PERIPHERAL ARTERY DISEASE
Peripheral artery disease (PAD) is a narrowing of the peripheral arteries to the legs, stomach, arms, and head – most commonly in the arteries of the legs. PAD is similar to coronary artery disease (CAD).
Both PAD and CAD are caused by atherosclerosis that narrows and blocks arteries in various critical regions of the body.
Why does peripheral artery disease matter?
Peripheral artery disease happens when fatty deposits build up in arteries outside the heart, usually the arteries supplying fresh oxygen and blood to the arms, legs, and feet.
Is PAD dangerous or life threatening?
Yes, PAD is dangerous because these blockages can restrict circulation to the limbs, organs and brain. Without adequate blood flow, vital organs, legs, arms, feet, and your brain, suffer damage. Left untreated, the tissue can die or harbor infection such as gangrene.
Does PAD cause additional health problems?
PAD may be the first warning sign of atherosclerosis – chronic fatty deposit build-ups – throughout your arteries. The whole circulatory system, including your heart and brain, are at risk when arteries are blocked and narrowed. Fatty deposits also increase the risk for vascular inflammation and blood clots that can block the blood supply and cause tissue death.
PAD is potentially a life-threatening condition that can be managed or even reversed with proper care.
People who smoke and/or have diabetes are at especially high risk. If you have risk factors for PAD, get screened for PAD, even if you’re not having symptoms.
PAD risk factors you can control
Certain risk factors for PAD can’t be controlled. These uncontrollable risk factors include aging, personal or family history of PAD, cardiovascular disease or stroke. However, you can control the following risk factors:
- Cigarette smoking – You can stop smoking. Smoking is a major risk factor for PAD. Smokers may have four times the risk of PAD than nonsmokers. Our guide to quitting smoking can help you.
- Obesity – You can reduce your weight. People with a Body Mass Index (BMI) of 25 or higher are more likely to develop heart disease and stroke even if they have no other risk factors. Calculate your BMI and learn healthy ways to manage your weight.
- Diabetes mellitus – You can manage diabetes and blood sugar levels. Having diabetes puts you at greater risk of developing PAD as well as other cardiovascular diseases. Learn more about the risks and how to manage diabetes.
- Physical inactivity – You can get moving. Physical activity increases the distance that people with PAD can walk without pain and also helps decrease the risk of heart attack or stroke. Supervised exercise programs are one of the treatments for PAD patients.
- High blood cholesterol – You can manage your cholesterol levels. High cholesterol contributes to the build-up of plaque in the arteries, which can significantly reduce the blood’s flow. This condition is known as atherosclerosis. Managing your cholesterol levels is essential to prevent or treat PAD.
- High blood pressure – You can manage your blood pressure. It’s sometimes called “the silent killer” because it has no symptoms. Work with your healthcare professionals to monitor and control your blood pressure.
You can choose more than one target to improve! Taking care of only one risk factor is not as effective as taking care of all those that you can control. Learn the facts. Develop a heart-healthy lifestyle and cooperate with your healthcare professionals. Your heart will thank you by functioning better and lasting longer.
Symptoms and Diagnosis of PAD
The most common symptom of peripheral artery disease (PAD) in the lower extremities is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs, or exercising.
The pain of PAD often goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow (View an animation of blood flow). Resting muscles can get by with less.
If there’s a blood-flow blockage due to plaque build-up, 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.
Many people with PAD have no symptoms or mistake their symptoms for something else.
Symptoms of severe PAD include:
- Leg pain that does not go away when you stop exercising
- Foot or toe wounds that won’t heal or heal very slowly
- Gangrene
- A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body
Understanding leg pain
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 healthcare professional and describe the pain as accurately as you can. If you have any of the risk factors for PAD, you should ask your healthcare professional about PAD even if you aren’t having symptoms.
Diagnosing PAD
PAD diagnosis begins with a physical examination.
Your healthcare provider will check for weak pulses in the legs. Your physical examination may include the following:
- Ankle-brachial index (ABI): a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.
If an ABI reveals an abnormal ratio between the blood pressure of the ankle and arm, you may need more testing. Your doctor may recommend one of these other tests.
- Doppler and Ultrasound (Duplex) imaging: a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
- Computed Tomographic Angiography (CT): a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents.
- Magnetic Resonance Angiography (MRA): a non-invasive test that gives information similar to that of a CT without using X-rays.
- Angiography: (generally reserved for use in conjunction with vascular treatment procedures) During an angiogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present. Learn more about peripheral angiogram.
As stated earlier, PAD often goes undiagnosed. Untreated PAD can be dangerous because it can lead to painful symptoms or loss of a leg, and patients with PAD have an increased risk of coronary artery disease, stroke and heart attack. Because people with PAD have this increased risk for heart attack and stroke, the American Heart Association encourages people at risk to discuss PAD with their healthcare professional to ensure early diagnosis and treatment.
Prevention and Treatment of PAD
Treatment for PAD focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow the progression or even reverse the symptoms of PAD
For further information on the treatment and care of PAD, please visit us or refer to the American Heart Association’s guidelines for treatment and care of PAD: http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Prevention-and-Treatment-of-PAD_UCM_301308_Article.jsp#.VrDOnRgrK2w
