Do You Need to Worry About Peripheral Artery Disease?
Cardiovascular Health
Peripheral artery disease — often referred to as PAD — is a blood vessel disease that makes it more difficult for the tissues in your arms and legs to get the oxygen and nutrients they need.
Researchers estimate that between 8 million and 12 million people in the United States (U.S.) are living with PAD. However, the actual number of people with PAD is likely higher. That’s because some people don’t have any symptoms of PAD and physicians may not recognize the signs of PAD.
Even if you haven’t been diagnosed with PAD, you may still have to worry about this silent disease with potentially serious health complications, such as limb amputation, heart attack, and stroke. In this article, we’ll review how PAD develops, common symptoms, and how it’s diagnosed and treated.
What Is Peripheral Artery Disease?
PAD happens when the arteries that supply the legs or arms become narrowed. Specifically, PAD affects the peripheral arteries — the blood vessels that carry oxygenated blood from the heart to the arms and legs.
When the arteries become narrowed, it makes it more difficult for the tissues in the legs or arms to get the oxygen and nutrients they need to function.
What Causes Peripheral Artery Disease?
The most common cause of PAD is atherosclerosis. Atherosclerosis is a gradual process where plaque builds up on the artery walls. Plaque is a sticky substance that’s made up of fats, cholesterol, and other substances. Over time, more and more plaque can collect on artery walls, making them thicker and harder. Eventually, enough plaque can build up that it affects how much blood can flow through the blood vessel. Atherosclerosis can be caused by several factors, including:
- High cholesterol levels
- High blood pressure
- Diabetes
- Smoking
Although atherosclerosis is the most common cause of PAD, other conditions can also narrow the blood vessels, including:
- Blood vessel inflammation
- Leg or arm injury
- Muscle or ligament changes
- Radiation therapy
Is Peripheral Artery Disease the Same as Coronary Artery Disease?
Coronary artery disease (CAD) is related to PAD, but they aren’t the same condition. CAD is the most common type of heart disease. It happens when atherosclerosis affects the arteries that supply the heart muscle with blood (the coronary arteries). When blood flow is restricted to the coronary arteries, it can cause a heart attack. Because of the relationship between CAD and PAD, if you have one, you should get tested for the other.
Who Gets Peripheral Artery Disease?
The risk of PAD increases with age. Most people with PAD are over the age of 50. African Americans are also more likely to have PAD compared to people of other races and ethnicities.
However the most important risk factor for PAD is using tobacco, which increases your risk of developing PAD by 400%. About 80% of people diagnosed with PAD currently smoke or have a past history of smoking.
People with certain medical conditions have an increased risk of PAD, including:- Diabetes
- High blood pressure
- High cholesterol
- Obesity
- Blood clotting disorder
- Kidney disease
What Are the Symptoms of Peripheral Artery Disease?
PAD may not cause any symptoms in the early stages. As more plaque builds up in the peripheral arteries, symptoms can become noticeable. Most people begin to experience symptoms when an artery is more than 60% blocked.
The first symptom is usually intermittent claudication — cramping and muscle pain in your legs and buttocks that happens when you’re active, but goes away with rest. It happens because your muscles aren’t getting enough oxygen while you’re active. Symptoms related to intermittent claudication may include:
- Muscle cramps or pain while walking or exercising
- Pain in your hips, thighs, or calves when climbing stairs
- Numbness in your lower legs or feet
- Weak pulse or no pulse in your legs or feet
If you have PAD in your arms, you may experience pain in your arms or hands when you do activities such as writing, sewing, or knitting.
Other symptoms of PAD may include:
- Burning or aching in your feet while lying flat
- Cold feet
- Discolored toes that may look pale, darker, or bluish
- Changes to the color of your skin on your legs
- Shiny skin
- Hair loss on the legs
- Frequent infections
- Sores or wounds on the legs and feet that don’t heal
- Erectile dysfunction
Can PAD Cause Serious Complications?
Without treatment, PAD can cause serious complications. Lack of blood flow and oxygen can cause tissue damage to the affected area. Eventually, it can lead to tissue death, called gangrene. Tissue damage and gangrene is most common in the feet and toes. If this happens, you may need an amputation (removal of part or all of your foot or leg). People with diabetes and PAD are more likely to need an amputation.
If you have atherosclerosis in your peripheral arteries, you’re also more likely to have atherosclerosis in other parts of your body, such as the blood vessels of your heart and brain. This increases your risk of having a heart attack or stroke.
What Are the Stages of PAD?
Physicians classify PAD into different stages to describe the severity. One system used to stage PAD is called the Fontaine system. In this system, PAD stages range from stage 1 (mild) to stage 4 (severe) based on your symptoms, as follows:
- Stage 1 — no symptoms
- Stage 2a — mild leg pain with exercise
- Stage 2b — moderate to severe leg pain with exercise
- Stage 3 — leg pain at rest
- Stage 4 — ulcers or tissue death
How Is Peripheral Artery Disease Diagnosed?
If you have symptoms of PAD, your physician will perform different tests to diagnose PAD.
Medical History and Physical Exam
Your medical history can help your physician understand your symptoms and if you’re at risk for PAD. They may ask you about your past medical history, current medical conditions, and family history. You should let your physician know if you’ve experienced any symptoms of PAD. You should include when your symptoms occur, and factors that improve or worsen your symptoms.
In a physical exam, your physician may check the pulse in your feet and hands. If you have PAD, your pulse may be weak or absent.
Laboratory Tests
Laboratory tests for PAD include blood tests to check for risk factors associated with PAD, such as high cholesterol and diabetes.
Ankle-Brachial Index
The ankle brachial index (ABI) is a quick and painless test for PAD your physician can perform in their office. The ABI compares the blood pressure in your arm to the blood pressure in your ankle.
The process of getting an ABI test is similar to the way your physician checks your blood pressure. However, an ABI involves a blood pressure cuff around each arm and each ankle. Your physician will also use an ultrasound device to listen to the blood flow in your arteries. If the results of the ABI aren’t conclusive, you may be asked to walk on a treadmill before the test is repeated.
If the results of your ABI test indicate that you likely have PAD, you’ll need additional testing.
Ultrasound
An ultrasound is an imaging test that uses sound waves to create a real-time image of soft tissues. An ultrasound of your legs or feet creates an image of how your blood moves through your blood vessels to help spot the problem.
A Doppler ultrasound is a special type of ultrasound that’s used to measure blood flow. It can help identify where arteries are blocked or narrowed.
Angiogram
An angiogram is another type of procedure that helps your physician see how your blood is flowing through your blood vessels. During this procedure, you’ll be injected with a contrast dye that helps your blood vessels appear more clearly on imaging tests. Different imaging tests can help create an image of your blood vessels, including an X-ray, computed tomography (CT) scan, or magnetic resonance imaging (MRI) scan.
Can Peripheral Artery Disease Be Caught Early?
Your physician may recommend an ABI test to catch PAD before it causes symptoms. This is known as a screening test. Health experts recommend that everyone over the age of 65 get an ABI test to check for PAD. You may need PAD before the age of 65 if you have risk factors for atherosclerosis, such as diabetes or tobacco use.
It’s also important to talk to your physician as soon as you recognize any early symptoms of PAD. Although pain in your legs while walking or exercising can be caused by other medical conditions, you should let your physician know your symptoms so they can investigate the cause. In the early stages, it may be possible to reverse PAD with proper management.
How Is Peripheral Artery Disease Treated?
The goals of PAD treatment are to improve your symptoms so you can get back to exercising and doing the activities you enjoy. With appropriate treatment, you can also lower your risk of serious complications, including limb amputation, heart attack, and stroke.
There are three main treatment approaches for PAD — healthy lifestyle changes, medication, and surgery.
Healthy Lifestyle Changes
Making healthy changes to your lifestyle can help reduce several risk factors associated with PAD. One of the most important lifestyle changes is to quit smoking or using other tobacco products. Smoking cessation can be difficult. Talk to your physician about smoking cessation programs.
Exercise is also an effective PAD treatment. If exercise is painful for you, start slowly. A supervised exercise therapy program can help make sure you’re exercising safely.
A heart healthy diet full of fruits, vegetables, and whole grains and low in saturated and trans fats may help you lower your cholesterol levels. With lower cholesterol levels, you can reduce your risk that atherosclerosis progresses.
You should also talk to your physician about how to care for your feet to avoid sores that may lead to serious infections and limb amputations.
Medication for PAD
Cilostazol (Pletal) is a medication that can help improve symptoms of intermittent claudication. It works by improving blood flow so you’re able to walk further without pain.
People with PAD may also take medications to treat related conditions and prevent complications, such as heart attack or stroke. Other medications for PAD may include:
- Cholesterol-lowering medications — Medications, such as statins, can reduce your cholesterol level to reduce the risk of atherosclerosis.
- Blood pressure-lowering medications — High blood pressure medications can help manage your risk of heart disease.
- Diabetes medications — If you have diabetes, these medications can help you manage your blood sugar.
- Medications to prevent blood clots — Antiplatelets (such as aspirin) and anticoagulants (such as rivaroxaban, or Xarelto) can lower your risk of developing dangerous blood clots that can form when PAD blocks blood flow.
Work with your physician to understand how your medical conditions can affect PAD and how meeting treatment goals may improve your symptoms.
Surgery for PAD
If lifestyle changes and medications aren’t enough to manage your symptoms, you may need a surgical procedure. Luckily, the procedures used to treat PAD are minimally invasive, meaning they only use small incisions and specialized tools.
An angioplasty and stent placement are procedures to help open a narrowed artery and improve blood flow. In this procedure, your physician will make a small incision and insert a long, thin tube (called a catheter) into the artery to reach the blockage. Once at the blockage, they’ll inflate a small balloon to widen the artery. In some cases, a wire tube (called a stent) can be placed to keep the artery open.
Another minimally invasive procedure your physician may suggest is an atherectomy. In this procedure, your physician will use a catheter with a sharp blade on the end. They’ll use the blade to remove plaque from the wall of the artery to widen it and improve blood flow.
If you have a longer section of an artery that’s blocked, you may need bypass surgery. This type of surgery uses a vein from another part of your body to create a new path for blood that “bypasses” the clogged artery.
Worried About PAD? Here’s What You Can Do
If you’re experiencing leg pain while walking or exercising, don’t ignore it. Talk to your physician to find the cause. An ABI test can help detect PAD early when you have more treatment options that may reverse the disease.
Even if you don’t have any symptoms of PAD, it’s important to understand your risk factors, such as smoking, diabetes, and high cholesterol. Work with your physician to manage your risk factors to lower your risk of PAD and heart disease. Although PAD is a serious condition, it’s manageable with treatment. The sooner you act, the lower your risk of serious complications.
