The peripheral artery disease (PAD) is the condition where blood is carried from the heart to the legs, and it occurs when these blood vessels narrow or become blocked due to fatty deposits called plaques that build up in them. In addition to causing pain, cramping, numbness, weakness, and other symptoms, PAD increases your risk of heart attack, stroke, and leg amputation, since it reduces blood flow to the legs.
Among the main causes of PAD is atherosclerosis, which is the hardening and narrowing of the arteries caused by plaques. Plaques are formed from cholesterol, fat, calcium, and other substances that stick to the artery walls. Plaques can grow larger and narrow the arteries over time, limiting the amount of blood that can pass through them. They can also rupture and cause blood clots that can block blood flow completely.
Some factors that can increase the risk of developing PAD include:
Smoking or using tobacco products
High blood pressure
High cholesterol
Diabetes
Obesity
Age (older than 50 years)
Family history of PAD or cardiovascular disease
Physical inactivity
Chronic kidney disease
Many people with PAD have mild or no symptoms at all. However, some common signs and symptoms of PAD include:
Leg pain or cramping that occurs when walking or exercising and goes away with rest. This is called claudication and it usually affects the calf muscles, but it can also affect the hips, thighs, or feet.
Coldness, numbness, tingling, or weakness in the lower leg or foot, especially when compared with the other side.
Skin color changes on the legs, such as paleness, blueness, or redness.
Shiny skin or loss of hair on the legs.
Slow growth or poor healing of toenails or wounds on the legs or feet.
Erectile dysfunction in men.
Pain in the legs or feet that occurs at rest or at night and is relieved by hanging them over the edge of the bed or walking around. This is called rest pain and it indicates severe PAD.
Symptoms and medical history will be discussed with a health care provider and a physical examination will be performed to diagnose PAD. Besides checking your pulse and blood pressure, the provider will look for signs of poor circulation, such as skin changes, hair loss, or ulcers. A provider may also order some tests to confirm the diagnosis and assess the severity of PAD.
Ankle-brachial index (ABI): This is a simple and noninvasive test that measures the ratio of blood pressure in your ankles to that in your arms. A low ABI indicates reduced blood flow in your legs due to PAD.
Doppler ultrasound: This is a test that uses sound waves to create images of your blood vessels and show how well blood is flowing through them. It can also detect any blockages or narrowing in your arteries.
Angiography: This is a test that uses X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans to visualize your arteries and any plaques or clots in them. A contrast dye is injected into your blood vessel before taking the images to make them more clear.
The goals of treatment for PAD are to relieve symptoms, improve blood flow in the legs, and prevent complications such as heart attack, stroke, and leg amputation. Treatment options for PAD include:
Lifestyle changes: These include quitting smoking, controlling blood pressure, cholesterol, and diabetes, eating a healthy diet, losing weight if needed, and exercising regularly. Walking is one of the best exercises for people with PAD as it can improve blood circulation and muscle strength in the legs.
Medications: These include drugs that lower cholesterol (statins), blood pressure (antihypertensives), blood sugar (antidiabetics), and blood clotting (antiplatelets or anticoagulants). These drugs can help prevent plaque buildup and reduce the risk of cardiovascular events. Some drugs can also help relieve leg pain by improving blood flow (vasodilators) or reducing muscle spasms (antispasmodics).
Angioplasty: This is a minimally invasive procedure that involves inserting a thin tube called a catheter into an artery in your groin or arm and guiding it to the blocked artery in your leg. A small balloon at the tip of the catheter is inflated to widen the artery and improve blood flow. Sometimes, a small metal mesh called a stent is also placed inside the artery to keep it open.
Bypass surgery: This is an open surgery that involves creating a detour around a blocked artery in your leg using a graft made of a synthetic material or a vein from another part of your body. This restores blood flow to the affected leg and relieves symptoms.
Endarterectomy: This is a surgery that involves removing the plaque from the inner lining of an artery in your leg. This improves blood flow and reduces the risk of plaque rupture and clot formation.
Amputation: This is a surgery that involves removing a part or all of a leg that has been severely damaged by PAD and cannot be saved by other treatments. This is usually done as a last resort when other options have failed or are not possible.
The best way to prevent PAD is to adopt a healthy lifestyle and avoid or manage the risk factors that can cause it. Some preventive measures include:
Quitting smoking or using tobacco products
Keeping your blood pressure, cholesterol, and diabetes under control
Eating a balanced diet that is low in saturated fat, salt, and sugar and high in fruits, vegetables, whole grains, and lean proteins
Maintaining a healthy weight
Exercising regularly, at least 30 minutes a day, five days a week
Limiting alcohol intake
Managing stress
Having regular check-ups with your health care provider and following their advice
PAD is a serious condition that can impact your quality of life and increase your risk of life-threatening complications. However, with proper diagnosis, treatment, and prevention, you can improve your symptoms, blood flow, and overall health. If you experience any signs or symptoms of PAD, contact your doctor as soon as possible.
