Peripheral artery disease (PAD) is a progressive narrowing of the blood vessels not within the coronary, aortic arch vasculature, or brain. It is most often caused by atherosclerosis, the collection of plaque or a fatty substance along the inner lining of the artery wall. Over time, this substance hardens and thickens, which may interfere with blood circulation to the arms, legs, stomach and kidneys. Blood circulation to the brain and heart may be reduced, increasing your risk for stroke and heart disease.
While PAD can affect anyone, one of out three diabetics over age 50 has the disease. Approximately 5 percent of the population over the age of 65 has detectable arterial blockage in the legs. About 20% of patients with mild PAD may be asymptomatic.
If untreated, it may result in severe disability and in serious cases, leg amputation. Up to 70 percent of all limb amputations not caused by trauma are performed on diabetics with severe PAD.
Blockage of the circulation in the legs is a common sign of atherosclerosis, or hardening of the arteries. Poor circulation of the legs also can be the result of less common causes including aneurysms, the compression of arteries and dissections or internal tears extending along the length of the artery.
While many patients with peripheral artery disease (PAD) have mild symptoms or no symptoms at all, about one in 10 experiences painful cramping or fatigue in the legs, hip, thigh or calf muscles after walking or climbing stairs, which is relieved by a short period of rest. This condition is called intermittent claudication.
The symptoms of arterial blockage vary by individual, including:
- Change in the color of the legs
- Changes in the toenails
- Coldness in the lower leg or foot, especially compared to the other leg
- Hair loss on the feet and legs
- Leg numbness or weakness
- Sores on the toes, feet or legs that won’t heal
- Pain when walking, called claudication
- Pain when at rest
- Foot ulcers
Treatment is based on the degree of blockage and the symptoms present. Many patients can be managed with non-invasive therapies such as lifestyle changes, medication, or both. If your condition does not respond to these approaches, surgery may be necessary. In the most advanced cases, limb amputation may be required.
Treatment may include the following:
- Lifestyle Changes
- Smoking cessation
- Diabetes control
- Blood pressure management
- Physical activity
- Diet low in saturated fats
- Cholesterol medication
- Specific medications
- Medications to prevent blood clots, called antiplatelet therapy, such as aspirin or clopidigrel
- Medications to lower your cholesterol, called statins, such as simvastatin, atorvastatin or pravastatin
- Medications that may help you walk, such as cilostazol or pentoxifylline
- Medications to treat your high blood pressure, called ACE inhibitors
- Balloon angioplasty where a catheter-guided balloon is inflated inside the affected artery to relieve the blockage
- Surgery — often bypass surgery to direct blood flow around the blocked area of the artery, or endarterectomy, the surgical removal of plaque from the blocked artery.