Peripheral Arterial Disease (PAD) / Arteriosclerosis of the Extremities

Peripheral arterial disease (PAD) is a chronic disorder that affects 12 million Americans and causes reduction of arterial blood flow to the pelvis, legs or arms. If you have PAD, you have an increased risk for heart attack and stroke. This is a common disorder, usually affecting men over the age of 50. People are at higher risk if they have a personal or family history of coronary artery disease (heart disease) or cerebrovascular disease (stroke), diabetes, smoking, hypertension or kidney disease involving hemodialysis.

An estimated one out of every three people with diabetes over the age of 50 has peripheral arterial disease, according to the American Diabetes Association. However, many people with warning signs do not realize that they have PAD and, therefore, do not receive treatment.

What Causes Peripheral Arterial Disease?

PAD, also called peripheral vascular disease (PVD), occurs when blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to your feet and legs. Though there potentially are multiple causes for the obstruction to blood flow responsible for this condition, atherosclerosis, commonly referred to as hardening of the arteries, is the most common cause.

Most patients who suffer from peripheral arterial disease do not have any symptoms. However, when the arteries to the arm or leg become narrow enough to significantly reduce nutrient and oxygen rich blood to the affected extremity, lactic acid begins to build up in the muscles leading to pain during exercise. The pain associated with exercise in this condition has been termed “intermittent claudication” and may be described as tiredness in the leg, muscle cramps or severe pain over the muscles. Though similar symptoms also may be found in venous disease, arthritis, neuropathy or spinal disease; patients with arterial claudication only experience symptoms with exercise, which will resolve after several minutes of rest. Patients who have multiple severe obstructed arteries also may have severe enough restriction to blood flow that they develop pain in the extremity at rest, non-healing ulcers or gangrene.

Symptoms that may appear include the following:

• Leg pain associated with exercise
• Numbness of the legs or feet at rest
• Cold legs or feet
• Muscle pain in the thighs, calves or feet
• Loss of hair on the legs and/or feet
• Change of color of the legs
• Paleness or blueness
• Pulse, weak or absent in the limb
• Walking/gait abnormalities

The diagnosis of peripheral arterial disease usually can be made on the basis of a thorough history and physical examination. Arterial Doppler studies often are obtained to provide a baseline study to help determine the extent of the vascular blockages. When surgery or endovascular therapy is being considered, more detailed imaging will be needed to plan the appropriate treatment. Though the gold standard for pre-operative planning is with an arteriogram, other less invasive alternative studies include CT angiogram, as well as MR angiogram.

Peripheral Arterial Disease Treatments

Treatment options for those patients with peripheral arterial disease are varied and depend on the overall health of the patient and the severity of the diagnosis. Treatment focuses on the relief of symptoms and self-care such as foot care to improve circulation.

Medications may be required to control the disorder, including pain relievers, blood thinners, and medications to enlarge or dilate the affected artery(ies)

Surgery usually is performed only on severe cases where the ability to work or pursue essential activities is affected. Surgery may consist of removing the lining of the artery (endarterectomy) or repairing or replacing the vessel (grafting); most commonly, bypass surgery is performed, using a vein or synthetic graft.

Alternatives to surgery may include treatments such as balloon angioplasty (a similar technique to that used to open the coronary arteries but performed on the blood vessels of the affected extremity), sometimes followed by stent implantation, laser treatment or other treatments.

The majority of patients will not require any surgery but should be counseled regarding lifestyle modifications, which can improve their ability to exercise but also will prevent atherosclerosis from developing in other arterial systems, including the heart and brain. Since the four major risk factors for developing atherosclerosis are smoking, high cholesterol, diabetes and hypertension, patients should be encouraged to discontinue all nicotine products and other medical problems should be addressed with diet and/or medications.

Exercise also is an important form of treatment since patients with peripheral arterial disease often times will see an improvement in their claudication symptoms by starting a regimented walking program.

When lifestyle modifications and an exercise program do not result in an improvement in their claudication symptoms, there are medications (Pentoxifylline and Cilostazol) that may help the patient with peripheral arterial disease lengthen their walking distance before having to stop and rest. If a patient with vascular blockages has severe lifestyle-limiting claudication symptoms unresponsive to the above treatments, rest pain and/or non-healing leg ulcers, interventional treatment for their vascular blockages may be considered.

Endovascular therapy, including angioplasty and stenting of the peripheral arteries, now plays a major role in helping patients with peripheral arterial disease. These less invasive procedures can provide durable results that significantly improve blood flow to the extremities and result in improvement of claudication symptoms. For those patients who are not candidates for endovascular therapy, open surgery can remove the arterial obstruction or a bypass may be utilized to improve blood flow to the extremity.

To make an appointment, call toll-free 1.877.UT.CARES (1.877.882.2737).