What is Peripheral Arterial Disease?
People with a condition called peripheral arterial disease (PAD) often experience “poor circulation” in the lower parts of their legs. This is usually because fat deposits, known as “atherosclerotic plaques,” have constricted the arteries that carry blood to the legs. This constriction actually decreases blood flow to the legs and can even cause pain, especially when activities like walking strain the muscles. This pain is called “intermittent claudication,” which simply means limping. However, it’s important to note that not all people with PAD have these typical symptoms – some might not experience any symptoms, while others might notice signs that don’t necessarily align with the common symptoms of PAD. In some severe cases, PAD can even compromise the circulation in a limb so significantly that immediate surgery is required.
Even in cases where PAD doesn’t cause symptoms, it’s important to diagnose the condition. This is because PAD can indicate the presence of “systemic atherosclerosis,” a condition where atherosclerotic plaques build up in arteries throughout the body, not just in the legs. These plaques can increase the risk of heart disease to a level similar to patients who’ve previously had a heart attack. To increase their chances of living a healthy life long-term, individuals with PAD should aggressively manage their risk factors. The treatment strategies may depend on the severity of PAD and the symptoms the patients are experiencing. These can range from lifestyle modifications and medications to procedures that target the blocked arteries and even surgery.
What Causes Peripheral Arterial Disease?
Peripheral artery disease often happens because of atherosclerosis, which is when plaque builds up in your arteries. Other things that can cause it include inflammation or injury of the blood vessels, or exposure to radiation.
There are also several risk factors that make it more likely for someone to develop peripheral artery disease:
You’re at a higher risk if you have diabetes, if you’re a smoker, or if you’re overweight (specifically, if your body mass index is over 30). High blood pressure and high cholesterol levels can also increase your risk. People who are over the age of 50, or who have a family history of peripheral artery disease, heart disease, or stroke are also more likely to develop the condition.
Finally, having high levels of homocysteine – a component that helps your body build and maintain tissue – can also contribute to the risk of developing peripheral artery disease.
Risk Factors and Frequency for Peripheral Arterial Disease
Peripheral Artery Disease (PAD) affects over 200 million adults around the world. The chances of having PAD get as high as 20% for people over the age of 70. While it used to be believed that the disease was more common in men, it now seems that elderly men and women are equally likely to have PAD.
One important issue is that PAD often goes undiagnosed in primary care because most patients don’t show the typical symptoms described in medical textbooks. One major risk factor for PAD is smoking, which increases the risk of PAD by four times. Smokers with PAD generally have shorter lives compared to non-smokers and are more likely to progress to severe limb damage and even amputation.
- Over 200 million adults worldwide have Peripheral Artery Disease (PAD).
- The risk of PAD is as high as 20% in people over 70 years old.
- Elderly men and women are equally likely to have the disease.
- Many cases of PAD go undiagnosed because patients don’t always show the typical symptoms.
- Smoking increases the risk of PAD by four times and leads to severe complications and shorter life spans.
Other risk factors for PAD include diabetes, high cholesterol, high blood pressure, race, and ethnicity.
Signs and Symptoms of Peripheral Arterial Disease
Peripheral Artery Disease (PAD) mainly causes a pain called claudication, which occurs in the muscles of the lower legs during walking and fades away when resting. Although many people describe this pain as a cramping sensation, others might experience it as fatigue, weakness, pressure, or an ache in the leg. The pain is usually felt in the muscles just below the artery that is affected by PAD. Thus, if the arteries in the thighs or buttocks are clogged, that’s where the pain will manifest. For those with blocked arteries in the femoropopliteal region, the pain is felt in the calf muscles. Various factors, such as the severity of the disease, the speed of walking, and the nature of the terrain or slope, influence the distance one can walk before experiencing pain.
Interestingly, not every person with PAD experiences these symptoms. There can be two broad reasons for this. Some people with mild to moderate PAD may not walk fast or long enough to demand increased blood flow in their leg muscles, and hence, avoid triggering these symptoms. Others may also feel discomfort when walking, but they may dismiss these symptoms as just part of getting older.
Those with severe PAD might experience ischemic rest pain, a burning sensation in the soles of the feet, which can be worse at night. The pain can be so intense that it can disrupt their sleep, forcing them to hang their lower leg over the side of the bed for relief. Surprisingly, the slight increase in blood flow due to gravity can provide temporary relief from this relentless pain. Another symptom of PAD can be erectile dysfunction, which often serves as an initial indication of the disease.
During a physical examination, professionals may spot the following signs of PAD:
- Absence of pulses
- Pain when touched
- Paleness
- Shrinking of muscles and loss of hair
- Cool and bluish skin
- Presence of bruit, a sound heard during examination with a stethoscope
Testing for Peripheral Arterial Disease
Diagnosing Peripheral Artery Disease (PAD), a condition that reduces blood flow to your limbs, involves considering your medical history, a physical exam, and the results of certain tests.
When looking at your medical history, your doctor will want to know about how much you’re able to walk. Not all patients experience the typical symptom of PAD, which is a cramping leg pain that comes on with walking a short distance and eases with rest. Some people may not walk much due to other health issues or may not mention any issues with walking unless asked directly. Other factors your doctor will consider include if you smoke, have high blood pressure, high cholesterol, or diabetes – these are all risk factors for PAD.
During the physical exam, your doctor will check the pulses in your lower body. A common way to do this is using a measure called the ankle-brachial index (ABI). This measures blood pressure in your lower body (ankle) compared to your upper body (arm). If the blood pressure is much lower at your ankle compared to your arm, it suggests reduced blood flow to the lower body – a sign of PAD. People with PAD usually have an ABI of between 0.5 and 0.9 (normal is 0.9 to 1.3).
Your doctor may also order some blood tests to check your kidney function and for any inflammation in your body, which could affect your ability to exercise. Imaging studies help locate where the blood flow is being blocked. These may include Doppler studies, CT angiography, MRI, among others. These tests may also help determine if any procedures are needed to improve blood flow.
If you have sores or ulcers, a method called transcutaneous oximetry could be used to quickly see how well your tissue is being perfused (supplied with blood). In some cases, an ECG, a test that measures the electrical activity of your heart, may be done to check for any heart rhythm problems which could be causing blood clots to form and block your arteries.
Treatment Options for Peripheral Arterial Disease
The purpose of treatment strategies for Peripheral Arterial Disease (PAD) is to reduce the risk of heart-related issues and improve walking ability. Patients with PAD, whether they have symptoms or not, are at a higher risk of stroke, heart attack, and blood clots compared to patients without arterial disease. This increased risk leads to a shorter life expectancy for PAD patients. Thus, making lifestyle changes such as quitting smoking, lowering cholesterol, and managing high blood pressure and diabetes is crucial for all patients diagnosed with PAD.
The methods to enhance walking ability depend on the patient’s symptoms and the severity of the disease. Exercise therapy is one option, which involves walking until the feeling of pain, resting for a short period, and then resuming walking once the pain has disappeared. This process should typically last 30 to 45 minutes and be repeated 3 to 4 times a week for at least 12 weeks. Supervised exercise programs are more effective, but they’re not usually covered by insurance companies.
There are some drugs that can help, one of them is cilostazol, a medication that widens blood vessels and slows down the growth of the cells that cause the narrowing of your blood vessels. Patients generally start feeling the positive impact of cilostazol within 12 weeks. However, it might not be suitable for those who have a history of congestive heart failure.
Pentoxifylline, a medication that increases the oxygen supply to your muscles and thus helps with walking, has been approved for PAD treatment. But it has had mixed results in comparison to placebos in studies measuring walking distance.
When symptoms are not improved by exercise or medication, a minimally invasive procedure such as balloon angioplasty or placing a stent can assist. These methods work best on patients with focal obstructions in the iliac (hip) and superficial femoral (leg) arteries. The success rates and long-term reliability of these methods decline with patients with long-segment total obstructions or disease in the arteries below the knee.
Since PAD is not typically a life or limb-threatening condition, surgery should be reserved for those patients who have serious symptoms and impairments despite treatment with non-surgical and endovascular therapy. Surgical options for PAD include bypass grafts, which creates a new pathway for blood flow around the blockage, or endarterectomy, which involves the surgical removal of the obstructive plaque.
The use of statin medications, which can reduce cholesterol and other substances in your blood, has been proven to alleviate the effects of atherosclerosis (hardening of the arteries), a common cause of PAD. But treatment alone is not enough, the patient has to commit to changing their lifestyle and reduce the risk factors for this disease.
What else can Peripheral Arterial Disease be?
The following conditions can also present similar symptoms with specific diseases and confuse the diagnosis:
- Deep Vein Thrombosis
- Low Back Pain
- Superficial Thrombophlebitis
- Raynaud’s Phenomenon
- Thromboangiitis Obliterans
- Sciatica
What to expect with Peripheral Arterial Disease
Even with medical treatment, predicting the outcome of Peripheral Artery Disease (PAD), a condition where narrowed arteries reduce blood flow to your limbs, can be tough. If the patient doesn’t make any lifestyle changes, this disease can get worse over time. Also, many PAD patients might also have other major illnesses like stroke (cerebrovascular disease) or heart disease (coronary artery disease) which can raise the risk of death.
It’s worth noting that the results in women are often more unfavorable than in men; this is mainly due to the smaller size of their arteries. Moreover, women are at a greater risk of developing complications and embolic events – a sudden blockage in a blood vessel.
Possible Complications When Diagnosed with Peripheral Arterial Disease
Possible Complications:
- Ischemia/Gangrene: a condition where tissue dies due to lack of blood supply
- Amputation: the removal of a body extremity by trauma or surgery
- Infection: invasion and multiplication of microorganisms such as bacteria, viruses, and parasites that are not usually present within the body
- Ulceration: the formation of ulcers or sores on the skin
- Heart attack: a sudden and fatal condition of insufficient blood supply to the heart muscle
- Stroke: a condition where the blood supply to the brain is interrupted or reduced, causing the brain cells to die
- Blood clots: a gel-like mass of blood formed by platelets and fibrin in response to an injury
- Erectile Dysfunction: the inability to get and maintain an erection sufficient for sexual intercourse
Recovery from Peripheral Arterial Disease
If you get diagnosed with Peripheral Vascular Disease (PVD), which is a circulatory issue where narrowed blood vessels reduce blood flow to your limbs, please know that you need to monitor it for life. This is because, unfortunately, there’s no cure for PVD. However, making lifestyle changes can help manage the condition and prevent it from getting worse.
Preventing Peripheral Arterial Disease
Stop smoking, as it can have a negative impact on your health. If you have diabetes, make sure it’s under control, because unmanaged diabetes can lead to other health issues. It’s also important to maintain a healthy weight, as being overweight can potentially cause a number of health complications. Starting an exercise program is a great way to keep your health in check and improve your well-being. Finally, make sure your blood pressure and cholesterol levels are under control. Both high blood pressure and high cholesterol levels can put you at risk for heart disease.
