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Treatment Peripheral Arterial Disease

Peripheral arterial disease (PAD) occurs when a fatty material called plaque builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs, and limbs. PAD is also known as atherosclerotic peripheral arterial disease.

Symptoms

At least half of the people who have peripheral arterial disease (PAD) don't have any signs or symptoms of the disease.

People who do have signs or symptoms may have pain when walking or climbing stairs, which may be relieved after resting. This pain is called intermittent claudication. Blood brings oxygen to the muscles, but during exercise, muscles need more blood flow. If there is a blockage in the blood vessels, muscles won't get enough blood. If a person has intermittent claudication and exercises while in pain, his or her muscles may be harmed. When resting, the muscles require less blood flow and the pain goes away. Claudication is more likely in people who also have atherosclerosis in other arteries, such as the heart and brain. About 10 percent of people with PAD have intermittent claudication.

Other signs and symptoms of PAD include:

  • Pain, numbness, aching, and heaviness in the muscles
  • Cramping in the legs, thighs, calves, and feet
  • A weak or absent pulse in the legs or feet
  • Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all
  • Color changes in skin, paleness, or blueness (called cyanosis)
  • A decreased temperature in one leg compared to the other leg
  • Poor nail growth and decreased hair growth on toes and legs
  • Erectile dysfunction, especially among people with diabetes

Diagnosis

Peripheral arterial disease (PAD) is diagnosed based on general medical and family history, history of leg or heart problems, personal risk factors, a physical exam, and test results. An accurate diagnosis is critical, because people with PAD face a six to seven times higher risk of heart disease or stroke than the rest of the population. PAD is often diagnosed after symptoms are reported. If you have PAD, your doctor also may want to look for signs of coronary artery disease (CAD).

A simple test called an ankle-brachial index (ABI) can be used to diagnose PAD. The ABI compares blood pressure in the ankle with blood pressure in the arm to see how well blood is flowing. A normal ABI is 1.0 or greater (with a range of 0.90 to 1.30). The test takes about 10-15 minutes to measure both arms and both ankles. It can help the doctor find out if PAD is affecting the legs, but it will not identify which blood vessels are blocked. The ABI can be performed yearly if necessary to see if the disease is getting worse.

The illustration shows the ankle-brachial index (ABI) test. The ABI gives the ratio of the systolic blood pressure in the ankle to the systolic blood pressure in the brachial artery of the arm. [Credit: NIH]

A Doppler ultrasound is a test that uses sound waves to tell whether a blood vessel is open or blocked. This test uses a blood pressure cuff and special device to measure blood flow in the veins and arteries in the arms and legs. The Doppler ultrasound can help to determine the level and degree of PAD.

A treadmill test will provide more information on the severity of the symptoms and the level of exercise that provokes symptoms. For this test, you will walk on a treadmill, which will help identify any difficulties that you may have during normal walking.

A magnetic resonance angiogram (MRA) uses radio wave energy to take pictures of blood vessels inside the body. MRA is a type of magnetic resonance imaging (MRI) scan. An MRA can detect problems that may cause reduced blood flow in the blood vessels. It can determine the location and degree of blockage. A patient with a pacemaker, prosthetic joint, stent, surgical clips, mechanical heart valve, or other metallic devices in his or her body might not be eligible for an MRA depending on the type of metallic device.

An arteriogram is a "road map" of the arteries used to pinpoint the exact location of the blockage in a limb. An x ray is taken after injecting dye through a needle or catheter into an artery. When the dye is injected, the patient may feel mildly flushed. The pictures from the x ray can determine the location, type, and extent of the blockage. Some hospitals are using a newer method that uses tiny ultrasound cameras to take pictures inside the blood vessel.

Blood tests may be done to check the patient's blood sugar level to screen for diabetes. Blood tests also may be used to check the patient's cholesterol levels.


Causes

The most common cause of PAD is atherosclerosis, which is the hardening of arteries. Atherosclerosis causes the arteries to narrow or become blocked, which can reduce or block blood flow. PAD most commonly affects blood flow to the legs.

Blocked blood flow can cause pain and numbness. It also can increase a person's chance of getting an infection, and it can make it difficult for the person's body to fight the infection. If severe enough, blocked blood flow can cause tissue death (gangrene). PAD is the leading cause of leg amputation.

The illustration shows the location of leg arteries that can be affected by peripheral arterial disease. 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, which is partially blocking blood flow (the inset image shows the degree to which the artery is blocked). [Credit: NIH]

 

Reference:

National Heart, Lung, and Blood Institute, USA.