Peripheral Artery Disease

Plaque in the arteries of the trunk, arms, and legs can reduce blood flow to limbs and organs, causing pain, weakness, organ failure, and other complications.

What is peripheral artery disease?

Peripheral Artery Disease (PAD) refers to the build-up of plaque in areas of the body such as the trunk, arms, and legs. This plaque reduces or blocks the flow of oxygen-rich blood, causing pain, weakness, and other complications.

PAD most commonly occurs in the lower abdomen and legs, but can affect arteries in the arms, kidneys, stomach, and head. Left untreated, it can lead to serious conditions such as stroke, organ failure, or—in the case of the leg—gangrene and amputation.

What are the symptoms of PAD in the lower extremities?

Typical symptoms include:

  • Pain or cramping (intermittent claudication) in the hip, thigh, or calf muscles, especially after exertion such as walking or climbing stairs
  • Coldness, numbness, weakness, or heaviness in the leg
  • Sores on the legs that won’t heal
  • Weak pulse in the legs or feet
  • Changes in skin color or shiny skin on the legs
  • Erectile dysfunction in men

PAD usually occurs in people over the age of 70, although it can occur in younger people with risk factors such as obesity, diabetes, smoking, and high blood pressure.

Those with PAD are also more likely to have coronary artery disease (CAD) or carotid artery disease—which can lead to serious conditions such as heart attack or stroke.

How is it diagnosed?

Various tests may be used to diagnose PAD, such as:

  • Tests to check the pulse and blood flow in the affected limbs – including an Ankle-Brachial Index (ABI), which compares blood pressure in the arms with that in the legs to see how well blood is flowing
  • Blood tests – to check for diabetes and high cholesterol
  • Treadmill test – to determine the impact of exercise on symptoms
  • Ultrasound, MRI, or angiogram – to check the flow of blood through the affected area and look for blockages

What causes PAD?

Atherosclerosis is caused by a build-up of plaque, which consists of fat, cholesterol, calcium, and fibrous substances in the blood. Atherosclerosis appears to stem from damage to the walls of the arteries in the heart, which may be due to a combination of:

  • High blood pressure
  • High LDL (“bad”) cholesterol
  • Low HDL (“good”) cholesterol
  • Smoking
  • Diabetes or insulin resistance
  • Obesity
  • Sedentary lifestyle
  • Inflammation

Other factors—such as blood clots, physical injury, and genetic conditions—may also play a part.

How is PAD treated?

Those with less severe cases may be advised to make lifestyle changes through exercise, diet, and smoking cessation. For more advanced cases, treatment may include:

  • Medication – to reduce blood cholesterol or high blood pressure, prevent blood clots, or treat pain
  • Angioplasty and stent placement – inserting a catheter into the blocked artery and inflating a balloon to press the plaque against the wall of the artery to improve blood flow; a stent (wire mesh tube) may be placed to keep the artery open
  • Atherectomy – inserting a catheter into the blocked artery and using a special device to remove the blockage
  • Bypass surgery – using a blood vessel from another part of the body to re-route or bypass the blockage

How many people are affected by PAD?

Nearly 8 million Americans are affected by PAD in the lower extremities, and the number is set to grow as the population ages due to the high incidences of diabetes, high blood pressure, smoking, and other risk factors in the population.

References:

Peripheral Artery Disease,” Mayo Clinic, accessed online 01.05.16.
What is Peripheral Artery Disease?,” NIH: National Heart, Lung, and Blood Institute, accessed online 01.05.16.
About Peripheral Artery Disease (PAD),” American Heart Association, accessed online 01.06.16.
Facts about Peripheral Arterial Disease (P.A.D.),” NIH: National Heart, Lung, and Blood Institute, accessed online 01.06.16.
Girish R. Mood, et. al., “Atherectomy in the Treatment of Lower-Extremity Peripheral Artery Disease: A Critical Review,” Vascular Disease Management, October 2013, 10(10), 192-197; accessed online 01.05.16.