Peripheral Artery Disease

Peripheral artery disease, also called PAD, is a condition that affects blood vessels outside the heart and brain, usually in the legs, where fatty deposits (plaque) build up in the artery walls. These deposits restrict or block blood flow or circulation. PAD is typically found in the arteries that lead to the kidneys, stomach, arms, legs and feet.

Causes, signs and symptoms

The most common cause of PAD is atherosclerosis, a buildup of plaque in the artery. Plaque buildup is a gradual process with no or few visible symptoms until later in life. The disease may also start when damage occurs to the inner layers of the arteries. This damage can be done by:

• Smoking,
• High amounts of fats and cholesterol in the blood,
• High blood pressure,
• Or high amounts of sugar in the blood due to diabetes.

Less common causes may include blood vessel inflammation, injury to limbs, unusual anatomy of ligaments or muscles, or radiation exposure.

The following risk factors are associated with PAD:

• Age (50 years or older)
• Diabetes
• Smoking
• High cholesterol
• High blood pressure
• Obesity
• Lack of exercise
• Family history

As the plaque builds up, blood circulation is restricted or blocked. Smaller blood vessels will try to compensate by rerouting blood around the blockage but these vessels are smaller than the artery and not able to support complete circulatory blood flow needs. As areas of the body react to lack of blood, pain can result. While most people with PAD report no symptoms, the following signs may be an indication for PAD:

• Pain in the calf of the leg, usually after some activity such as walking or climbing stairs, that goes away with rest
• Thigh or buttock pain during exercise and relieved by rest
• A lower temperature in one leg when compared to the other
• Changes in skin color, especially in the feet, including paleness or bluish appearance
• Sores or wounds on toes, feet, or legs that heal slowly or not at all
• Poor nail growth or decreased hair growth on legs
• Weak or absent pulse in lower extremities

As the blockages increase in number and severity, symptoms and results can become more extreme, including pain that wakes up the individual from sleep and/or non-healing ulcers or gangrene, usually found in the feet.

Diagnosis and Treatment

Diagnosis of PAD is done in the physician’s office with a visual examination to look at the appearance and color of the legs and feet, observe for signs of poor wound healing and by checking the pulse in the legs and feet to determine adequate blood flow. An ankle-brachial index (ABI) test may be performed. This is a painless and easy procedure that compares blood pressure readings in your ankles with the blood pressure reading in your arms. If changes are noted, your physician may also perform an ultrasound, or Doppler test, to determine where a blockage may be located in the artery.

The treatments for PAD vary based on severity and number of blockages. First and foremost, if you smoke you will be asked to quit. Lifestyle changes may be suggested to modify your diet, increase your activity levels, or lose weight. If you have high blood pressure, high cholesterol or diabetes, you may also be prescribed medications to help manage these conditions in addition to some medications that help prevent the formation of blood clots.

Treatments include minimally-invasive procedures such as stenting or angioplasty. For more severe blockages, bypass surgery may be performed.

If you have a family history of PAD, are over 50, or smoke, talk with your physician about your risk for this disease and steps you can take now to prevent or minimize it.