If this condition is left untreated, a foot or leg may need to be amputated.
Signs and Symptoms of PAD.
While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (intermittent claudication).
Intermittent claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by 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, from mild discomfort to debilitating pain. Severe intermittent claudication can make it hard for you to walk or do other types of physical activity.
Classical Symptoms of PAD:
Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs (intermittent claudication)
- Leg numbness or weakness
- Coldness in your lower leg or foot, especially when compared with the other leg
- Sores on your toes, feet or legs that won't heal
- A change in the color of your legs
- Hair loss or slower hair growth on your feet and legs
- Slower growth of your toenails
- Shiny skin on your legs
- No pulse or a weak pulse in your legs or feet
- Erectile dysfunction in men
Also note that the pain of PAD usually goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow. Resting muscles can get by with less. If there's a blood-flow blockage due to plaque buildup, the muscles won't get enough blood during exercise to meet the needs. The "crampy" pain (called "intermittent claudication"), when caused by PAD, is the muscles' way of warning the body that it isn't receiving enough blood during exercise to meet the increased demand.
Please also note that many people with PAD may have no symptoms or may mistake their symptoms for something else.
Risk factors for PAD
An individual is at risk for developing PAD when one or more of these risk factors are present:
- Obesity(a body mass index over 30)
- History of heart or blood vessel disease: A personal or family history of heart or blood vessel disease may be an indicator for PAD
- High blood pressure (hypertension)
- High cholesterol (hyperlipidemia)
- Excess levels of homocysteine, a protein component that helps build and maintain tissue
Diagnosis and Tests.
First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. As part of your history and exam, your physician will ask you if you smoke or have high blood pressure. Your physician will also want to know when your symptoms occur and how often. As part of the physical exam, your physician will conduct pulse tests, which measure the strength of your pulse in arteries behind your knees and feet.
After your exam, if your physician suspects peripheral artery disease, he or she may perform tests, such as:
Ankle-brachial index (ABI), which compares the blood pressure in your arms and legs
Blood tests for cholesterol or other markers for artery disease
To better understand the extent of your leg artery disease, your physician may also recommend duplex ultrasound, pulse volume recording, magnetic resonance angiography (MRA), or angiography.
Duplex ultrasound uses high-frequency sound waves to measure real-time blood flow and detect blockages or other abnormalities in the structure of your blood vessels
Pulse volume recording measures the volume of blood at various points in the legs using an arm blood pressure cuff and a Doppler probe
Magnetic resonance angiography (MRA) uses magnetic fields and radio waves to show blockages inside your arteries
Computed tomographic angiography (CTA) uses specialized CT scans and contrast dye to show blockages inside your arteries
Angiography, which produces x ray pictures of the blood vessels in your legs using a contrast dye to highlight your arteries
Physicians usually reserve angiography for people with more severe forms of leg artery disease.
Treatment of PAD
Lifestyle changes, medications and interventional procedures are the treatments available for PAD.
Lifestyle Changes. Initial treatment of PAD includes making lifestyle changes to reduce your risk factors.
Changes you can make to manage your condition include:
Quit smoking. Ask your doctor about smoking cessation programs available in your community.
Eat a balanced diet that is high in fiber and low in cholesterol, fat and sodium. Limit fat to 30 percent of your total daily calories. Saturated fat should account for no more than 7 percent of your total calories. Avoid trans fats including products made with partially-hydrogenated and hydrogenated vegetable oils. If you are overweight, losing weight will help you lower your total cholesterol and raise your HDL (good) cholesterol. A registered dietitian can help you make the right dietary changes.
Exercise. Begin a regular exercise program, such as walking. Walking is very important and can aid the treatment of PAD. Patients who walk regularly can expect a marked improvement in the distance they are able to walk before experiencing leg pain.
Manage other health conditions, such as high blood pressure, diabetes or high cholesterol.
Practice good foot and skin care to prevent infection and reduce the risk of complications.
Medications may be recommended to treat conditions such as high blood pressure (anti- hypertensive medications) or high cholesterol (statin medications).
An antiplatelet medication such as aspirin or clopidogrel (Plavix) may be prescribed to reduce the risk of heart attack and stroke.
Cilostazol (Pletal) may be prescribed to improve walking distance. This medication has been shown to help people with intermittent claudication exercise longer before they develop leg pain and to walk longer before they must stop because of the pain. However, not all patients are eligible to take this medication. Your doctor will tell you if you are eligible.
Interventional procedures. More advanced PAD can be treated with interventional procedures such as angioplasty (to widen or clear the blocked vessel), angioplasty with stent placement (to support the cleared vessel and keep it open), or atherectomy (to remove the blockage).
In some cases,surgical procedures such as peripheral artery bypass surgery may be performed to reroute blood flow around the blood vessel blockage.
Many people dismiss leg pain as a normal sign of aging. You may think it's arthritis, sciatica or just "stiffness" from getting older. For an accurate diagnosis, consider the source of your pain. PAD leg pain occurs in the muscles, not the joints.
Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that is a burning or painful discomfort of the feet or thighs. If you're having any kind of recurring pain, talk to your doctor and describe the pain as accurately as you can. If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren't having symptoms.