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Peripheral Artery Disease

Peripheral artery disease (PAD) is a condition that approximately 8.5 million people live with.

PAD is a condition where the peripheral arteries in the body become narrowed. The peripheral arteries serve the stomach, head, legs and arms. PAD most often affects the leg’s arteries.

Atherosclerosis is the most common cause of PAD. This happens when plaques form in the artery walls. This results in the flow of blood through the affected arteries decreasing. Other possible causes of PAD that are less common include injury to the limbs, radiation exposure, blood vessel inflammation, and abnormal ligament or muscle anatomy.

There are also risk factors that can make someone’s chances of developing PAD higher. These include:

  • Diabetes
  • High blood pressure
  • Being older than age 50
  • High homocysteine levels in the body
  • Smoking
  • Obesity
  • High cholesterol
  • Family history of heart disease, PAD, or stroke
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Symptoms

For many people, this condition does not cause any symptoms, especially in the early stages. When symptoms occur, claudication is possible. This issue is characterized by painful cramping in the thighs, lower legs, and hips when moving around. Other symptoms may include:
  • Leg weakness or numbness
  • Sores that are not healing on the legs, toes, or feet
  • Toenails grow slowly
  • Foot or lower leg is cold
  • Slowed hair growth on the legs or feet, or hair loss
  • Leg skin has a shiny appearance
  • Leg color changes
  • Feet or legs have a weakened or absent pulse
  • Men may experience erectile dysfunction
Some cases of PAD are caused by atherosclerosis, an issue where plaque accumulates in the blood vessels. When atherosclerosis is the cause, it’s possible that the patient could experience stroke, heart attack, or critical limb ischemia.

Diagnosis

The doctor will usually start by doing an examination of the feet and legs to look for the visible symptoms of PAD. During this examination, the doctor will examine and listen to the arteries and pulse points to determine of there are any whooshing sounds. This is done with a stethoscope. Any leg or foot wounds can be examined to determine if healing is too slow. Blood testing might also be done to look at blood sugar and cholesterol levels. The doctor may perform an ankle-brachial index test. For this test, the doctor will check a patient’s blood pressure using their arm and their ankle. They will look to see the difference between both readings. Doppler ultrasound can be performed. This test will look at how blood is flowing through the blood vessels. It can help the doctor to see any narrowing or blockages. Angiography involves injecting a dye into the blood vessels. The dye makes it easier for the doctor to examine blood flow. Once the dye is injected, imaging is performed.
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Treatment involves working to stop atherosclerosis progression and alleviate a person’s symptoms so that they can be active. There are certain medications that can be prescribed for PAD:
  • Medications to reduce blood pressure for people who have hypertension
  • Cholesterol-lowering drugs
  • Medications to reduce the risk of blood clots
  • Blood sugar control medications
  • Medication to increase how much blood flows to the extremities
There are certain surgical procedures that might be considered if medications and conservative treatments are not effective. These may include:
  • Bypass surgery helps to bypass the flow of blood around an area in a vessel that is blocked or significantly narrowed
  • Angioplasty can be done to help open up a vessel. A stent is often inserted after opening the vessel to help keep it open
  • Thrombolytic therapy involves injecting a drug that can dissolve blood clots into the artery to help break it up

There are ways to reduce the risk of developing PAD. These methods are relatively easy and involve living a healthy lifestyle. Prevention methods include:

  • Not smoking
  • Exercising for 30 to 45 minutes at least three days per week
  • Eating foods low in saturated fat
  • Controlling blood sugar (for patients with diabetes)
  • Achieving and maintaining healthy levels of blood pressure and cholesterol
  • Staying at a healthy weight

Left untreated, PAD puts people at risk for gangrene and the potential need for amputation. Those who suspect that they have this condition should not hesitate to make an appointment with their doctor. The diagnostic process is not extensive and there are viable treatments that can help people to live comfortably and reduce the risk of complications.

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