Peripheral Artery Disease

What is peripheral artery disease?

Peripheral artery disease is a type of atherosclerosis. Atherosclerosis is a hardening and narrowing of the arteries. The peripheral arteries are the blood vessels that supply blood to the arms and legs. In most cases, peripheral artery disease affects the legs. When the problem is severe, it causes pain in the legs or hips when you walk.

How does it occur?

The narrowing of the inside of the arteries happens when deposits of cholesterol and calcium build up over time, clogging the arteries. These deposits on the inner artery walls are called plaque. After a time, the plaque may get so thick that it completely blocks the flow of blood through the arteries. Clogged or blocked arteries cannot provide enough oxygen and fuel for the body.

Several factors can increase your risk for developing peripheral artery disease:

• an inherited (genetic) tendency in your family
• diabetes
• high levels of blood fat (lipids), such as cholesterol
• high blood pressure
• cigarette smoking
• being overweight
• being physically inactive.

What are the symptoms?

The disease does not cause any symptoms until the arteries have become much narrower.

The first symptom, called claudication, is usually pain or cramping in the calf muscles when you walk or exercise your legs. The discomfort quickly goes away when you rest, but it may come back soon after you start walking again. As the narrowing gets worse, the pain gets worse. You may have pain in the thighs and buttocks if the narrowing is in the arteries bringing blood to the thighs. The pain may be in one or both legs.

Other possible symptoms are:

• feet that feel cool
• loss of feeling in the feet and toes
• loss of hair on the tops of your feet
• thickened nails
• pale, shiny, or bluish skin
• if you are a man, trouble getting and keeping an erection
• slow healing of cuts and scrapes on the feet and legs.

How is it diagnosed?

Your healthcare provider will examine you and ask about your symptoms and your personal and family medical history. He or she will check the pulses in your feet, legs, and groin.

Tests may be done to find which arteries are blocked. You may have an angiogram or Doppler (ultrasound) test.

• For an angiogram, dye is injected into the arteries. With the dye, your provider can watch the flow of blood through your arteries. Your provider can measure the narrowing of the arteries and find blockages.
• An arterial Doppler study is a painless test that sends ultrasound waves into your blood vessels. A computer uses echoes of these high-frequency sound waves to show blood flow. You don’t need any injections when you have a Doppler test, and it is helpful as a first test, but it is not as precise as an angiogram.

How is it treated?

The first important step of treatment is to manage any risk factors. For example, you will need to:

• Stop smoking.
• If you have diabetes, get better control of your blood sugar.
• Lower your blood pressure to a normal level.
• Lower the levels of fats (cholesterol or lipids) in your blood.

Your healthcare provider may recommend taking a small dose of aspirin every day. Nonsteroidal anti-inflammatory medicines (NSAIDs), such as aspirin, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your provider, do not take aspirin for more than 10 days for any reason.

You may need to make changes in your diet. A diet high in whole grains, such as whole wheat, oatmeal, and bran; fruits; and vegetables; and low in salt, animal fats, and refined sugar, is healthy for nearly everyone. It is especially important in the treatment of diabetes, high blood pressure, lipid problems, and vascular disease.

If you are a smoker, you must stop smoking. One of nicotine's effects is narrowing of the arteries. Each cigarette you smoke decreases blood flow as the inhaled nicotine circulates in your blood. It can cause a blood clot, which could bring on a heart attack or stroke.

Your healthcare provider may need to change the medicines you are taking or adjust your dosages. Some dosages or drugs are better for good blood flow than others. Your provider may prescribe new medicine to try to improve blood flow.

Exercise can help you improve and keep good blood flow. Your provider may recommend an exercise program for you. However, you may need surgery for significant blockages before you can exercise a lot. For example, you may have bypass surgery to remove the blocked area and replace it with a piece of a vein removed from another part of your body. If you have blockages in the arteries that flow into your legs, you may need abdominal surgery.

In some cases blockages in the peripheral arteries may be treated with angioplasty instead of surgery. Angioplasty is a procedure for stretching open a blocked artery using a thin tube called a catheter. The catheter has a balloon at the end that can be inflated to open up the artery. The catheter may also be used to put a metal mesh device called a stent in the artery to help keep the artery open.

If your disease is very severe and these procedures aren’t recommended for you, your foot or leg may need to be removed (amputated). Amputation is usually necessary if you have so little blood flow that the skin and other tissues die and you are at risk for life-threatening infection. Amputation is a last resort, but if peripheral vascular disease is not controlled, it is a possible result.

Ask your provider if you need to take medicine to keep blood clots from forming in your arteries. Blood clots can cause very serious problems when the arteries get too narrow. If you smoke, you have an even greater risk of blood clots.

How long will the effects last?

Peripheral artery disease is a disease that you will keep having and that will get worse unless you get treatment and do things to prevent plaque formation.

How can I take care of myself?

• Follow your healthcare provider's instructions on diet, exercise, and medicine.
• If you are a smoker, stop smoking.
• Take care not to hurt the affected leg. Injuries to that leg will heal much more slowly. Proper shoes, safe terrain, and safe exercise equipment are important.
• To prevent infection of the feet, inspect and care for them regularly. Wash your feet and change stockings daily. Wear comfortable shoes and trim your toenails straight across. If you have corns or calluses, get help from your healthcare provider or a podiatrist (foot specialist) to care for them safely.
• When you are exercising, stop and rest if you have too much pain in your legs. Start walking again when the discomfort has gone away. It may not seem like it makes sense to ask someone who has leg pain to walk, but research has shown that regular exercise can cause new blood vessels to form around the blocked ones.
• See your healthcare provider right away if your symptoms (pain, coolness, bluish color) suddenly get worse. It may mean that you have a complete blockage.

What can I do to help prevent peripheral artery disease?

The best way to try to prevent peripheral artery disease is to stay fit.

• Do not smoke.
• Try to reach and keep a normal weight, normal blood pressure, and normal levels of lipids and sugar in your blood.
• Eat a diet low in fat and refined sugar and high in whole grains, fruits, and vegetables.
• Exercise at least 3 to 4 times a week. Try to walk 20 or more minutes each time, or according to your healthcare provider's recommendation. Cycling and swimming are good alternatives to walking, but you should consult with your provider before you start a more vigorous program.