About Peripheral artery disease (also called peripheral arterial disease)
Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs, usually the legs.
When your legs do not receive enough blood flow to keep up with demand, this condition causes leg pain when walking. This is called “intermittent claudication” because the leg pain stops when you rest.
Unfortunately, PAD can go undiagnosed. Left untreated, peripheral artery disease can be dangerous because it can lead to painful symptoms: loss of a leg, increased risk of coronary artery disease, and carotid atherosclerosis. Peripheral artery disease may also be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). Such a condition may be reducing blood flow to your heart and brain, as well as your legs. People with PAD have an increased risk for heart attack and stroke.
What are the symptoms of Peripheral Artery Disease (PAD)?
The most common symptom of PAD is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising.
The pain of PAD usually goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow. Resting muscles can get by with less blood flow. If there’s a blood-flow blockage due to plaque buildup, the muscles won’t get enough blood during exercise to meet the needs.
This crampy pain (called intermittent claudication), when caused by PAD, is the muscles’ way of warning the body that it is not receiving enough blood during exercise to meet the increased demand.
Many people with PAD have no symptoms or mistake their symptoms for something else.
What is the prevalence of PAD?
PAD affects approximately 12 percent of the US population, or approximately 8 to 12 million Americans.The prevalence of the disease increases with age. As the population ages, the prevalence may reach somewhere between 9.6 to 16 million in those age 65 and older.
PAD affects men and women equally. Studies suggest a disproportionately higher prevalence of PAD among African Americans compared with non-Hispanic whites.
Informal screening for Peripheral Arterial Disease
Do you think you have PAD? Take a look at this four-question screening sheet. Talk to your primary care doctor or schedule an appointment to have your condition evaluated. This screening is not a substitute for medical advice.
When PAD is severe, what are the symptoms?
- Leg pain that does not go away when you stop exercising
- Foot or toe wounds that will not heal, or heal very slowly
- A marked decrease in the temperature of your lower leg or foot particularly compared to the other leg or to the rest of your body
Understanding leg pain
Many people dismiss leg pain as a normal sign of aging. You may think it’s arthritis, sciatica or just “stiffness” from getting older. PAD leg pain occurs in the muscles, not the joints.
Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that is a burning or painful discomfort of the feet or thighs. If you are having any kind of recurring pain, talk to your healthcare professional and describe the pain as accurately as you can. If you have any of the risk factors below for PAD,ask your healthcare professional about PAD even if you aren’t having symptoms.
What are the risk factors for PAD?
People who smoke and/or have diabetes are at especially high risk. If you have risk factors for PAD, get screened for PAD, even if you’re not having symptoms.
How can you prevent Peripheral Arterial Disease?
Risk factors you can’t control
- Personal or family history of PAD
- Cardiovascular disease
Risk factors you CAN control
Here are things you can do!
- Cigarette smoking – You can stop smoking. Smoking is a major risk factor for PAD. If you smoke, you increase your risk of pad by four times the risk of non-smokers.
- Obesity – You can reduce your weight. People with a Body Mass Index (BMI) of 25 or higher are more likely to develop heart disease and stroke even if they have no other risk factors. We know it is easier said than done, but it’s definitely worth the effort – for many reasons. A diet low in saturated fat, trans fat and cholesterol can help lower blood cholesterol levels, but cholesterol-lowering medication may be necessary to maintain the proper cholesterol levels.
- Diabetes mellitus – If you have this diabetes, learn how to manage it. Having diabetes puts you at greater risk of developing PAD as well as other cardiovascular diseases.
- Not following medication instructions. -Take the medication as recommended by your healthcare professional. If you have been prescribed high blood pressure medications and/or cholesterol-lowering medications. Not following directions increases your risk for PAD, as well as heart attack and stroke.
- High blood cholesterol – You can manage your cholesterol levels. High cholesterol contributes to the build-up of plaque in the arteries, which can significantly reduce the blood’s flow. This condition is known as atherosclerosis. Managing your cholesterol levels is essential to prevent or treat PAD.
- High blood pressure – You can manage your blood pressure. Sometimes called “the silent killer,” high blood pressure has no symptoms. You must work with your healthcare professional to monitor and control your blood pressure.
- Physical inactivity – You can get moving. Physical activity increases the distance that people with PAD can walk without pain and also helps decrease the risk of heart attack or stroke. Regular physical activity is key.
How is peripheral artery disease diagnosed?
PAD diagnosis begins with a physical examination. Your provider will check for weak pulses in the legs. The physical examination for PAD may include the following:
- Ankle-brachial index (ABI) – This is a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure. With severe narrowing, it may register as less than 50 percent. If your ABI reveals an abnormal ratio between the blood pressure of the ankle and arm, we may recommend one of the tests below.
- Doppler and Ultrasound (duplex) imaging. This non-invasive method enables us to visualize the artery with sound waves. It measures the blood flow in an artery, which may indicate a blockage.
- Computed Tomographic Angiography (CT). This is a different, non-invasive test used by interventional radiologist to visualize the arteries in the abdomen, pelvis and legs. It uses X-ray technology. If a patient has a stent or pacemaker, this test is particularly useful.
- Magnetic Resonance Angiography (MRA). This is a non-invasive test that gives information similar to that of a CT, but uses magnets rather than X-rays to produce a series of images.
- Angiography. Angiography is usually reserved for use in conjunction with vascular treatment/procedures. During an angiogram, a contrast agent is injected into the artery. X-rays are taken to 1) visualize blood flow, 2) view arteries in the legs and 3) to pinpoint any blockages.
How is PAD treated?
If it is determined that minimally invasive treatment or surgery may be needed, your interventional radiologist will explain the recommended course of action.
Minimally invasive procedures consist of angioplasty and/or stent placement (clot-removal treatment). Both procedures are nonsurgical.
- Angioplasty is performed by making a small incision in the leg or the neck, through which a catheter is inserted to reach the blocked artery. A tiny balloon is inflated inside the artery to open the clog.
- A stent — a tiny wire mesh cylinder — may also be implanted at this time to help hold the artery open.
- Medicine will be administered through the catheter, or a special device called a stent, can be inserted through it to remove a clot that is blocking the artery.
When is surgery necessary?
If a long portion of the artery in your leg is completely blocked and you have severe symptoms, surgery may be required. A vein from another part of the body can be used to “bypass” and reroute blood around the closed artery. Your healthcare professional will discuss your options and help choose the best procedure for your situation. If surgical intervention is required, your RIA Endovascular interventional radiologist will refer you to a vascular surgeon to treat your PAD.