Learn more about this common circulatory condition, often first signaled by leg pain when walking. Lifestyle changes and medications can help.
Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.
When you develop peripheral artery disease (PAD), your legs or arms — usually your legs — don't receive enough blood flow to keep up with demand. This may cause symptoms, such as leg pain when walking (claudication).
Peripheral artery disease is also likely to be a sign of a buildup of fatty deposits in your arteries (atherosclerosis). This condition may narrow your arteries and reduce blood flow to your legs and, occasionally, your arms.
You often can successfully treat peripheral artery disease by exercising, eating a healthy diet and quitting tobacco in any form.
While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (claudication).
Claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location.
The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity.
Peripheral artery disease signs and symptoms include:
If peripheral artery disease progresses, pain may even occur when you're at rest or when you're lying down. It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.
If you have leg pain, numbness or other symptoms, don'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 artery disease, you may need to be screened if you are:
Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits build up on your artery walls and reduce blood flow.
Although discussions of atherosclerosis usually focus on the heart, the disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease.
Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.
Factors that increase your risk of developing peripheral artery disease include:
People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.
If your peripheral artery disease is caused by a buildup of plaque in your blood vessels, you're also at risk of developing:
The best way to prevent claudication is to maintain a healthy lifestyle. That means:
Some of the tests your doctor may rely on to diagnose peripheral artery disease are:
Ankle-brachial index (ABI). This is a common test used to diagnose PAD. It compares the blood pressure in your ankle with the blood pressure in your arm.
To get a blood pressure reading, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow.
You may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
Angiography. Using a dye injected into your blood vessels, this test allows your doctor to view blood flow through your arteries as it happens. Your doctor can trace the flow of the dye using imaging techniques, such as X-rays, magnetic resonance angiography (MRA) or computerized tomography angiography.
Catheter angiography is an invasive procedure that involves guiding a small hollow tube (catheter) through an artery in your groin to the affected area and injecting the dye. This type of angiography allows your doctor to treat a blocked blood vessel at the time of diagnosis. After finding the narrowed area of a blood vessel, your doctor can then widen it by inserting and expanding a tiny balloon or by administering medication that improves blood flow.
Treatment for peripheral artery disease has two major goals:
You may be able to accomplish these goals with lifestyle changes, especially early in the course of peripheral artery disease. If you smoke, quitting is the single most important thing you can do to reduce your risk of complications. Walking or doing other exercise on a regular basis following a schedule, referred to as supervised exercise training, can improve your symptoms dramatically.
If you have signs or symptoms of peripheral artery disease, you likely will need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.
Cholesterol-lowering medications. You may take a cholesterol-lowering drug called a statin to reduce your risk of heart attack and stroke.
The goal for people who have peripheral artery disease is to reduce low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L). The goal is even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.
High blood pressure medications. If you also have high blood pressure, your doctor may prescribe medications to lower it.
Your blood pressure treatment goal should be less than 130/80 millimeters of mercury (mm Hg). This is the guideline for anyone with coronary artery disease, diabetes or chronic kidney disease. Achieving 130/80 mm Hg is also the goal for healthy adults age 65 and older and healthy adults younger than age 65 with a 10% or higher risk of developing cardiovascular disease in the next 10 years.
Medications to prevent blood clots. Because peripheral artery disease is related to reduced blood flow to your limbs, it's important to improve that flow.
Your doctor may prescribe daily aspirin therapy or another medication, such as clopidogrel (Plavix).
Symptom-relief medications. The drug cilostazol increases blood flow to the limbs both by keeping the blood thin and by widening the blood vessels. It specifically helps treat leg pain in people who have peripheral artery disease. Common side effects of this medication include headache and diarrhea.
An alternative to cilostazol is pentoxifylline (Pentoxil). Side effects are rare with this medication, but it's generally doesn't work as well as cilostazol.
In some cases, angioplasty or surgery may be necessary to treat peripheral artery disease that's causing claudication:
Angioplasty. In this procedure, a catheter is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to flatten the plaque into the artery wall and reopen the artery while stretching the artery open to increase blood flow.
Your doctor may also insert a mesh tube (stent) in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.
Your doctor likely will prescribe a supervised exercise training program to increase the distance you can walk pain-free. Regular exercise improves symptoms of PAD in a number of ways, including helping your body use oxygen more efficiently.
Many people can manage the symptoms of peripheral artery disease and stop the progression of the disease through lifestyle changes, especially quitting smoking. To stabilize or improve PAD:
Stop smoking. Smoking contributes to constriction and damage of your arteries and is a significant risk factor for the development and worsening of PAD. If you smoke, quitting is the most important thing you can do to reduce your risk of complications.
If you're having trouble quitting on your own, ask your doctor about smoking cessation options, including medications to help you quit.
Exercise. This is a key component. Success in the treatment of PAD is often measured by how far you can walk without pain. Proper exercise helps condition your muscles to use oxygen more efficiently.
Your doctor can help you develop an appropriate exercise plan. He or she may refer you to a claudication exercise rehabilitation program.
In addition to the above lifestyle changes, take good care of your feet. People with PAD, especially those who also have diabetes, are at risk of poor healing of sores and injuries on the lower legs and feet.
Poor blood flow can postpone or prevent proper healing and increases the risk of infection. Follow this advice to care for your feet:
Peripheral artery disease can be frustrating, especially when the exercise that will help you get better causes you pain. Don't get discouraged, however. As you continue exercising, you'll increase the distance you can walk without pain.
You may find it helpful to raise the head of your bed by 4 to 6 inches (10 to 15 centimeters), because keeping your legs below the level of your heart usually lessens pain.
Another tip for reducing your symptoms is to avoid cold temperatures as much as possible. If you can't avoid the cold, be sure to dress in warm layers.
You're likely to start by seeing your family doctor. However, you may then be referred to a doctor who specializes in disorders of blood vessels (vascular specialist) or a doctor who specializes in the heart and circulatory system (cardiologist).
Because appointments can be brief and there's often a lot to discuss, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment and know what to expect from your doctor.
For peripheral artery disease, some basic questions to ask your doctor include:
Don't hesitate to ask additional questions during your appointment if you don't understand something.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
If you're a smoker, it's never too soon to quit smoking. Smoking increases the risk of peripheral artery disease and can make existing PAD worse. Eating less saturated fat and adding more fruits and vegetables to your diet are two other healthy lifestyle habits you can immediately adopt.
July 15th, 2021