Peripheral Arterial Disease

According to the American Heart Association , the most common symptom of peripheral arterial disease (PAD) is painful muscle cramping in the calves, thighs, buttocks, and feet. This is called intermittent claudication, and occurs during exercise when your muscles need increased blood flow. If your blood vessels are narrowed or blocked, your muscles won't receive the blood it needs, which then triggers the painful, cramping symptom. The pain typically disappears after a few minutes of rest.

Intermittent claudication affects around 10% of those with PAD. Most people with PAD have no symptoms or often mistake their symptoms for something else. However, other signs and symptoms of PAD can include:

• Leg numbness or weakness
• Sores or wounds on your toes, feet, or legs that heal slowly, poorly, or not at all
• A pale or bluish color to your skin
• Coldness in your leg or foot, especially when compared to the other side
• Slower growth of your toenails
• Hair loss or decreased hair growth on your legs
• Weak or absent pulses in your legs or feet
• Shiny skin on your legs
• Erectile dysfunction, especially among men who have diabetes

Don’t dismiss leg pain, numbness or other symptoms as a normal part of aging. See your doctor to find out what the cause of your complications.

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

PAD is often caused by atherosclerosis, or hardening of the arteries, which occurs when fatty deposits build up, forming a substance called plaque inside the arteries. This is a very serious condition. The clogged arteries restrict blood flow to your extremities, usually the legs, which can result in pain when walking, and eventually gangrene and amputation.

Because atherosclerosis affects the body as a whole, individuals with PAD are likely to have blocked arteries in other areas of the body. This means that those with PAD are at increased risk for heart disease and stroke. PAD can also indicate the presence of other conditions, such as diabetes and hypertension.

Those who are at highest risk for PAD are:

• Over age 50
• Smokers
• Diabetic
• Overweight
• Inactive
• Have high blood pressure, high cholesterol or diabetes
• Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke

After evaluating your medical and family histories, some of the tests your doctor may use to diagnose peripheral arterial disease (PAD) are:

• Physical exam: During the physical exam, your doctor will check the blood flow in your legs or feet to see whether you have weak or absent pulses. He or she may also compare blood pressure between your limbs to determine whether the pressure is lower in the affected limb. The physical exam might also involve checking for poor wound healing or any changes in your hair, skin, or nails that may be indicate PAD.
• Blood tests: Your doctor may recommend blood tests to check for PAD risk factors, such as diabetes and high blood cholesterol.
• Ankle-brachial index (ABI): The Royal Australian College of General Practitioners states that ankle-brachial index measurement should be the initial diagnostic tool used to identify PAD. It compares the blood pressure in your ankle with the blood pressure in your arm to show how well blood is flowing in your limbs. ABI can confirm whether PAD is affecting your limbs, but it won't reveal which blood vessels are narrowed or blocked.
• Ultrasound: Special ultrasound imaging techniques, such as Doppler ultrasound, can identify blocked or narrowed arteries and show the severity of PAD.
• Angiography: By injecting a dye 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 computed tomography angiography (CTA). 

Treatment for peripheral arterial disease (PAD) aims to manage your symptoms and reduce your risk of heart attack or stroke. Your treatment plan will take into account your symptoms, risk factors, and the results from your diagnostic exams. Treatment options include lifestyle changes, medicines, and surgery or procedures.

• Lifestyle changes: Long-lasting lifestyle changes, such as quitting smoking, exercising regularly and lowering your blood pressure can alleviate symptoms and prevent further progression of the disease. According to Mayo Clinic , quitting smoking is the single most important thing you can do to reduce your risk of complications.
• Medicines: If lifestyle changes are not enough, your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms. Some common types of medications include:
  • Medications to prevent blood clots: As PAD already causes reduced blood flow to your limbs, it's important to minimise 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).
  • Cholesterol-lowering medications: Your doctor may recommend a cholesterol-lowering drug called a statin to reduce your risk of heart attack and stroke.
  • High blood pressure medications: If you also have high blood pressure, your doctor may prescribe medications to lower it.
  • Symptom-relief medications: Some medications, such as cilostazol (Pletal), can be taken to reduce leg pain and other symptoms of PAD. It works by preventing blood clots and by widening the blood vessels to increase blood flow to the limbs.
• Surgery or procedure: Some cases may require surgery or other procedures to treat PAD:
  • Angioplasty: Angioplasty is a nonsurgical procedure that opens blocked or narrowed arteries. During this procedure, a thin, flexible tube with a balloon on the end is threaded through a blood vessel to the affected artery. The balloon is then inflated to compress the plaque against your artery walls. This restores blood flow through the artery. During the procedure, the doctor may also place a small mesh tube called a stent in the artery to help prevent blockages in the future.
  • Bypass surgery: For this surgery, your doctor uses a blood vessel from another part of your body or a man-made tube to make a graft. This graft allows blood to bypass, or flow around, the blocked or narrowed artery. While this surgery doesn't cure PAD, it may relieve symptoms by increasing blood flow to the affected limb.
  • Atherectomy: With this treatment, a tiny catheter is inserted into the artery at the site of blockage that is able to shave or cut the plaque from the inside of the artery and remove it from the body.
     

The best way to prevent peripheral arterial disease is to maintain a healthy lifestyle. That includes:

• Maintain a healthy weight: If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control heart disease risk factors.
• Stop smoking: Smoking is a known risk factor for heart disease. It can damage and tighten blood vessels and raise your chance of developing peripheral arterial disease. Talk with your doctor about strategies and program that can help you quit.
• Control conditions such as high blood pressure, high cholesterol and diabetes: If you have high cholesterol, high blood pressure or diabetes, take your prescription medicine to control the conditions. Follow the correct dosage and do not stop taking your medication without consulting your doctor first. Doing so is likely to make your symptoms worse and put your health at risk.
• Stay physically active: Generally, 30 minutes or more of moderate activity, such as bicycle riding and brisk walking, per day is a good initial goal. Aerobic exercise, which uses large muscle groups in a rhythmic, repetitive fashion for prolonged periods of time, is the best type of exercise for the heart. However, flexibility exercises and resistance exercises are also beneficial.
• Eat a healthy, well-balanced diet: A heart healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, and beans and peas. Avoid foods that are high in salt, added sugars, solid fats, and refined grains.
• Reduce and manage stress: A growing body of evidence suggests that psychological factors can impact your heart health and can contribute to cardiac risk. Stress from all sorts of challenging situations and events plays a significant role in cardiovascular symptoms and outcome. So while it’s not always possible to eliminate all stressful events from your life, consider making some positive changes or employing relaxation techniques that can reduce stress levels, such as tai chi, yoga or meditation.