Peripheral artery disease

Definition

Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Symptoms

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. Calf pain is the most common location.

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.

Peripheral artery disease symptoms include:

• 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 side
• 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

If peripheral artery disease progresses, pain may even occur when you’re at rest or when you’re lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

When to see a doctor

If you have leg pain, numbness or other symptoms, don’t dismiss them as a normal part of aging. Call your doctor and make an appointment.

Even if you don’t have symptoms of peripheral artery disease, you may need to be screened if you are:

• Over age 70
• Over age 50 and have a history of diabetes or smoking
• Under age 50, but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure

Risk factors

Factors that increase your risk of developing peripheral artery disease include:

• Smoking
• Diabetes
• Obesity (a body mass index over 30)
• High blood pressure (140/90 millimeters of mercury or higher)
• High cholesterol (total blood cholesterol over 240 milligrams per deciliter, or 6.2 millimoles per liter)
• Increasing age, especially after reaching 50 years of age
• A family history of peripheral artery disease, heart disease or stroke
• High levels of homocysteine, a protein component that helps build and maintain tissue

People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow

Tests and diagnosis

Some of the tests your doctor may rely on to diagnose peripheral artery disease are:

• Physical exam. Your doctor may find signs of PAD during a physical examination, such as a weak or absent pulse below a narrowed area of your artery, whooshing sounds (bruits) 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 decreased blood pressure in your affected limb.
• Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm. To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
• Ultrasound. Special ultrasound imaging techniques, such as Doppler ultrasound, can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
• Angiography. By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor is able to trace the flow of the contrast material using imaging techniques, such as X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA). Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in your groin to the affected area and injecting the dye that way. Although invasive, this type of angiography allows for simultaneous diagnosis and treatment — finding the narrowed area of a blood vessel and then widening it with an angioplasty procedure or administering medication to improve blood flow.
• Blood tests. A sample of your blood can be used to measure your cholesterol and triglycerides and to check for diabetes.

Treatments and drugs

Treatment for peripheral artery disease 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 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.

Supervised exercise program

In addition to 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.

Lifestyle and home remedies

Many people can manage the symptoms of peripheral artery disease and stop the progression of the disease through lifestyle changes, especially quitting smoking. To stabilize or improve PAD:

• Stop smoking. Smoking contributes to constriction and damage of your arteries and is a significant risk factor for the development and worsening of PAD. If you smoke, quitting is the most important thing you can do to reduce your risk of complications. If you’re having trouble quitting on your own, ask your doctor about smoking cessation options, including medications to help you quit.
• Exercise. This is a key component. Success in treatment of PAD is often measured by how far you can walk without pain. Proper exercise helps condition your muscles to use oxygen more efficiently. Your doctor can help you develop an appropriate exercise plan. He or she may refer you to a claudication exercise rehabilitation program.
• Eat a healthy diet. A heart-healthy diet low in saturated fat can help control your blood pressure and cholesterol levels, which contribute to atherosclerosis.

Careful foot care

In addition to the above suggestions, take good care of your feet. People with peripheral artery disease, especially those who also have diabetes, are at risk of poor healing of sores on the lower legs and feet. Poor blood circulation can postpone or prevent proper healing and increases the risk of infection. Follow this advice to care for your feet:

• Wash your feet daily, dry them thoroughly and moisturize often to prevent cracks that can lead to infection. Don’t moisturize between the toes, however, as this can encourage fungal growth.
• Wear well-fitting shoes and thick, dry socks.
• Promptly treat any fungal infections of the feet, such as athlete’s foot.
• Take care when trimming your nails.
• Avoid walking barefoot.
• Have a foot doctor (podiatrist) treat bunions, corns or calluses.
• See your doctor at the first sign of a sore or injury to your skin.

Prevention

The best way to prevent claudication is to maintain a healthy lifestyle. That means:

• Quit smoking if you’re a smoker.
• If you have diabetes, keep your blood sugar in good control.
• Exercise regularly. Aim for 30 minutes at least three times a week after you’ve gotten your doctor’s OK.
• Lower your cholesterol and blood pressure levels, if applicable.
• Eat foods that are low in saturated fat.
• Maintain a healthy weight.