Peripheral artery disease is also known as peripheral arterial disease, peripheral vascular disease or peripheral heart disease. It affects the blood vessels outside the brain and heart, causing them to narrow, thus restricting the blood flow to the arms, legs, kidneys or stomach.
Patients with peripheral artery disease most commonly have symptoms in their legs. Experts say that this disease is often a sign of excess accumulation of fatty deposits in the arteries - atherosclerosis.
Heart disease is the leading cause of death in the United States. About 10 million people in the country have peripheral vascular disease, i.e. approximately 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 major 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 develop peripheral vascular disease.
Peripheral vascular disease is more common in smokers. Patients with diabetes who are regular smokers tend to have the most severe symptoms.
Researchers from the UK and USA reported in The Lancet (August 2013 issue) that peripheral artery disease is on the rise globally. In 2000 there were 164 million people with PAD, compared to 202 million ten years later.
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, pain may be a symptom while dilated pupils may be a sign.
Experts say that about half of all people with peripheral heart disease do not know they have it, because they have no symptoms.
The most common signs and symptoms associated with peripheral artery disease include:
- Hair loss on the feet and legs
- Intermittent claudication - the thigh or calf muscles may feel pain when walking or climbing stairs. Some people complain of painful hips
- Leg weakness
- A foot or the lower leg may feel cold
- Numbness in the legs
- Brittle toenails
- Toenails grow slowly
- Ulcers on the legs and feet that take a long time to heal (or never heal)
- The skin on the legs becomes shiny, or turns pale or bluish
- Difficulty in finding a pulse in the leg or foot
- Erectile dysfunction (impotence in men, problems achieving or sustaining an erection).
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 - 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.
Researchers from Harvard Medical School wrote in Annals of Internal Medicine that smoking raises a woman's risk of developing PAD tenfold.
In a study involving over one thousand men and women, a team from the San Francisco VA Medical Center and the University of California, San Francisco found that people with depression have a higher risk of developing PAD.
Recent developments on peripheral artery disease from MNT news
Dark chocolate 'may improve walking ability for PAD patients' - Numerous studies claim that in moderation, dark chocolate is good for our health. Now, a new study published in the Journal of the American Heart Association adds to the evidence, suggesting that it may help increase walking distance for people with peripheral artery disease.
Diagnosing peripheral artery diseaseIf peripheral artery disease is suspected, the doctor will initially check the patient's leg.
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.
The doctor may also recommend an ultrasound scan, angiography and blood tests to check levels of 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 patient's 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 American College of Cardiology Foundation and the American Heart Foundation (ACCF/AHA) published "2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline)" in the journal Circulation.
The most effective treatment is regular physical activity. A doctor may recommend a program of supervised exercise training. The patient may have to start off slowly. 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. Ideally, the patient should do these exercises on a treadmill in a rehabilitation center.
Many patients have elevated cholesterol levels. A diet low in saturated fat, trans fat and cholesterol, as well as plenty of fruit and vegetables can help lower blood cholesterol levels.
Tobacco smoke greatly increases the risk for PAD, 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.
The doctor may prescribe antihypertensive drugs as well as statins to lower cholesterol levels. Cilostazol and pentoxifylline may be recommended for patients with intermittent claudication. The ACE inhibitor ramipril improved pain-free walking by 60% in a study published in JAMA (Journal of the American Medical Association).
If the treatments mentioned above do not help enough, the doctor may advise the angioplasty.
Recent developments in treating peripheral artery disease from MNT news
Home-based exercise programs 'improve mobility for PAD patients' - new research suggests that home-based exercise programs may improve mobility for patients with peripheral artery disease. To reach their findings, published in the Journal of the American Heart Association, the team enrolled 81 PAD patients into a 6-month home-based exercise program that focused on walking.
Preventing peripheral artery diseaseTaking action to control risk factors can help prevent or delay peripheral arterial disease and its complications.
Family history - if you or someone in your family has/had periphery artery disease, be sure to tell your doctor.
Smoking - quit!! Smoking is more closely related to developing heart disease than any other risk factor. Regular smokers are four times as likely to develop PAD than lifetime non-smokers. Talk to a doctor about programs and products that can help you quit smoking.
Diet - follow a healthy eating plan that's low in total fat, saturated fat, trans fat, cholesterol, and sodium. Eat plenty of fruits, vegetables, and low-fat dairy products. Overweight/obese patients should work with a doctor to create a reasonable weight-loss plan.
Written by Sy Kraft (B.A.)