Legs/Peripheral Vascular Disease

 

What is Peripheral Arterial Disease?
Peripheral Arterial Disease (PAD) is a common, yet serious, vascular disease that affects more than eight million people in the United States. It occurs when extra cholesterol and other fats circulating in the blood collect in the walls of the arteries that supply blood to your limbs. This buildup – called plaque – narrows your arteries, often reducing or blocking the flow of blood. PAD is most commonly seen in the legs, but can also be present in the arteries that carry blood from your heart to your head, arms, kidneys and stomach. Many individuals with PAD suffer from an inability to walk as far or as fast as they could in the past. This can become lifestyle-limiting, and even debilitating.

People who have PAD are more likely to have foot problems. Minor foot injuries can cause sores or ulcers that can turn into serious infections. If these sores are not treated right away, they may lead to losing a toe, foot or leg. In fact, PAD is one of the leading causes of foot or leg amputations in the United States. Finding and treating PAD early can help keep your legs healthy, lower your risk for heart attack or stroke, and save your life and limbs.

What causes PAD?

PAD is caused by atherosclerosis, a disease process which results in plaque formation within arteries. It is the build-up of plaque which narrows or occludes arteries, thereby restricting blood flow to the tissues of the limbs. There are several risk factors for the development of PAD.

Your risk increases if you:

Are over the age of 50. 

Smoke or used to smoke. Those who smoke or have a history of smoking have up to four times greater risk of PAD.

Have diabetes. One in every three people over the age of 50 with diabetes is likely to have PAD.

Have high blood pressure. Also called hypertension, high blood pressure raises the risk of developing plaque in the arteries.

Have high cholesterol. Excess cholesterol and fat in your blood contribute to the formation of plaque in the arteries, reducing or blocking blood flow to your heart, brain or limbs.

Have a personal history of vascular disease, heart attack or stroke. If you have heart disease, you have a one in three chance of also having PAD.

What are the signs and symptoms of PAD?

In the early stages of PAD, most people do not have any symptoms. If they are present, the typical signs and symptoms of the disease include the following:

Claudification - fatigue, heaviness, tiredness, and cramping in the leg muscles (buttocks, thigh, or calf) that occurs during activity such as walking or climbing stairs. This pain or discomfort goes away once the activity is stopped and during rest.

Pain in the legs and/or feet that disturbs sleep.

Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all.

Color changes in the skin of the feet, including paleness or blueness.

A lower temperature in one leg compared to the other leg.

Poor nail growth and decreased hair growth on toes and legs.

How is PAD diagnosed?
The first step is to talk with your health care provider about your risk for PAD. Your provider will take your medical and family history, perform a physical exam, and conduct diagnostic tests.

Diagnostic Tests: When checking you for PAD, your health care provider may perform a simple noninvasive test called an ankle-brachial index (ABI). Painless and easy, the ABI compares the blood pressure readings in your ankles with the blood pressure readings in your arms. An ABI can help determine whether you have PAD, but it cannot identify which arteries are narrowed or blocked. Your health care provider may obtain additional imaging studies such as Doppler ultrasound to determine specific sites of arterial blockage. Your health care provider may also perform blood tests to see if you have diabetes and check your cholesterol levels. Other tests are also used to help diagnose PAD. Talk with your health care provider for more information.

How is PAD treated?
The overall goals for treating PAD are to reduce any symptoms; improve quality of life and mobility; and prevent heart attack, stroke and amputation. Your health care provider will determine the best treatment options for you, based on your medical history and the severity of your condition. There are four main approaches to treating PAD:

Lifestyle Changes: PAD treatment often includes making long-lasting lifestyle changes. If you have PAD, or are aiming to prevent it, your health care provider may prescribe one or more of the following:

Quit smoking. Consult with your health care provider to develop an effective cessation plan and stick to it.

Lower your numbers. Work with your health care provider to correct any high blood pressure, cholesterol and blood glucose levels.

Follow a healthy eating plan. Choose foods that are low in saturated fat, trans fat and cholesterol. Be sure to include whole grains, vegetables and fruits.

Get moving. Make a commitment to be more physically active. Aim for 30 minutes of moderate-intensity activity on most, preferably all, days of the week.

Aim for a healthy weight. If you are overweight or obese, work with your health care provider to develop a supervised weight-loss plan.

Medical Management: In addition to lifestyle changes, your health care provider may prescribe one or more medications. These medications are used for the following reasons:

Lower high blood pressure and cholesterol levels and treat diabetes.

Prevent the formation of blood clots that could cause a heart attack or stroke.

Help reduce leg pain while walking or climbing stairs.

Stenting: If your symptoms of PAD are severe or don’t respond to medical therapy, your doctor may request diagnostic studies to determine the exact extent of your PAD. In many cases, a balloon can be used to dilate the narrowed segment of the affected artery. Sometimes a stent is necessary to maintain the newly dilated channel.

Surgery: In some instances, minimally invasive techniques may not be possible or advisable. Instead, surgical bypass can be performed to restore circulation to the involved extremity. Bypass can be constructed using a segment of vein from the patient’s leg, or alternatively, with an artificial blood vessel.