Peripheral Artery Disease (PAD)

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As plaque builds up, a normal artery (A) becomes partially blocked (B), and blood flow is diminished.

Illustration courtesy of NHLBI

peripheral artery disease statistic
Surgical bypass graft
Stenting to treat PAD

Peripheral Artery Disease (PAD  also known as Peripheral Vascular Disease or PVD) results from a progressive thickening of an artery’s lining caused by a buildup of plaque, which narrows or blocks blood flow, reducing circulation of the blood to a specific organ or region of the body. This process, atherosclerotic occlusive vascular disease or atherosclerosis, is often called "hardening of the arteries."

If the plaque surface becomes irregular or ulcerated, it may accumulate small blood clots and plaque contents. The particles (emboli) travel in the circulatory system, ultimately blocking flow through tiny blood vessels, which can also damage sensitive organs, such as the brain, by causing stroke.

Often people with PAD do not have any symptoms. Almost all symptoms are caused by the leg muscles not having enough blood. Typically, people with PAD experience a painful cramping in the hips, thighs or calves with walking, climbing stairs or exercising that is relieved with rest. Those with severe PAD might have the following symptoms:


Warning Signs

  • A cramping pain that does not go away when you stop exercising

  • A noticeable decrease in the temperature of your lower leg or foot compared to the rest of your body

  • Toe or foot wounds that will not heal or heal very slowly

  • Dusky or pale in color

  • Gangrene

  • Thin, shiny skin

  • Absence of hair


Risk Factors

There are many risk factors that can cause or hasten the development of PAD. The most important are: 

  • Hypertension (high blood pressure) needs to be carefully managed to decrease the risk of having vascular diseases. If you have a tendency to have high blood pressure, have it checked regularly and talk to your doctor about treatments to bring it under control.
  • Smoking always puts you at very high risk of arterial diseases. Quitting now can have a tremendous benefit on your circulatory system. This is probably the single most important thing you can do to reduce or eliminate the chances of developing PVD.
  • Diabetes puts you at increased risk for vascular diseases. Please discuss ways to keep your blood sugar under control with your vascular surgeon or primary care physician.
  • Obesity, lack of exercise, and high cholesterol causes vascular disease. High cholesterol (a kind of fat) in the arteries is toxic. Obesity and lack of exercise can cause overall deterioration of the arterial system. Controlling these factors greatly reduces your risk of vascular disease. Ask your primary care physician what weight is normal for a person with your build and at your age. With proper diet and exercise, strive to arrive at that weight and maintain it. Also be sure to ask about your cholesterol level and how often it needs to be checked. If it is high you will need more frequent check ups, and possibly prescription medications.
  • Age considerations: Men over age 60 are at greater risk for PAD. Women after menopause exhibit the same risks as men over age 60. Regardless of your age, exercise regularly! It will put more oxygen into your blood, lower high blood pressure and improve circulation and overall health. Ask your doctor about developing an exercise program and how to reduce intake of fatty foods.
  • Genetics play a vital role in the development of occlusive vascular disease. Be sure to inform your vascular surgeon physician about parents or grandparents who had poor circulation. Poor blood circulation in the leg affects about 10 million Americans, yet only a quarter of these actually receive treatment.


Treatment

If you have PAD, there are several treatment options:

  • Prescription Medications: Drugs can be prescribed by your doctor to lower cholesterol levels, to reduce or control high blood pressure, to improve blood flow, and to control blood sugar in diabetes.
  • Arterial Surgery: The traditional treatment for symptoms caused by peripheral vascular disease is to remove or bypass the arterial disease. These techniques are safe, effective, and durable. Bypass surgery used in arterial blockage in the abdomen or legs is the preferred method of treatment since the disease is more extensive. A synthetic graft is placed to carry normal blood flow around the diseased segment.
  • Angioplasty & Stenting is a newer treatment procedure that is less invasive than surgery. It opens blockages by using small balloons introduced with a catheter into an artery. The balloon is then inflated (angioplasty). As it inflates, it stretches and opens the artery for improved blood flow. A metallic device called a “stent” can then be inserted to maintain the expanded artery, thereby improving blood flow to the leg.
  • Clot Removal: When clots completely obstruct blood flow, a catheter can be used to deliver drugs to dissolve the clot, or remove the clot directly to restore blood flow and preserve the limb.


Prevention

The best way to try to prevent PAD is to maintain a healthy, active life-style: