Peripheral Arterial Disease

What is peripheral arterial disease?

Peripheral arterial disease (also called peripheral artery disease) is a common circulatory problem that causes your arteries in the limbs, neck (carotids), aorta, or branches of aorta to become narrower, thereby reducing blood flow.

What causes peripheral arterial disease?

The cause of peripheral artery disease is often atherosclerosis, a condition characterized by a buildup of fatty deposits (plaques) in your artery walls which gradually reduces your blood flow. While the heart is usually the focus of atherosclerosis, it can and usually will affect arteries throughout your entire body. When located in the arteries outside of the heart, it causes peripheral arterial disease. Less frequently, the cause of peripheral arterial disease may be an injury to your limbs, unusual anatomy of your ligaments or muscles, blood vessel inflammation, or radiation exposure.

What are the common symptoms of peripheral arterial disease?

When you develop peripheral arterial disease, your extremities — usually your legs — don’t receive enough blood flow to keep up with demand. Although many people with peripheral arterial disease have mild symptoms or none at all, others experience leg pain when walking (intermittent claudication). Intermittent claudication symptoms include muscle pain, cramping or heaviness in the arms or legs, triggered by an activity such as walking or use of arms, which disappears after a few minutes resting.

The location of the pain is determined by the location of the clogged or narrowed artery. The most common location is the calf. The severity of intermittent claudication can vary widely, from mild discomfort to severe and debilitating pain. Severe intermittent claudication can make it extremely difficult to walk or do certain other physical activities. If the narrowing occurs in the arteries of the neck, or carotids, you may experience dizziness, lightheadedness, or symptoms of a stroke.

Peripheral arterial disease symptoms include:

• painful cramps in your butt, thigh, hip, calf after activities like walking and climbing stairs (intermittent claudication)
• a change in the color of your legs
• leg weakness or numbness
• sores on your toes, feet or legs that won’t heal
• coldness in your lower leg or foot, especially when compared with the other side
• slower growth of your toenails
• a weak pulse or no pulse in your legs or feet
• slower hair growth or hair loss on your feet and legs
• shiny skin on your legs
• erectile dysfunction in men

With the progression of peripheral arterial disease, pain may even occur when you are resting or lying down. It may be intense enough to awaken you from your sleep. Hanging your legs over the edge of your bed or walking around may relieve the pain temporarily.

Is peripheral arterial disease dangerous?

Peripheral arterial disease is most often a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis) which reduces blood flow to your heart and brain as well as to your legs. Possible complications may include: coronary arterial disease; blood clots which block off small arteries; open sores on the lower legs; impotence, and tissue death (gangrene).

What factors increase your risk of peripheral arterial disease?

You may be at risk of peripheral arterial disease if you are: over age 70; over age 50 with a history of diabetes or smoking; or are under age 50, but have diabetes and other peripheral arterial disease risk factors, such as obesity or high blood pressure. A family history of peripheral arterial disease, heart disease or stroke may also increase the odds of your incurring peripheral arterial disease.

What complications are brought about by peripheral arterial disease?

If your peripheral arterial disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you’re also at risk of developing critical limb ischemia, a condition which begins as an injury, open sores that don’t heal, or an infection of your legs or feet. Critical limb ischemia occurs when such infections or injuries progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.

Other complications include stroke and heart attack. The atherosclerosis that causes the signs and symptoms of peripheral arterial disease is not confined to your legs. Fat deposits may also build up in arteries supplying your brain and heart and therefore result in a stroke or heart attack respectively.

How is peripheral arterial disease detected?

During your physical examination, your doctor may look for signs which suggest the presence of peripheral arterial disease, including: specific sounds (called bruits) that are audible over the arteries with a stethoscope; absent or weak artery pulses in the extremities; changes in blood pressure in the limbs during exercise or at rest (treadmill test); and changes in nails or skin color due to tissue ischemia. Additionally, your doctor can combine your history of symptoms and the physical signs of peripheral arterial disease described above with imaging tests including: duplex ultrasound, an angiogram or an MRI (magnetic resonance imaging).

How is peripheral arterial disease treated?

Balanced exercise with rest. Stop smoking. Reduce your weight if you are overweight; if you are overweight and your cholesterol is high, eat a low-cholesterol and low-fat diet. Make sure your blood pressure is well controlled. Take care of your feet, especially if you also have diabetes; monitor your blood sugar levels if you have diabetes, and keep them under control.

Medications may be needed to control your peripheral arterial disease, including: pain relievers; aspirin or a medication called clopidogrel (Plavix) to keep your blood from clotting in your arteries; Cilostazol, a medicine that enlarges (dilates) the affected artery or arteries for moderate-to-severe cases that are not candidates for surgery; and medication to help lower your cholesterol.

Surgery may be an option if the condition is severe and affects your ability to work or do other important activities, or if you are having pain while resting. Options include: peripheral artery bypass surgery of the leg; and angioplasty and stent placement of the peripheral arteries. Some people with extreme peripheral arterial disease may need to have a diseased limb amputated.

When should I see a doctor if I believe I have peripheral arterial disease?

If you have numbness, leg pain, or other symptoms, doesn’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 arterial disease, you may need to be screened if you are: over age 70; over age 50 and have a history of diabetes or smoking; or are under age 50 but have diabetes and other peripheral arterial disease risk factors, such as high blood pressure, obesity, or high blood pressure.