Overview

Peripheral arterial disease (PAD) is a very common condition affecting millions of people worldwide. It is estimated that there are currently more than 8 million people with PAD in the United States, but general awareness of the disease is very low. With this lack of awareness, there are many people who go undiagnosed or untreated and suffer with PAD.

Definition

PAD, which can also be referred to as peripheral vascular disease (PVD), is the narrowing or blockage of arteries in various critical regions of the body.

Cause

PAD happens when there is a buildup of fatty material, called plaque, inside your arteries. Another name for this condition is atherosclerosis, or hardening of the arteries.

The plaque deposits (also called calcifications) can cause your arteries to stiffen (calcify) and become narrowed or blocked, limiting the supply of oxygen-rich blood throughout your body. This can cause different health problems, depending on which arteries are blocked.

Comparison of a healthy artery (top)
to an artery with plaque buildup (bottom)

Symptoms

Lower Extremity PAD

Lower extremity PAD affects the arteries that supply blood to the muscles in the legs. Three of the arteries most commonly blocked are the iliac artery, the superficial femoral artery (known as SFA), and the infrapopliteal arteries that are below the knee.

When the main arteries in the legs become blocked by plaque, smaller arteries, called collateral pathways, take over as the main route to supply blood to the leg muscles. These smaller arteries can supply the muscles with enough blood when a person is at rest, but they can’t do a good enough job when a person is physically active and the leg muscles need more blood and oxygen.

People with lower extremity PAD often have pain or discomfort when walking or going about their daily tasks. Doing physical activities is often hard because of the decreased blood supply to the legs, usually causing symptoms to get worse over time unless they get treatment.

Lower extremity anatomy with PAD

These symptoms may include:

• Pain or tiredness in the lower extremities
• Buttock pain
• Burning or tingling in the feet
• Sores or breaks in the skin of the legs and feet
• Loss of hair on the feet or toes
• Aching in the feet or toes when at rest
• Changes in skin color (reddish, bluish, or pale discoloration)
• Decrease in skin temperature
• Impotence (inability to get or maintain an erection)

Risk Factors

Millions of people worldwide have or are at risk for PAD. Many who suffer from the disease are never diagnosed or treated.

While some hardening of the arteries and plaque buildup in the arteries is normal as you grow older, certain risk factors, including behaviors, conditions or habits, can lead to developing PAD sooner. The more risk factors you have, the higher your chances of developing PAD.

Some of the risk factors for PAD are:

• Age over 50 years old
• Smoking
• Diabetes
• Family history of heart or vascular disease
• High blood pressure (also called hypertension)
• High levels of cholesterol and triglycerides in your blood
• Lack of exercise or physical activity
• Obesity (overweight)
• Stress

Although you can't control risk factors like your age and family history, you can control or manage some risk factors to lower your risk. These include smoking, diabetes, high blood pressure, high cholesterol, obesity, and leading an inactive lifestyle. Your doctor can advise you in making healthier choices about your diet, tobacco use, and activity level and stress management.

If you are at risk of developing PAD, it is important to talk with your doctor about ways to lower your risk factors. In addition to having atherosclerosis (hardening of the arteries), people with PAD are also at high risk for suffering a heart attack or stroke.

Diagnosis

When making a diagnosis, your doctor will review your medical and family history, risk factors and symptoms. If your doctor suspects you have PAD, he or she may give you a series of tests and examinations before deciding on a treatment plan. These tests are designed to measure how well your blood is flowing through your arteries and identify areas of concern.

Tests or examinations you may be given include:

• Ankle-brachial index (ABI): Used to diagnose PAD in the lower extremities (legs). An ABI compares the blood pressure measured at your ankle with the blood pressure measured in your arm. A regular blood pressure cuff and special ultrasound device are used in this test.
• Exercise stress test: Involves walking on a treadmill for a period of time, usually about 5 minutes, or until you must stop walking because of tiredness or discomfort in your legs.
• Ultrasound: Uses high-frequency sound waves to create an image that can help your doctor evaluate blood flow and narrowing or blockages in your blood vessels.
• Magnetic resonance imaging (MRI): Uses magnetic fields and radio waves to create an image that shows blockages inside your arteries.
• Angiography: Uses an imaging technique called fluoroscopy, which uses X-ray technology and a fluid called contrast dye to "film" the blood flow in your arteries. These images can show the exact location of any narrowing in the blood vessel. This test is done in a catheterization laboratory, or "cath lab."
• Computed tomography (CT): Uses specialized X-ray scans to make detailed pictures of your arteries to detect blockages.

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