In the United States, more than 8 million people ages 40 and older have peripheral artery disease, or PAD. Also called peripheral arterial disease, PAD is caused by atherosclerosis, or plaque buildup, that reduces the flow of blood in peripheral arteries — the blood vessels that carry blood away from the heart to other parts of the body. This health topic focuses on the most common type of PAD, called “lower extremity PAD,” which reduces blood flow to the legs and feet.

You may have lower extremity PAD if you have muscle pain or weakness that begins with physical activity, such as walking, and stops within minutes after resting. About 1 in 4 people who have PAD experience these symptoms. But you may experience other symptoms or no symptoms at all. If you smoke or have high blood pressure or other risk factors for PAD, even without symptoms, ask your healthcare provider about getting tested. It is important to be aware that if you have lower extremity PAD, you may also have plaque buildup in other arteries leading to and from your heart and brain, putting you at higher risk of stroke or heart attack. A person with peripheral vascular disease is up to six times more likely to have a heart attack or stroke.

Symptoms of peripheral vascular disease

In some cases, a person with peripheral vascular disease does not have any symptoms until the condition is advanced and severe. Symptoms depend on which body part is deprived of sufficient blood, but may include:

• Intermittent pain (claudication), which may feel like cramps, muscle fatigue or heaviness (usually in the legs) •Worsening pain during exercise (usually in the legs)
• Easing of pain during rest (usually in the legs)
• Coldness of the affected body part
• Numbness
• Pins and needles
• Muscular weakness
• Blue or purple tinge to the skin
• Wounds that won’t heal (vascular ulcers)
• Blackened areas of skin or skin loss (gangrene).

Causes of peripheral vascular disease

In most cases the cause is atherosclerosis, the build-up of fatty deposits within the blood vessel that reduces blood flow to the area. Commonly this occurs in the body where a blood vessel kinks or subdivides.

Apart from fatty deposits, other causes of peripheral vascular disease include:

• Diabetes – high blood sugar damages and weakens blood vessels, causing them to narrow.
• Obstruction – a blood clot (thrombus) may lodge within the blood vessel.
• Infection – can cause scarring and narrowing of the blood vessels. Syphilis or salmonellosis, for example, can lead to peripheral vascular disease.
• Arteritis – inflammation of arteries. Some autoimmune diseases can cause arteritis.
• Blood vessel defects – blood vessels may be unusually narrow at birth. The cause is unknown.
• Blood vessel spasms – conditions such as Raynaud’s disease may cause narrowing of blood vessels in response to certain factors, including cold temperatures or stress.

Risk factors of peripheral vascular disease

Risk factors for peripheral vascular disease include:

• Diabetes – this is the most significant risk factor
• Cigarette smoking
• Advancing age
• Family history of peripheral vascular disease, stroke or coronary artery disease
• Medical history of stroke, cardiovascular disease or heart attack
• Overweight or obesity
• Sedentary lifestyle High blood pressure (hypertension)
• High blood cholesterol (hypercholesterolaemia).

Diagnosis of peripheral vascular disease

Diagnosis of peripheral vascular disease may include:

• Medical history
• Physical examination
• Family history
• Pulse check, using a stethoscope to listen for signs of reduced blood flow through a blood vessel
• Ankle/brachial index (ABI) test, which compares the blood pressure readings of the arms and legs to check for differences
• Exercise test, usually performed on a treadmill while blood pressure is taken to check for a drop in blood pressure within the affected body part
• Scans such as ultrasound or magnetic resonance imaging (MRI) to locate narrowed sections of blood vessels
• Angiography, the injection of a contrast dye into the blood vessel that shows up on x-ray examination – this test is less common now that advanced imaging techniques, such as MRI, are available.

Treatment of peripheral vascular disease

Treatment options may include:

• Medications – to help treat atherosclerosis, such as statins to lower LDL cholesterol and antihypertensive drugs to lower blood pressure.
• Drugs to treat blood clots – treatment may include various medications (including anticoagulants and anti-platelet drugs) to prevent blood clots from developing and medications (including thrombolytics) that dissolve existing blood clots.
• Angioplasty – this procedure, usually performed under sedation and local anaesthetic, involves threading a thin tube (catheter) into the narrowed blood vessel through a small incision, usually in the leg. Once the catheter reaches the narrowed or blocked site, the small balloon on its tip is inflated. This widens the blood vessel and improves blood flow. Angioplasty is usually considered as a temporary measure.
• Surgical insertion of a stent – a stent is a metal ‘sleeve’ that is implanted inside the narrowed blood vessel during an angioplasty procedure to prop it open. Stents may be impregnated with medications that help to prevent scar tissue from narrowing the treated area of blood vessel.
• Atherectomy – this operation involves cutting away the fatty obstruction with a small scalpel-like instrument.
• Bypass surgery – this operation is usually only considered in severe cases that don’t respond to other treatments or in cases that involve large sections of the diseased blood vessel. A section of healthy vein is taken from somewhere else in the body and surgically grafted to re-route blood flow around the blockage in the affected blood vessel. A surgeon may sometimes use a piece of synthetic tubing to detour blood flow.

Self-help treatment of peripheral vascular disease

Lifestyle changes are an important part of treatment. Be guided by your doctor, but general self-help suggestions include:

• Take steps to properly manage risk factors, such as diabetes or high blood pressure, as advised by your doctor.
• Quit smoking.
• Exercise regularly. Ask your doctor for advice on appropriate activities.
• Eat a low-fat, high-fiber diet.
• Maintain a healthy weight for your height and build.
• Take care of injuries to the affected area, for example, dress wounds promptly and seek medical attention. •Take all medications strictly as prescribed.
• See your doctor for regular check-ups.
• See your doctor if you have symptoms in the affected body part such as redness, warmth and swelling. These symptoms could be signs of infection. Treatment may include antibiotics.

Schedule an Appointment Today!

At Vascular Care Specialists of Los Angeles, we strive to provide the best service, care, and results possible. If you have peripheral arterial disease and other circulation conditions, give us a call at 626-275-9566 to schedule an appointment. You can also visit us at www.vcsla.com for more information.