A Guide To Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is a common circulatory condition where narrowed arteries reduce blood flow, usually in the legs. Periphery artery disease can lead to symptoms like leg pain, cramps and severe movement limitations.

Affecting more than 12 million Americans, peripheral artery disease can contribute to an increased risk of having a heart attack or stroke. PAD can be life-threatening if left untreated.

What Is Peripheral Artery Disease?

Peripheral artery disease is a slow and progressive disorder of the blood vessels. PAD occurs when arteries that supply blood to the arms and legs become narrowed due to plaque buildup – a condition known as atherosclerosis. While PAD can affect any part of the body, it primarily impacts the legs and can lead to symptoms of mild discomfort, severe pain and difficulty moving.

“When you walk, you have to use your muscles, and those muscles crave oxygen,” said Franciscan Health Physician Network vascular surgeon Neal Ramchandani, MD. “They crave those nutrients, and when they don’t have enough oxygen or enough blood, it leads to cramps.”

He said people often complain that even walking a few blocks or to the mailbox increases cramping in the calves. “That certainly warrants an evaluation for peripheral arterial disease,” he said.

A possible sign of underlying health concerns

Since vascular disease is system, or an all-body, disease, sometimes vascular conditions like PAD can be a sign of underlying health concerns. For example a person with peripheral artery disease may have diabetes, high blood pressure or heart disease.

Early stages of peripheral artery disease

In the early stages of peripheral artery disease, your arteries accumulate plaque, a sticky substance of fat and cholesterol. This plaque causes the arteries to become stiff and narrow. Just like blockages in the heart arteries can lead to heart attacks, blockages in peripheral arteries can seriously affect your leg health.

In mild cases of peripheral artery disease, a person has no symptoms, but as the condition gets worse, he or she may experience leg cramping or pain on a consistent basis, especially while walking and usually in the calf area. This pain, called claudication, usually goes away with rest.

Later stages of peripheral artery disease

Over time, these plaque in your arteries can worsen your PAD symptoms and, in serious cases, could even lead to the loss of limbs. The reduced mobility caused by PAD can lead to significant emotional stress, anxiety and depression.

Left untreated, advanced PAD can put you at risk for infections, wounds that won't heal, or cause serious damage to your legs or arms from restricted blood flow, requiring amputation.

However, with comprehensive treatment and support, people living with PAD can maintain a high quality of life.

What Causes Peripheral Artery Disease?

Plaque buildup and stiffened arteries, known as atherosclerosis, are the primary cause of peripheral artery disease. Blood clots can travel down the bloodstream and cause a total blockage of that narrowed artery. Blocked arteries starve the limbs of oxygen, which can lead to tissue death. Several factors contribute to the development of PAD, including age and:

• Diabetes: This condition affects blood sugar levels, which can damage blood vessels, promote plaque buildup and lead to atherosclerosis. People can manage diabetes through diet, medication and monitoring blood sugar levels to help reduce the risk of PAD.
• Smoking: Smoking damages the inner lining of the arteries. The chemicals in tobacco smoke, including nicotine and carbon monoxide, lead to inflammation, which speeds up the process of atherosclerosis.
• High cholesterol and high blood pressure: These conditions can worsen vascular health and lead to the buildup of fatty deposits in the arteries, which can block blood flow. People can manage these conditions through diet, medication and lifestyle changes to help prevent PAD.
• Personal or family history of vascular disease, heart disease or stroke: Family history can play a significant role in a person’s risk levels. A high risk for genetic conditions, like high cholesterol or high blood pressure, heart disease or vascular disease, can contribute to poor vascular health.

Other causes of peripheral arterial disease may include:

• Injury to the arms or legs
• Infection
• Irregular anatomy of muscles or ligaments

What Are The Symptoms Of Peripheral Artery Disease?

When peripheral artery disease starts, you might not notice any symptoms at first. But as the condition progresses, you may experience leg pain or cramps. This pain usually goes away when you rest, but it tends to come back when you resume activities.

PAD causes several symptoms, mainly in the legs. These symptoms can include:

• Change in the color of your legs
• Cramps with exercise, known as claudication
• Erectile dysfunction in men
• Hair loss on the lower legs
• Numbness or weakness in the legs
• Pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
• Paleness on the legs when elevated
• Reddish-blue discoloration of the feet and toes
• Slower growth of the toenails
• Weak pulses in the legs and feet
• Wounds that won’t heal over pressure points, such as heels or ankles

Can You Prevent PAD?

You can minimize many risk factors for PAD through changes in your daily routine and lifestyle. These changes include:

• Quit smoking: Ask your doctor or healthcare professional about ways to quit smoking. Smoking causes inflammation that can lead to plaque in the arteries and constricted blood flow.
• Regular physical activity: Exercise is often an effective treatment for PAD symptoms. Even if you feel pain when you walk, doctors will encourage you to walk through the pain so the blood vessels can create new pathways to deliver oxygen to the muscles.
• Maintain a healthy weight: A healthy weight can reduce your risk for not only PAD but also coronary heart disease, high blood pressure, high cholesterol, diabetes and other chronic diseases.
• Eat a balanced diet rich in fruits and vegetables: Eat whole grains, colorful fruits and vegetables, low-fat dairy choices and lean proteins.
• Control your chronic health conditions: If you have diabetes, high blood pressure or high cholesterol, it is important to get these conditions under control to help prevent further progress of PAD, stroke and heart attack.

How Do Doctors Diagnose Peripheral Artery Disease?

Noninvasive methods like an ultrasound and a blood pressure test can initially detect PAD and assess its severity. The Arterial Brachial Index (ABI), a quick Doppler ultrasound test (an imaging technique that uses high-frequency sound waves to produce images of the body’s internal structures and assess the blood movement), measures the difference in blood pressure between the ankle and the arm. If these tests identify significant PAD, your doctor may need more detailed imaging, such as CT angiogram (CTA) or MR angiograms (MRA), to determine the best treatment options for you.

Can Peripheral Artery Disease Be Treated?

In some cases, you can manage your symptoms with lifestyle changes and medical care.

“Conservative management, such as medication and lifestyle changes, are first-line treatments,” Dr. Ramchandani said. 

Reducing symptoms of PAD

Exercise and dietary adjustments also play an essential role in treatment and can often reduce the symptoms of PAD. These lifestyle changes include:

• Regular exercise: Physical activities can help improve blood circulation and overall vascular health.
• Smoking cessation: Not smoking reduces damage to the arteries and complications associated with PAD.
• Dietary changes: A balanced diet with fewer saturated fats helps reduce cholesterol levels.
• Reduced cholesterol levels: Medications or diet changes to lower cholesterol can slow the progression of plaque buildup.
• Controlled blood glucose: Individuals with diabetes should manage their blood sugar levels to prevent additional complications from PAD.

Surgical treatments for PAD

If your peripheral artery disease is severe, and you don’t get relief with lifestyle changes, you may need medical intervention. Surgical treatments for PAD may include:

• Angioplasty: During an angiogram, surgeons access the artery through the groin to inject a dye, which allows doctors to see the affected area. Then, a tiny balloon is inserted into the artery and is inflated to help widen the blocked or narrowed section.
• Atherectomy: A minimally invasive procedure to remove plaque buildup, open blocked arteries and restore blood flow.
• Bypass surgery: This approach can reroute the blood supply around the blocked artery.
• Stent placement: Sometimes, surgeons also place a stent to keep the artery open. “We use advanced stents that slowly release medication to prevent the artery from narrowing again,” Dr. Ramchandani said.

More direct medical care, such as surgery, may be necessary for some people. These outpatient procedures mean patients can go home the same day, allowing you to recover more quickly at home and resume your regular activities almost immediately.

Learn How To Prevent And Manage Peripheral Artery Disease

Even if you have PAD, you can maintain a good quality of life when you understand and manage your condition. You can manage your symptoms effectively with comprehensive care and support from Franciscan Health. Talk to your primary care provider today about your vascular health.