Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels - the arteries, veins, or lymphatic vessels. Organs supplied by these vessels such as the brain, heart, and legs, may not receive adequate blood flow for ordinary function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

Risks of Peripheral Arterial Disease

Risks of peripheral arterial disease that cannot be changed include the following:

• age (especially older than 50)
• history of heart disease
• male gender
• diabetes mellitus (type 1 diabetes)
• postmenopausal women
• family history of dyslipidemia (elevated lipids in the blood, such as cholesterol), hypertension, or peripheral arterial disease

Risks of peripheral arterial disease that may be changed or treated include:

• coronary artery disease
• impaired glucose tolerance
• dyslipidemia
• hypertension (high blood pressure)
• obesity
• physical inactivity
• smoking or use of tobacco products

Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow.

Symptoms of Peripheral Arterial Disease

Approximately half the people diagnosed with peripheral arterial disease are symptom free. For those experiencing symptoms of peripheral arterial disease , the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.

Other symptoms of peripheral arterial disease may include:

• changes in the skin, including decreased skin temperature, or thin, brittle shiny skin on the legs and feet
• diminished pulses in the legs and the feet
• gangrene (dead tissue due to lack of blood flow)
• hair loss on the legs
• impotence
• non-healing wounds over pressure points, such as heels or ankles
• numbness, weakness, or heaviness in muscles
• pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
• pallor (paleness) when the legs are elevated
• reddish-blue discoloration of the extremities
• restricted mobility
• severe pain
• thickened, opaque toenails

Diagnosis of Peripheral Arterial Disease

In addition to a complete medical history and physical examination, the diagnosis of peripheral arterial disease may include any, or a combination, of an angiogram, ankle-brachial index, blood lipid profile, Doppler ultrasound flow study, MRA, treadmill exercise test, photoplethysmography, pulse volume recording, reactive hyperemia test or segmental blood pressure measurements.

Treatment of Peripheral Arterial Disease

There are two main goals for treatment of peripheral arterial disease : control the symptoms and halt the progression of the disease to lower the risk of heart attack, stroke and other complications.

Treatments of peripheral arterial disease may include lifestyle modifications to control risk factors, medications for improving blood flow, angioplasty or vascular surgery.