Peripheral Artery Disease

What Is Peripheral Artery Disease?

Peripheral artery disease (PAD) is a narrowing of blood vessels in the legs, arms or neck. This makes it harder for the blood to carry oxygen and nutrients to tissues in the body. Decreased blood flow can cause injury to the skin, muscles and nerves. When it occurs in the neck it can cause a stroke.

Peripheral artery disease can be caused by atherosclerosis. This is the buildup of fatty plaque in the arteries. It is most common in the legs. PAD is estimated to affect between 10 and 14 million people in the U.S. It most often affects people over age 50.

Signs and Symptoms

The first symptom of peripheral artery disease is often pain or cramping in the legs, especially during physical activity. Patients with narrowing in the neck arteries often do not have symptoms until they have a mini-stroke (TIA) or stroke. Half of people with PAD don’t have any symptoms. The effects may not become apparent until later in life. Many people with PAD don’t experience symptoms until arteries narrow by 60% or more.

Other symptoms of more serious peripheral artery disease include:

• Cold skin on your feet
• Decreased toenail growth
• Difficulty finding a pulse in the affected area
• Discolored skin
• Hair loss or decreased hair growth on the legs
• Numbness or weakness in the legs
• Sores or ulcers that don’t heal

Pain and cramping from peripheral artery disease is called claudication. This can cause a domino effect. Over time, discomfort in the muscles of your feet, calves and thighs during exercise can occur more quickly and with less activity.

Early detection of peripheral artery disease is key so you can start treatment before the disease becomes serious enough to lead to complications. When left untreated, PAD can cause heart attack, stroke or limb loss.

Tobacco use is the most significant risk factor for peripheral artery disease. Between 80% - 90% of people with PAD currently smoke or previously smoked. Tobacco can increase the risk of PAD by 400%. People who smoke are also more likely to develop peripheral artery disease symptoms almost 10 years earlier than nonsmokers and may experience more severe complications.

Risk Factors

• Age 75 or older
• Chronic kidney disease
• Diabetes
• Diet high in saturated fats
• Family history of heart disease or blood vessel disease
• High blood pressure or high cholesterol
• Lack of exercise
• Obesity

Diagnosis

If you have symptoms of peripheral artery disease, your doctor will perform a physical exam and go over your medical history and risk factors. PAD can often be diagnosed through noninvasive tests.

Exercise Tests

Treadmill exercise test. This test looks at how blood flow changes during exercise.

Imaging Tests

Ankle-brachial index: This is the most common test to diagnose peripheral artery disease. It compares blood pressure in the arm to blood pressure in the leg. Your blood pressure should be the same throughout the body. A difference in blood pressure in different areas of the body can indicate a blocked artery.

CT Angiography: This imaging test uses X-rays and contrast dye to provide highly detailed images of the arteries and can show blockages.

CT scans: This noninvasive test takes images of the arteries of the abdomen, pelvis and legs.

Doppler and ultrasound: This test uses sound waves to visualize the artery and measure blood flow.

Magnetic resonance angiography (MRA): This is an imaging test that uses magnets and radio waves to examine the blood vessels.

Pulse volume recording (PVR) test: This is a quick and non-invasive way to test for PAD. It measures blood pressure and blood flow in the legs and can help identify partially blocked arteries.

Lab Tests

Blood tests: Cholesterol levels, diabetes and inflammation markers can be checked with blood tests.

Diagnostic Procedures

Angiography: This procedure uses a special dye to see the inside of the arteries. Your doctor will use a plastic tube called a catheter to inject the dye. X-rays of the arteries are taken. Some treatments can be performed during this procedure. A blood clot can be dissolved or a partially blocked artery can be opened with a balloon during this procedure.

Treatment

Early diagnosis, lifestyle changes and treatment can prevent peripheral artery disease from getting worse.

The main goals of peripheral artery disease treatment are reducing the risk of serious heart events and decreasing pain while walking. Managing other conditions with medications can reduce the complications of PAD, such as stroke or heart attack. This can improve your quality of life with PAD.

Medications Antiplatelet medications (to prevent blood clots)

• Blood pressure medications
• Cholesterol drugs
• Cilostazol (improves blood flow to increase your walking distance)
• Diabetes medication when the condition is also present
• Pain relievers

Procedures

• Angioplasty: During this procedure, your doctor will use a small balloon to create more space inside an artery so blood can pass through.
• Atherectomy: This procedure removes buildup and opens narrow or blocked arteries.
• Peripheral artery bypass surgery: This procedure redirects blood flow around blocked arteries. Your surgeon will use a section of healthy vein from your arm or leg.
• Stents: A stent is placed in the problem area during this procedure. A stent is a small metal tube that holds the artery open so blood can go through better.

Lifestyle Management

• Eat a balanced diet: A low-cholesterol and low-fat diet can help control cholesterol and blood pressure and improve heart health.
• Exercise: One of the first recommended treatments for peripheral artery disease is exercise. A monitored exercise program can improve pain in your legs with walking. This helps you walk farther. A structured program usually includes walking on a treadmill at least three times a week. People with PAD should also walk on their own for 30 to 60 minutes per day.
• Manage other health conditions: Keeping high blood pressure, diabetes and high cholesterol under control can decrease the risks of PAD.
• Quit smoking: Tobacco use narrows the arteries and decreases the blood’s ability to carry oxygen. This increases the risks of blood clots. Stopping smoking reduces your risk of heart attack and stroke. Talk to your doctor about a smoking cessation program.
• Take good care of your feet: Wear shoes that fit and pay attention to cuts, scrapes or injuries on the foot, especially if you also have diabetes. Good foot care reduces the risk of infection.

Clinical Trials

Clinical trials help determine new treatment options for diseases and conditions. Patients with heart disease have access to clinical trials and should speak with their doctor to determine what trials might work best for them. 

See a Specialist

If you or a loved one have symptoms of peripheral artery disease, it’s important to be evaluated by a cardiologist in conjunction with a peripheral vascular specialist.

At National Jewish Health in Denver, Colorado, we have one of the region’s leading cardiology programs. Learn more about our program or use the button below to make an appointment.