What Is Peripheral Artery Disease? What Causes Peripheral Artery Disease?

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Main Category: Vascular
Article Date: 17 May 2010 - 0:00 PST

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Peripheral artery disease (PAD) refers to diseases of the blood vessels located outside the heart and brain.

Peripheral artery disease is also known as peripheral vascular disease or peripheral heart disease. This disease affects the blood vessels outside the brain and heart, causing them to narrow and restricting the blood flow to the arms, legs, kidneys or stomach.

The part of the body that is most often affected is the legs. Peripheral heart disease is often a sign of widespread atherosclerosis, or the accumulation of fatty deposits in the arteries.

Heart disease is the leading cause of death in the United States. About 10 million people in the United States have peripheral vascular disease, which translates to about 5% of people older than 50 years.

There are different types of heart disease, each with its own symptoms and risks. Peripheral heart disease is a huge risk factor for heart attack and stroke. It is more common in African-Americans than any other ethnic or racial group. Men are slightly more likely than women to have peripheral vascular disease.

Peripheral vascular disease is more common in smokers, and the combination of diabetes and smoking almost always results in more severe disease.

What are the symptoms of peripheral artery disease?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Approximately half of people with peripheral heart disease do not experience any symptoms.

The symptoms of peripheral heart disease will vary according to the location of the clogged artery. These symptoms include painful cramps in thighs, hips, or calves after climbing stairs or walking, leg numbness and weakness, sores on the toes, legs or feet that don't seem to heal, coldness in the foot or lower leg, hair loss on your feet and legs, change in color in the legs and changes in toenails.

Impotence is an occasional complaint in men. Pain at rest is uncommon.

What are the causes of peripheral artery disease?

The most common cause of peripheral vascular disease is atherosclerosis. Atherosclerosis is a gradual process in which a fatty material called plaque, builds up inside the arteries. The fat may then mix with calcium, scar tissue, and other substances and harden slightly, forming plaques. These plaques block, narrow, or weaken the vessel walls. Blood flow through the arteries can be restricted or blocked totally.

Other, less common causes of peripheral heart disease are infection, blood clots in your arteries, injury to your limbs and unusual anatomy of your muscles and ligaments.

Risk factors that contribute to PAD are diabetes, smoking, obesity, high blood pressure, increasing age, high cholesterol, family history of heart disease, excess levels of C-reactive protein and excess levels of homocysteine.

Diagnosing peripheral artery disease

If a doctor suspects that you have peripheral heart disease, they will likely do a physical exam as the first step in diagnosis.

The most common test for PAD is the ankle-brachial index, a test that compares the blood pressure in the ankle with the blood pressure in the arm.

Other tests that a doctor might perform include ultrasound, angiography and blood tests to check the levels of your cholesterol, homocysteine and C-reactive protein.

Doppler and Ultrasound (Duplex) imaging is a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.

Computed Tomographic Angiography (CT) is also a non-invasive test that can show the arteries in your abdomen, pelvis and legs. This test is particularly useful in patients with pacemakers or stents. Magnetic Resonance Angiography (MRA) gives information similar to that of a CT without using X-rays.

Angiography is normally reserved for use in conjunction with vascular treatment procedures. During an angiogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint any blockages that may be present.

Undiagnosed or untreated PAD can be dangerous because it can lead to painful symptoms, loss of a leg, increased risk of coronary artery disease and carotid atherosclerosis. Because people with PAD have this increased risk for heart attack and stroke, the American Heart Association encourages people at risk to discuss PAD with their healthcare professional to ensure early diagnosis and treatment.

What are the treatment options for peripheral artery disease?

The most effective treatment is regular physical activity. A doctor may recommend a program of supervised exercise training for you. One may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs three times a week can result in decreased symptoms in just four to eight weeks.

Exercise for intermittent claudication takes into account the fact that walking causes pain. The program consists of alternating activity and rest in intervals to build up the amount of time you can walk before the pain sets in. It's best if this exercise program is undertaken in a rehabilitation center on a treadmill and monitored.

Many patients have elevated cholesterol levels. A diet low in saturated fat, trans fat and cholesterol can help lower blood cholesterol levels, but medication may be necessary to maintain the proper cholesterol levels.

Tobacco smoke greatly increases your risk for PAD and your risk for heart attack and stroke. Smokers may have four times the risk of developing PAD than nonsmokers. Stop smoking. It will help to slow the progression of PAD and other heart-related diseases.

One may be prescribed high blood pressure and/or cholesterol-lowering medications. It's important to make sure that one takes the medication as recommended by a healthcare professional. Not following directions increases risk for PAD, as well as heart attack and stroke.

Medications that a doctor may prescribe to help improve the distance you can walk include cilostazol and pentoxifylline. In addition, one may be prescribed antiplatelet medications (aspirin and clopidogrel) to help prevent blood clots.

Some particular cases are stubborn and don't respond to the other treatments, thus angioplasty or surgery may be needed.

Preventing peripheral artery disease

Taking action to control risk factors can help prevent or delay peripheral arterial disease and its complications.

Know family history of health problems related to peripheral heart disease. If you or someone in your family has this disease, be sure to tell a doctor.

If one smokes, quit. Smoking is more closely related to getting heart disease than any other risk factor. Risk increases four times if one smokes or has a history of smoking. Talk to a doctor about programs and products that can help you quit smoking.

Follow a healthy eating plan that's low in total fat, saturated fat, trans fat, cholesterol, and sodium. Eat more fruits, vegetables, and low-fat dairy products. If someone is overweight or obese, they should work with a doctor to create a reasonable weight-loss plan.

Written by Sy Kraft (B.A.)


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