Peripheral artery disease (PAD), Peripheral Arterial Disease, or Peripheral Vascular Disease is a common condition in which the patient’s arms or legs receive less blood than they should due to the narrowing of the arteries.
The patient’s limbs do not receive enough blood flow to satisfy demand. In most cases, the problem is with the lower limbs (legs). PAD causes several symptoms, including claudication. The term claudication refers to muscle pain caused by a lack of oxygen. Symptoms get worse with activity and better with rest.
Peripheral artery disease is one of the signs of atherosclerosis, i.e., the narrowing of the arteries caused by an accumulation of fatty deposits.
As Johns Hopkins Medicine explains, PAD may occur in any blood vessel outside of the heart:
“PAD may affect any blood vessel outside of the heart including the arteries, veins, or lymphatic vessels. Organs supplied by these vessels, such as the brain, and legs, may not get enough blood flow for proper function. However, the legs and feet are most commonly affected.”
Causes of peripheral artery disease
As PAD affects blood vessels, we say that it is a form of vascular disease or cardiovascular disease. A cardiovascular disease is one that affects the heart, blood vessels, or both, while a vascular disease affects just the blood vessels.
It is typically caused by an accumulation of fatty deposits in the walls of the arm or leg arteries. We refer to these deposits as atheroma, atherosclerotic plaque, or simply plaque. Plaque consists of cholesterol, fibrin, calcium, and other waste substances.
The following are also possible causes of PAD (but less common):
- Exposure to radiation.
- Changes in ligaments or muscles.
- A leg or arm injury.
- Inflammation of a blood vessel.
A risk factor is any attribute or exposure that increases the likelihood of developing a disease or health condition.
The following may increase your risk of developing peripheral arterial disease:
- Hypertension (high blood pressure).
- Hypercholesterolemia (high cholesterol).
- High levels of homocysteine (an amino acid).
- Being over 65.
Signs and symptoms
Many patients have PAD but don’t know because they have no symptoms. The following are the most common signs and symptoms if your legs are affected:
- Intermittent claudication – painful legs when walking. The pain recedes when the patient rests.
- Numbness and weakness.
- Brittle toenails. Slow-growing toenails.
- Open sores (ulcers) on legs and feet. They might not heal.
- Legs turn paler or blue. This sign is harder to detect on brown or black skin.
- Shiny skin.
- Coldness in the foot or lower leg.
- Weak pulse (or no detectable pulse) in the feet or legs.
- Cramping after certain activities, such as climbing stairs or walking.
- Erectile dysfunction.
- Hair loss on the legs.
Diagnosing peripheral artery disease
Diagnosis of PAD usually begins with a physical examination, which can include checking the pulse in your legs or arms. The doctor may also order the following tests and scans:
- ABI (ankle-brachial index)
This test compares the blood pressure in your ankle and arm.
- Imaging tests
These may include an ultrasound, angiography, or MRI if the doctor wants to view the blood flow in your arteries.
- Blood tests
These can assess levels of certain substances in your blood associated with PAD.
- Genetic testing
Genetic testing for PAD might be considered in cases of a strong family history, early disease onset without typical risk factors, or the presence of multiple vascular conditions.
Treatment for peripheral artery disease often involves a combination of lifestyle modifications, medications, and in more severe cases, surgical intervention:
- Adhering to a heart-healthy, well-balanced diet is crucial.
- Regular physical activity, tailored to the individual’s capacity, can help improve symptoms and slow disease progression.
- If overweight or obese, aim to achieve and maintain a healthy weight.
- Smoking cessation is critical as tobacco use accelerates PAD.
- You may have to moderate your alcohol consumption (be honest with your doctor about how much/often your drink).
- Proper management of co-existing conditions, such as hypertension, diabetes, or high cholesterol, is necessary.
- Physicians may prescribe medications to control cholesterol levels, manage high blood pressure, prevent blood clots, and alleviate pain associated with claudication.
- In cases of severe claudication, critical limb ischemia, or progressing disease, revascularization procedures such as angioplasty, stenting, or bypass surgery may be considered.
Always consult with a healthcare provider for a treatment plan tailored to your individual needs and circumstances.
PAD, primarily caused by atherosclerosis, can lead to several serious complications:
- Coronary Heart Disease
Atherosclerosis can block coronary arteries, reducing blood flow to the heart, leading to chest pain (angina) and potentially a heart attack.
Atherosclerosis can block the arteries leading to the brain, increasing the risk of a stroke, which occurs when part of the brain doesn’t receive enough blood.
- Critical Limb Ischemia (CLI)
A severe form of PAD, CLI occurs when PAD progresses to the point where blood flow to the extremities is significantly reduced, leading to severe pain, ulcers, or gangrene.
- Poor Wound Healing
Reduced blood flow impairs the body’s ability to heal wounds, particularly on the legs and feet, increasing the risk of infection.
- Restricted Mobility
Pain or discomfort from PAD can limit physical activity.
- Loss of a Limb
In severe cases, PAD can lead to tissue death (gangrene), which may necessitate amputation.
All these complications underscore the importance of managing PAD and its underlying causes.
Prevention of PAD largely involves leading a heart-healthy lifestyle:
- Avoid Tobacco
Refrain from smoking and exposure to second-hand smoke. Both can cause damage to your blood vessels, increasing your risk of PAD.
- Healthy Diet
Adopt a diet low in saturated fats, cholesterol, and sodium to help lower blood pressure and cholesterol levels, reducing PAD risk.
- Manage Cardiovascular Conditions
Proper treatment of conditions like hypertension, high cholesterol, and diabetes can help prevent PAD.
- Maintain Healthy Weight
Aim for a body mass index (BMI) in the healthy range to decrease your risk of PAD and its complications.
- Limit Alcohol
Either quit alcohol (if are an alcoholic) or cut down (if you drink too much).
- Regular Exercise
Engage in regular physical activity to improve overall cardiovascular health. If new to exercise, consult a healthcare professional for guidance.
- Regular Check-ups
Regular health screenings can detect potential risk factors and early signs of PAD.
These measures can significantly reduce your risk of developing PAD.