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PAD

PAD

Peripheral arterial disease (P.A.D.) is a disease in which plaque (plak) builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.

 

When plaque builds up in the body's arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

 

P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses on P.A.D. that affects blood flow to the legs.

 

The illustration shows how P.A.D. can affect arteries in the legs. Figure A shows a normal artery with normal blood flow. The inset image shows a cross-section of the normal artery. Figure B shows an artery with plaque buildup that's partially blocking blood flow. The inset image shows a cross-section of the narrowed artery.

 

Blocked blood flow to your legs can cause pain and numbness. It also can raise your risk of getting an infection in the affected limbs. Your body may have a hard time fighting the infection.

 

If severe enough, blocked blood flow can cause gangrene (tissue death). In very serious cases, this can lead to leg amputation.

 

If you have leg pain when you walk or climb stairs, talk with your doctor. Sometimes older people think that leg pain is just a symptom of aging. However, the cause of the pain could be P.A.D. Tell your doctor if you're feeling pain in your legs and discuss whether you should be tested for P.A.D.

 

Smoking is the main risk factor for P.A.D. If you smoke or have a history of smoking, your risk of P.A.D. increases up to four times. Other factors, such as age and having certain diseases or conditions, also increase your risk of P.A.D.

 

P.A.D. increases your risk of coronary heart disease (CHD; also called coronary artery disease), heart attack, stroke, and transient ischemic attack ("mini-stroke"). If you have CHD, you have a 1 in 3 chance of having blocked leg arteries.

 

Although P.A.D. is serious, it's treatable. If you have the disease, see your doctor regularly and treat the underlying atherosclerosis.

 

P.A.D. treatment may slow or stop disease progress and reduce the risk of complications. Treatments include lifestyle changes, medicines, and surgery or procedures. Researchers continue to explore new therapies for P.A.D.

Symptoms

While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (intermittent claudication).

 

Intermittent claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common.

 

The severity of intermittent claudication varies widely, from mild discomfort to debilitating pain. Severe intermittent claudication can make it hard for you to walk or do other types of physical activity.

 

Peripheral artery disease symptoms include:

 

  • Painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs (intermittent claudication).
  • Leg numbness or weakness.
  • Coldness in your lower leg or foot, especially when compared with the other leg.
  • Sores on your toes, feet or legs that won't heal.
  • A change in the color of your legs.
  • Hair loss or slower hair growth on your feet and legs.
  • Slower growth of your toenails.
  • Shiny skin on your legs.
  • No pulse or a weak pulse in your legs or feet.
  • Erectile dysfunction in men.

 

If peripheral artery disease progresses, pain may even occur when you're at rest or when you're lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

 

When to see a doctor 

 

If you have leg pain, numbness or other symptoms, don't dismiss them as a normal part of aging. Call your doctor and make an appointment.

 

Even if you don't have symptoms of peripheral artery disease, you may need to be screened if you are:

  • Over age 70.
  • Over age 50 and have a history of diabetes or smoking.
  • Under age 50 but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure.

Causes

The most common cause is the buildup of plaque on the inside of arteries. Plaque is made of extra cholesterol, calcium, and other material in your blood. Over time, plaque builds up along the inner walls of the arteries, including those that supply blood to your legs.

 

If plaque builds up in your arteries, there is less room for blood to flow. Every part of your body needs blood that is rich in oxygen. But plaque buildup prevents that blood from flowing freely and starves the muscles and other tissues in the lower body. See a picture of peripheral arterial disease of the legs.

 

This process of plaque buildup usually happens at the same time throughout the body. It is called atherosclerosis or hardening of the arteries. If you have this problem in your legs, you most likely will have it in the arteries that supply blood to your heart and brain. This increases your chance of having a heart attack or stroke.

 

Plaque builds up bit by bit over a lifetime. But symptoms often do not start until after age 65. High cholesterol, high blood pressure, and smoking make you more likely to get atherosclerosis and peripheral arterial disease.

Treatment

One of the most important things you can do for PAD is to quit smoking. If you need help quitting, talk to your doctor about programs and medicines that can help you stop. These can increase your chances of quitting forever.

 

There are also products that gradually wean you off nicotine. These include nicotine patches, chewing gums, nasal sprays, inhalers, and lozenges. These treatments help people have better success in the long term.

 

Your doctor may tell you to eat healthy foods and to get more exercise. You may need to take aspirin and medicines to lower your cholesterol and control your symptoms. If you have diabetes, you will need to carefully control your blood sugar.

 

Combined, these measures can help control your symptoms and reverse the blockage of your arteries. Keeping your arteries open can help lower your risk of heart attack and stroke. And it may also improve the quality and length of your life.

 

If your leg pain does not get better after a few months of treatment, your doctor may prescribe a medicine called cilostazol (Pletal) to help with the pain when you walk.

 

If you still do not get better, you may need a procedure called angioplasty or bypass surgery to open narrowed arteries or reroute blood flow around them. These treatments are usually used for severe peripheral arterial disease.

 

In rare cases, advanced PAD can cause tissues in the leg or foot to die because they do not get enough oxygen as a result of poor blood flow. If this happens, part of the leg or foot must be removed (amputated). This is more common in people who also have diabetes.

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