Peripheral Artery Disease - PAD

Definition

Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.

Often, you can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet.

Symptoms

While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (intermittent claudication).

Intermittent claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common.

The severity of intermittent claudication varies widely, from mild discomfort to debilitating pain. Severe intermittent claudication can make it hard for you to walk or do other types of physical activity.

Peripheral artery disease symptoms include:

v  Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs (intermittent claudication)

v  Leg numbness or weakness

v  Coldness in your lower leg or foot, especially when compared with the other leg

v  Sores on your toes, feet or legs that won't heal

v  A change in the color of your legs

v  Hair loss or slower hair growth on your feet and legs

v  Slower growth of your toenails

v  Shiny skin on your legs

v  No pulse or a weak pulse in your legs or feet

v  Erectile dysfunction in men

If peripheral artery disease progresses, pain may even occur when you're at rest or when you're lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

When to see a doctor

If you have leg pain, numbness or other symptoms, don't dismiss them as a normal part of aging. Call your doctor and make an appointment.

Even if you don't have symptoms of peripheral artery disease, you may need to be screened if you are:

v  Over age 70

v  Over age 50 and have a history of diabetes or smoking

v  Under age 50 but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure

Causes

Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up in your artery walls and reduce blood flow.  Although the heart is usually the focus of discussion of atherosclerosis, this disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease.  Less commonly, the cause of PAD may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.

Risk factors

Factors that increase your risk of developing peripheral artery disease include:

v  Smoking

v  Diabetes

v  Obesity (a body mass index over 30)

v  High blood pressure (140/90 millimeters of mercury or higher)

v  High cholesterol (total blood cholesterol over 240 milligrams per deciliter, or 6.2 millimoles per liter)

v  Increasing age, especially after reaching 50 years of age

v  A family history of peripheral artery disease, heart disease or stroke

v  Excess levels of homocysteine, a protein component that helps build and maintain tissue

v  People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.

Complications

If your peripheral artery disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you're also at risk of developing:

v  Critical limb ischemia. This condition begins as open sores that don't heal, an injury, or an infection of your feet or legs. Critical limb ischemia (CLI) occurs when such injuries or infections progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.

v  Stroke and heart attack. The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn't limited to your legs. Fat deposits also build up in arteries supplying your heart and brain.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in disorders of blood vessels (vascular specialist) or a doctor who specializes in the heart and circulatory system (cardiologist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

v  What you can do

v  Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

v  Make a list of all medications, vitamins or supplements that you're taking, and include dosage information.

v  Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. For peripheral artery disease, some basic questions to ask your doctor include:

v  What's the most likely cause of my symptoms?

v  Are there other possible causes for my symptoms?

v  What kinds of tests do I need? Do these tests require any special preparation?

v  Is peripheral artery disease temporary or long lasting?

v  What treatments are available, and which do you recommend?

v  What types of side effects can I expect from treatment?

v  Are there any alternatives to the primary approach that you're suggesting?

v  What can I do on my own that might help me get better?

v  I have other health conditions. How can I best manage these conditions together?

v  Is there a generic alternative to the medicine you're prescribing me?

v  Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

v  When did you first begin experiencing symptoms?

v  Are your symptoms continuous or occasional?

v  Do your symptoms get worse when you exercise?

v  How severe are your symptoms?

v  Do your symptoms get better when you're resting?

v  Do you use tobacco products? If yes, how much?

What you can do in the meantime
It's never too soon to quit smoking if you're a smoker. Smoking increases the risk of peripheral artery disease and can make existing PAD worse. Other healthy lifestyle habits you can immediately adopt are eating less saturated fat and adding more fruits and vegetables to your diet.