Peripheral Arterial Disease of the Legs
Overview
- Peripheral arterial disease (PAD) is poor blood flow in your arteries, most commonly in your legs. The goal of treatment is to help control your symptoms and reverse the blockage of your arteries. Keeping your arteries open can help lower your chance of heart attack and stroke. And it may also improve the quality and length of your life.
- One of the most important things you can do for PAD is to quit smoking. If you need help quitting, talk to your doctor about programs and medicines that can help you stop. These can increase your chances of quitting for good.
- Even though walking causes you pain, it may be the best exercise you can get. You will need to rest as soon as the pain starts and walk a little farther once it goes away. Make sure to talk to your doctor first before you start.
- If your leg pain does not get better after a few months of treatment, your doctor may prescribe a medicine that can help you walk longer distances without pain.
- You may need to take ASA and medicines to lower your cholesterol and control your symptoms. If you have diabetes, you will need to carefully control your blood sugar.
- If other treatments have not helped, you may need surgery to open narrowed arteries or reroute blood flow around the narrowed arteries.
What is peripheral arterial disease of the legs?
Peripheral arterial disease (PAD) is poor blood flow in the arteries. The arteries carry blood to the organs and muscles. If arteries get narrowed or blocked because of disease, the muscles and organs may not get enough blood to work properly.
PAD increases your chance of having a heart attack or stroke. People with PAD are 3 to 4 times more likely to die from a stroke or heart attack than people of the same age who do not have PAD.1
Peripheral arterial disease is also called peripheral vascular disease. This topic focuses on peripheral arterial disease of the legs, the area where it is most common.
What causes PAD?
The most common cause is the buildup of plaque on the inside of arteries. Plaque is made of extra cholesterol, calcium, and other material in your blood. Over time, plaque builds up along the inner walls of the arteries, including those that supply blood to your legs.
If plaque builds up in your arteries, there is less room for blood to flow. Every part of your body needs blood that is rich in oxygen. But plaque buildup prevents that blood from flowing freely and starves the muscles and other tissues in the lower body. See a picture of peripheral arterial disease of the legs
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This process of plaque buildup usually happens at the same time throughout the body. It is called atherosclerosis or hardening of the arteries. If you have this problem in your legs, you most likely will have it in the arteries that supply blood to your heart and brain. These arteries are called coronary arteries and carotid arteries.
Plaque builds up bit by bit over a lifetime, but symptoms often do not start until after age 65. High cholesterol, high blood pressure, and smoking make you more likely to get atherosclerosis and peripheral arterial disease.
What are the symptoms?
The most common symptom is tight, aching, or squeezing pain in the calf, thigh, or rear end (buttock). This pain, called intermittent claudication, usually happens after you have walked a certain distance. For example, your pain may always start after you have walked a block or two or after a few minutes. The pain goes away if you stop walking. As PAD gets worse, you may have pain in your foot or toe when you are not walking.
Some people do not have any symptoms.
How is PAD diagnosed?
Your doctor will talk with you about your symptoms and past health and will do a physical examination. During the examination, your doctor will check your pulse at your groin, behind your knee, on the inner ankle, and on the top of your foot. Your pulse shows the strength of blood flow. An absent or weak pulse in these spots is a sign of PAD. Your doctor may also look at the colour of your foot when it is higher than the level of your heart and after exercise. The colour of your foot can be a clue to whether enough blood is getting through your arteries.
You will likely have a test that compares the blood pressure in your legs with the blood pressure in your arms. This test is called an ankle-brachial index. A test called an arterial Doppler ultrasound may be done to check the blood flow in your arteries.
Blood tests to check your cholesterol and blood sugar can tell whether you may have other problems related to PAD, such as high cholesterol and diabetes.
How is it treated?
One of the most important things you can do for PAD is to quit smoking. If you need help quitting, talk to your doctor about programs and medicines that can help you stop. These can increase your chances of quitting for good.
There are also products that gradually wean you off nicotine. These include nicotine patches, chewing gums, nasal sprays, inhalers, and lozenges. These treatments help people have better success in the long run.1
Your doctor may tell you to eat healthy foods and to get more exercise. You may need to take ASA and medicines to lower your cholesterol and control your symptoms. If you have diabetes, you will need to carefully control your blood sugar.
Combined, these measures can help control your symptoms and reverse the blockage of your arteries. Keeping your arteries open can help lower your risk of heart attack and stroke. And it may also improve the quality and length of your life.
If your leg pain does not get better after a few months of treatment, your doctor may prescribe a medicine called pentoxifylline (Trental) to help with the pain when you walk.
If you still do not get better, you may need a procedure called angioplasty or bypass surgery to open narrowed arteries or reroute blood flow around them. These treatments are usually used for severe peripheral arterial disease.
In rare cases, advanced PAD can cause tissues in the leg or foot to die because they do not get enough oxygen as a result of poor blood flow. If this happens, part of the leg or foot must be removed (amputated). This is more common in people who also have diabetes.
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| Author: | Shannon Erstad, MBA/MPH Richard P. Terra | Last Updated: January 13, 2006 |
| Medical Review: | Martin Gabica, MD - Family Medicine Adam Husney, MD - Family Medicine David A. Szalay, MD - Vascular Surgery | |
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