Peripheral artery disease, also known as peripheral arterial disease, is a medical condition in which the arteries that carry oxygenated blood from the heart to the peripheral parts of the body, such as your legs or arms, become narrow or blocked. PAD is a type of peripheral vascular disease. Although it can occur in any blood vessel, it is more common in legs than arms.
The blockage or narrowing is due to atherosclerosis (plaque formation), caused by the accumulation of fats and/or cholesterol in the blood vessels. Narrowing leads to a reduced blood supply, not meeting the demand for nutrients and oxygen. This further leads to symptoms such as leg pain while walking.
PAD could go unnoticed for some time, or you might feel mild symptoms. Few people do not experience any symptoms. Broadly, the classic PAD symptom is claudication, i.e. experiencing leg pain while doing physical activity such as walking. The pain gets better after resting. The claudication symptoms include aches, muscle pain, or cramps in the legs or arms; however, the exact location of the pain /cramp will be the location of the clogged artery. The calf muscle is the most common location of PAD-associated pain.
The severity of the pain could vary from mild to debilitating pain and depend on the blockage's extent. Severe pain could bar you from walking or doing other physical activities.
Other symptoms of PAD could include the following:
- Pain and cramps in calf, thigh, or hip muscles in one or both the legs
- Pain in the arms while writing or doing any other manual activity
- Weakness of legs
- Feeling of numbness in legs
- Feeling of cold leg or foot in one limb compared to the other one
- Feeling no or weak pulse in leg/feet
- Non-healing sores in feet or toes
- Color change of your leg skin
- Shining of your leg skin
- The slow growth of toenails
- The slow growth of hairs on your legs
- Erectile dysfunction (in males)
Progression of PAD could lead to severe pain even during a resting state and could also disturb your sleep.
The most common cause of PAD is atherosclerosis, in which plaque is formed in the peripheral blood vessels. The plaque is made up of fatty deposits that start to build up along the wall of the arteries, leading to reduced blood flow.
In the beginning, plaque is waxy due to fat accumulation and starts to deposit on the sides of the walls. Slowly, the arteries become narrower and more complex, and the blood flow tends to reduce as the plaque formation increases.
Other causes of PAD could include the following:
- Inflammation of the blood vessels
- Trauma or injury to the limbs
- Exposure to radiation
- Abnormal anatomy of the muscles or ligaments
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Various risk factors that increase the chance of developing PAD include the following:
- Smoking is a significant risk factor for PAD. The majority of the people with PAD are current or former smokers.
- Using other tobacco products
- History of diabetes
- History of cardiovascular conditions or complications
- Being obese
- Family history of heart or vascular diseases
- Not being physically active
- History of hyperlipidemia (high lipid levels in the blood, including cholesterol)
- Age >50 years increases the chances of developing PAD
- African Americans are more prone to develop PAD
- History of hypertension (high blood pressure)
- History of blood clotting disorders
- History of kidney disease
If you experience pain in the extremities, numbness, or any other symptoms associated with PAD, you should consult a doctor and get a diagnosis done for PAD. These could be initial signs of the disease, and early treatment saves you from potential complications and saves a lot of money. Per the American Heart Association (AHA), early detection is the key.
You should get the PAD screening done, even if there are no visible symptoms, in the following scenarios:
- You are above 65 years of age
- You are above 50 years of age and are diabetic or a smoker
- You are above 50 years of age and have diabetes, high blood pressure, or obesity
Diagnosis of PAD typically starts with a physical examination and assessment of the symptoms. Your doctor could physically examine the location of the pain, look for a weak or absent pulse, or look for signs of numbness. Your doctor may also recommend specific blood tests such as blood glucose levels for diabetes or lipid and cholesterol levels. In addition, you might undergo the following tests:
- Ankle-brachial index (ABI): This test compares the blood pressure in your arm to that of your ankle.
- Ultrasound: This imaging technique helps your doctor assess the blood vessels and look for signs of blockage or narrowing.
- Angiography: This test helps assess the blood flow with the help of imaging techniques such as X-ray, Magnetic resonance angiography (MRI), or Computerized tomography (CT). A dye could be used to enhance the image quality and detect the blockage.
Having PAD increases the risk of developing various cardiovascular diseases that could cause significant morbidity and mortality. The risk of developing coronary artery disease (CAD) is also increased multifold if you have PAD. If left untreated, the following complications could occur:
- Heart attack: Extended reduction in blood supply due to atherosclerosis could lead to permanent damage to the muscle of your heart, leading to a heart attack.
- Stroke or Transient Ischemic Attack (TIA): Interruption of the blood supply to the brain could lead to stroke or TIA, which could be life-threatening.
- Critical limb ischemia: Untreated PAD could lead to non-healing sores and infections, eventually leading to tissue death.
- Renal artery disease: Blood supply to the kidney is reduced due to narrowing (stenosis) or blockage of the artery supplying blood to the kidney.
- Amputation: This is more common in people with diabetes, where a part of the feet or leg is removed due to gangrene or other complications.
You can follow handy lifestyle preventive tips to stay ahead of the disease and live a complication-free life.
- Quit smoking: Quitting smoking will reduce your chances of developing PAD and associated cardiovascular complications. In addition, stop using any other tobacco products.
- Exercise: Regular exercise and physical activity are crucial to keeping you healthy. You should aim for at least 30-45 minutes of exercise daily or 150 minutes in a week. Waking is an excellent exercise for people with PAD, and regular walking helps to reduce the symptoms such as pain and numbness.
- Healthy diet: Aim for a healthy diet with a good mix of proteins, fiber, and nutrients. Cut down on junk foods and processed foods rich in fats, sodium, or sugar content. Avoid foods high in Trans fats, saturated fats, and cholesterol.
- Manage diabetes: If you have diabetes, keep your blood sugar levels in control. Doing so will help reduce the risk of PAD and associated complications.
- Maintaining a healthy weight: Managing obesity and maintaining a healthy weight is crucial to reducing the risk of developing PAD and other vascular disorders. You should aim to maintain your body mass index (BMI) close to 25.
- Managing stress: You should aim to reduce stress levels and practice Yoga, meditation, or deep breathing exercises to calm your nerves.
- Stay alert: Keep a lookout for any potential symptoms of PAD. Get your PAD screening done if you experience any of the symptoms.
Keep good care of your foot and skin to avoid the risk of developing any sores, infections, or associated conditions.
Treatment of PAD will depend on the severity of the symptoms, age of the patient, location of the clogged artery, and overall health condition of the patient. The treatment aims to reduce the risk of complications such as stroke or heart attack and improve your quality of life (QOL) through pain relief. The following treatment approaches are available:
- Medications: Various medications such as lipid-lowering drugs, anti-hypertensive drugs, anti-diabetic medications, and anti-platelet aggregation drugs are given to control a range of factors associated with plaque formation and reduce morbidity. In addition, drugs such as cilostazol could be prescribed that help reduce the symptoms of PAD and aid in pain-free walking.
- Angioplasty: These minimally invasive procedures include placing a balloon or stents inside your arteries through catheters to keep them open.
- Surgery: Alternatively, a surgical approach such as peripheral artery bypass surgery or atherectomy could be employed to remove the blocked artery or plaque.
- Supervised exercise program: A supervised exercise program helps to improve the pain and blood flow in the arteries. It aims to increase the walking distance that you can cover without pain.