Peripheral artery disease (PAD) is a common condition in which narrowed arteries reduce blood flow to the arms or legs. If you have peripheral artery disease, your arms or legs — typically the legs — don’t receive enough blood flow to keep up with demand. This may cause leg pain when walking and other symptoms.

At Vascular Care Specialists of Los Angeles, Dr. Mathew Cheung and Dr. Peter Lin discuss what two common symptoms associated with peripheral artery disease which are rest pain and critical limb ischemia. In this discussion, you can better symptoms associated with PAD, and treatment available to improve your leg circulation or symptoms related to PAD.

One of the common symptoms that patients may experience due to their PAD is called rest pain. In the beginning stages of PAD, rest pain is identified as a burning sensation of the lower extremities; the legs, feet, or toes. This is caused by a lack of blood flow through the arteries when at rest or when the lower extremities are elevated.

In most cases rest pain has shown to be the result of certain health conditions such as diabetes as well as lifestyle choices such as a sedentary lifestyle, smoking, and unhealthy diet. Usually, pain at rest disappears as a result of walking due to gravity restarting the blood circulation. Many of those who suffer from these symptoms will often have difficulty having a full night’s rest or being comfortable lifting their feet on an ottoman or sit back on a reclining chair.

Critical limb ischemia , or CLI is a chronic condition that results in severe pain in the feet or toes, even while resting. Complications of poor circulation can include sores and wounds that won’t heal in the legs and feet. Left untreated, the complications of CLI will result in amputation of the affected limb. A quarter of patients diagnosed with CLI are likely to go through a leg amputation within the first year of diagnosis.

The most prominent features of critical limb ischemia are called ischemic rest pain — severe pain in the legs and feet while a person is not moving, or non-healing sores on the feet or legs. Other symptoms include:

•Pain or numbness in the feet

•Shiny, smooth, dry skin of the legs or feet

•Thickening of the toenails •Absent or diminished pulse in the legs or feet

•Open sores, skin infections or ulcers that will not heal

•Dry gangrene (dry, black skin) of the legs or feet

Risk factors for chronic limb ischemia are the same as those for atherosclerosis — hardening and narrowing of the arteries due to the build up of fatty deposits, called plaque. The following all contribute to this condition:

• •Age
• •Smoking
• •Diabetes
• •Overweight or obesity
• •Sedentary lifestyle •High cholesterol
• •High blood pressure
• •Family history of atherosclerosis

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.

Critical limb ischemia is a serious condition that requires immediate treatment to re-establish blood-flow to the affected area. The number one priority is to preserve the limb.

• 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 anesthetic medication, 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.

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