Peripheral artery disease (PAD), also known as peripheral vascular disease (PVD), is a condition in which blockages appear in the arteries that carry nutrient-rich blood to the head, organs and limbs. PAD most commonly occurs in the arteries of the leg.
When gummy plaque builds up in the arteries (a process known as atherosclerosis), it can thicken over time and impede blood flow to your vital organs and limbs, leading to leg pain and problems with walking.
As it progresses, the blockages can get worse, resulting in pain at night, as well as ulcers that don’t heal properly.
Smoking or having a history of smoking greatly increases your chances of developing PAD; and, quitting smoking significantly slows the progression of the disease.
Wear and tear from older age, obesity, high levels of cholesterol, high blood pressure, elevated blood sugar from diabetes, and physical inactivity, can damage the inner layers of the arteries. To heal the arteries, the body manufactures a sticky substance called plaque. Eventually, the plaque may fracture or burst, causing blood platelets to bind to the injured area which may coalesce together to form blood clots. The formation of blood clots can seriously impede the arteries and restrict the flow of blood to the body.
Those most at risk of developing PAD are people who smoke, are overweight, have hypertension, diabetes or kidney failure, do minimal or no physical exercise, and have an unhealthy diet, with high cholesterol and a high sugar intake. People of older age who display a combination of risk factors have a greater chance of developing peripheral artery disease.
Many people who have PAD do not experience any signs or symptoms. Those who do encounter symptoms may do so while walking or climbing stairs. They may feel discomfort, numbness and aching in the legs; and they may experience cramping in the legs, hips, buttocks or feet. The symptoms usually subside with rest. An unhealed ulcer on your toes or feet can be a clear signal that you have developed peripheral artery disease; untreated ulcers can lead to gangrene, and therefore, need urgent medical attention.
Other indications of PAD may include:
- Faint pulsating in the lower extremities
- Color changes in the legs
- Different temperature from one leg to the other
- Less hair on the legs and deficient nail growth
- Erectile dysfunction in men
About 30% of people who have had deep vein thrombosis or a pulmonary embolism are at risk for another episode.
Your vascular surgeon will sit down with you, evaluate your medical and family history and give you a physical examination; this may involve measuring your blood pressure at your ankle and at your arm and then correlating the two. An angiogram, CT scan or MRI may be performed to ascertain the exact location of plaque build up and determine your treatment options. Treatment for peripheral arterial disease can be medical or interventional. Medical treatment emphasizes alleviating symptoms and stopping any further development of the condition.
A change in lifestyle, such as quitting smoking, regular exercise, taking medications to reduce cholesterol in the blood, taking antiplatelet agents which help blood flow, like aspirin, and treating diabetes or high blood pressure. All of those actions can go a long way to slowing the development of PAD, or even reverse its symptoms altogether.
Advanced treatments for treating more serious symptoms, involve removing or opening up the blockages in the arteries, which will enhance blood flow to the legs. This can be achieved through balloon angioplasty, placement of a stent (a small mesh tube), or surgical bypass.
Bypass grafting surgery involves taking a blood vessel from another area of the body, or an artificial duct, to create a graft, which will circumvent the clogged section of the artery, thereby increasing blood flow to the leg.
During angioplasty, your vascular surgeon will insert a catheter containing a balloon into the blocked artery, which will expand the arterial lining and renew blood circulation. A stent may be inserted during the procedure to keep the artery free flowing afterwards.
Before his aortobifemoral bypass with Jon M. Wesley, M.D., Raymond could barely walk 100 feet without having pain in his legs. Days at Disney World with his family and cruises abroad with his wife required frequent stops to rest his legs thanks to the chronic discomfort.
After surgery, the site of the incision may be tender and bruising may be visible for several days following the operation. Mobility will be restricted, however, you will be able to take short walks. It is advised to refrain from going up and down stairs, lifting heavy objects, and strenuous activity or sports for two to three days after the procedure. Your physician will inform you when you’ll be able to resume your normal activities.
Patients can take a number of preventative measures in order to keep their blood vessels vigorous and healthy, and prevent the reoccurrence of atherosclerosis:
- Control blood pressure and diabetes
- Quit smoking
- Eat a low fat and low cholesterol diet
- Engage in regular physical activity
- Lose weight
Peripheral arterial disease is a major cause of leg pain; simple methods exist that can reduce its effects in the short term, as well as long term changes that patients can undergo in order to prevent the reoccurrence of PAD.
The best rule of thumb is talk to your physician about ways that you can maintain and improve the health of your arteries. If you experience any of the symptoms associated with peripheral arterial disease or are concerned about developing PAD, you should contact your physician immediately for a consultation.
When your vascular specialist is creating a treatment plan with you, there are two goals: manage symptoms and stop the progression of peripheral artery disease (PAD). This can be managed with lifestyle changes such as quitting smoking and becoming active.
If lifestyle changes don’t help, your vascular specialist may recommend medications to control blood pressure, cholesterol and blood sugar. If these conservative measures don’t work, your vascular surgeon may suggest surgery.
When conservative measure fail to alleviate symptoms and stop the progression of peripheral artery disease (PAD), your vascular specialist may suggest angioplasty, bypass surgery or thrombolytic surgery.
Angioplasty occurs when a small hollow tube, called a catheter, is threaded through a blood vessel to the affected artery. Then, a small balloon on the tip of the catheter is inflated to reopen the artery and stretch the artery to help keep it open.
Bypass surgery occurs when a graft bypass is created using a vessel from another part of the body or a synthetic fabric. This allows blood to flow around the narrowed artery.
Thrombolytic therapy involves injecting a clot-dissolving drug into the artery at the point of the clot to break it up.
After surgery, PAD will need to be monitored, but surgery will likely alleviate the symptoms of PAD and help prevent its progression.
The chances of having peripheral artery disease (PAD) increases with certain factors. These risk factors include:
- Having diabetes
- Having high blood pressure
- Having high cholesterol
- Being physically inactive
- Having a family history of peripheral artery disease, heart disease or stroke
If you smoke, have diabetes or are over age 70, you should be screened for PAD yearly, even if you don’t have symptoms.