Peripheral Artery Disease

What is peripheral artery disease?

Peripheral artery disease (PAD) is a common, but serious disease in which plaque builds up inside the arteries of the vascular system, which reduces the flow of blood. It can affect any artery in the body, including arteries in the heart, brain, arms, legs, and pelvis.

Arteries carry oxygen-rich blood from the heart to the rest of the body. Over time, cholesterol and other fats circulating in the blood collect in the walls of the arteries, creating a waxy substance called plaque. As plaque builds, it causes atherosclerosis, which is when arteries narrow and harden, slowing or blocking the flow of blood to the organs and limbs that need it to remain healthy.

Most often, PAD affects the legs, causing intermittent claudication, which is basically leg pain when walking. Though not everyone experiences this pain, almost all who have PAD find that they cannot walk as fast or as far as they could before developing the condition.

It’s not known why plaque builds up in the limbs, and the rate at which is progresses is different for each person. Factors believed affect its progress include the patient’s overall health and the location in the body where the plaque has built up.

There are certain risk factors that can increase your chances of developing PAD. They include:

  • being over age 50
  • being a current or former smoker, which increases the risk up to four times
  • having high cholesterol, which contributes to plaque buildup in the arteries
  • having high blood pressure (hypertension)
  • having diabetes
  • having a medical history of heart attack, vascular disease, or stroke
  • being African-American, which can double the risk over their Caucasian counterparts

PAD can be treated. For some people, treatment may be as simple as eating a healthy diet, following a routine exercise program, and quitting smoking. But, if left untreated, PAD can lead to other serious health problems, such as:

  • heart attack (myocardial infarction), in which the flow of oxygen-rich blood to the heart is blocked, causing a section of the heart muscle to become damaged and begin to die
  • stroke, which is a sudden loss of brain function caused by the interruption of flow of blood to the brain or the rupture of blood vessels in the brain causing brain cells in the affected area to die
  • transient ischemic attack (TIA)—also called a mini-stroke—which occurs when blood flow to a part of the brain stops for a brief time causing stroke-like symptoms
  • renal artery disease or stenosis, which is is the narrowing of arteries that carry blood to one or both of the kidneys, often leading to high blood pressure, kidney damage, or kidney failure
  • amputation, which is the removal of part or all of the foot or leg due to poor circulation caused by narrowing of the arteries, particularly in those who have diabetes

What are the symptoms of peripheral artery disease?

Most people who have PAD do not have any symptoms, or if they do, they are mild. However, since PAD builds up over time, symptoms may not appear until later in life, or until an artery has narrowed by 60 percent or more.

Often, the first symptom that appears is intermittent claudication, which is a pain, cramping or discomfort in the leg muscles caused by reduced blood flow that is felt during activities, such as walking or climbing stairs. The problem tends to go away after a few minutes of rest, when less blood flow is needed.

Where the pain is felt in the leg depends on the location of the blocked or narrowed artery. Many people feel it in their calves, while others experience it in their thighs or buttocks. The level of pain can range from mild discomfort to severely debilitating, making it difficult to get around. Other symptoms of intermittent claudication can include tiredness or fatigue, weakness, numbness, or heaviness in the legs.

Other symptoms that can come with advanced PAD include:

  • pain, burning or aching in the legs and feet when at rest, or at night when lying fat
  • coldness in one leg foot, but not the other
  • weak or no pulse in your legs or feet
  • sores or wounds on the legs, feet, or toes that have trouble healing
  • color changes of the legs or feet, such as paleness, redness, or blueness
  • decreased hair growth on the legs or feet
  • slower or poor toenail growth
  • increased number of infections on the legs or feet
  • erectile dysfunction

If you are experiencing any of these symptoms, contact your doctor to be tested for PAD and learn what you can do to lower your risk.

How is peripheral artery disease diagnosed?

If you are experiencing leg muscle pain or if you suspect you may have or be at risk for PAD, you should contact a doctor for an evaluation and diagnostic testing. The goal is to evaluate your risk, diagnose, and treat the condition before it becomes severe and leads to complications, such as a heart attack or stroke.

Your appointment with the doctor will start with a review of your medical and family history. The doctor will ask you a number of questions about:

  • any health conditions you may have that could be risk factors for PAD, such as diabetes, high blood pressure, or high cholesterol levels
  • whether your family has a history of cardiovascular disease or other risk factors
  • any pain you might have in your legs when you stand, walk, climb stairs, or when you’re sitting or lying down
  • whether you currently or used to smoke
  • your diet
  • any medications you are taking

Next, your doctor will perform a physical exam during he or she will be looking for signs of PAD, such as:

  • unusual sounds in your arteries using a stethoscope
  • the color, look, and temperature of your legs and feet
  • a weak or absent pulse in your legs and feet to determine if enough blood is flowing there
  • decreased blood pressure in your legs and feet
  • signs of poor wound healing on the legs and feet where blood flow could be blocked

After the physical exam, the doctor may order one or more tests to help confirm a diagnosis of PAD, check related conditions, and determine how advanced your condition may be. These tests could include:

  • blood tests, which measure your cholesterol and triglyceride levels and check for diabetes
  • ankle/bracial index (ABI), which is a painless, noninvasive test that compares the blood pressure readings in your ankles with the blood pressure readings in your arms. Blood pressure cuffs are placed on your ankles and arms, then inflated as a handheld ultrasound device evaluates blood pressure and flow. ABI is a highly-effective way to detect PAD.
  • pulse volume recording (PVR), which is similar to ABI, but uses multiple cuffs on the leg to measure and record blood volume changes in the leg; its purpose is to help locate blockages in the arteries
  • vascular ultrasound, which uses a device that creates sound waves that bounce off of an artery and creates an image to measure blood flow and detect any blockages
  • angiography, which involves using iodine dye and x-rays to show the inside of your blood vessels so that the doctor can see the flow of blood through your arteries and veins

How is peripheral artery disease treated?

Once you have been diagnosed with PAD, you’ll want to work with your doctor to develop a plan for managing your condition. There is no cure for PAD, so the focus of your plan will be to:

  • address any symptoms you might have
  • improve your quality of life
  • stop the progression of atherosclerosis to reduce your risk of having a heart attack, stroke, kidney problem, or amputation

There are three main ways to help you achieve these goals, including lifestyle changes, medication, and
medical procedures or surgery. Based on your medical history, test results, and severity of your condition, your doctor will determine the best way or ways to treat your condition.

Lifestyle changes

Changing the way you live can reduce your risk factors and help stop the progression of PAD. In fact, if your condition isn’t that severe, the following changes may be the only thing you need to do accomplish these goals:

  • quit smoking
  • eat a healthy, balanced diet (such as whole grains, vegetables, and fruits and foods that are low in cholesterol, sodium, and saturated and trans fat)
  • manage any other high risk conditions (such as diabetes, high blood pressure, or high cholesterol) by lowering your glucose, blood pressure, and cholesterol levels
  • get to and maintain a healthy weight; losing excess weight will lower your total cholesterol and raise your good cholesterol
  • take care of your feet and skin to avoid infections
  • get active by exercising (particularly walking) at least 30 minutes every day

Along with exercising on your own, your doctor may recommend a specialized exercise training program that would help relieve the symptoms of intermittent claudication and enable you to walk longer distances without pain, and alleviate other symptoms associated with PAD.

Medications

If lifestyle changes alone are not enough to reduce your risk for problems related to PAD, your doctor may prescribe one or more of the following types of medications:

  • statins to lower cholesterol and help prevent further blockage in your blood vessels and heart attacks
  • anti-hypertensives to lower high blood pressure and keep it below levels based on your age and/or any related conditions you may have, reducing your risk of heart attack or stroke
  • antiplatelets to prevent blood clots from forming by keeping platelets (a type of blood cell that plays a vital role in the clotting process) from sticking together and blocking the flow of blood through an artery
  • pills to control blood glucose because people with diabetes are at a higher risk of developing PAD; controlling glucose levels reduces the risk and slows its progression
  • symptom relief medications including cilostazol, which increases blood flow to limbs by widening blood vessels and preventing blood clots to relieve leg pain from intermittent claudication

Medical procedures and Surgery

If it's determined that your PAD is more advanced and the arteries in one of your legs are blocked, your doctor may recommend one of the following procedures or surgeries in addition to the lifestyle changes and medications:

  • thrombolic therapy, which involves injecting a drug directly into a blocked artery to break up or dissolve blood clots, which are the main cause of heart attacks and stroke
  • angioplasty, during which a small tube is threaded through a blood vessel to the blocked artery; once there, the balloon is inflated to compress the plaque against the wall of the artery to restore blood flow. To keep the artery open, a small wire mesh tube, called a stent, may be inserted.
  • atherectomy, which is a procedure that uses a catheter with a sharp blade on the end to remove plaque from an artery and eliminate the blockage
  • peripheral artery bypass surgery, which uses blood vessels from other areas of the body or a synthetic material to create a pathway around a blocked artery and improve blood flow

Advanced Cardiovascular Care at Jeanes Hospital

If you’re experiencing symptoms of peripheral artery disease, the academic-level vascular surgeons and at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your condition.

The Temple vascular surgeons at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious cardiovascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there's no need to travel to another institution to have it done. Since 2006, Temple vascular surgeons have been performing vascular surgery and procedures at Jeanes Hospital. Our surgeons are supported by a full-time team of anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed here for the diagnosis and treatment of PAD and its related conditions include:

  • atherectomy with cutting blade/burr or laser
  • clot removal or lysing
  • cryoplasty
  • diagnostic angiography
  • extremity balloon angioplasty and stenting
  • renal and mesenteric artery angioplasty and stenting

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a vascular surgeon at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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