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Peripheral Arterial Disease

peripheral arterial disease

Peripheral arterial disease (PAD) is narrowing of one or more arteries (blood vessels). It mainly affects arteries that take blood to your legs.

What causes peripheral arterial disease?

The narrowing of the arteries is caused by atheroma. Atheroma is like fatty patches (plaques) that develop within the inside lining of arteries. A thick patch of atheroma makes the artery narrower. This reduces the flow of blood through the affected section of artery. Tissues downstream have a reduced blood supply, which can lead to symptoms and problems.

What causes atheroma?

Lifestyle risk factors that can be prevented or changed:

  1. Smoking.
  2. Lack of physical activity.
  3. Obesity.
  4. An unhealthy diet.
  5. Excess alcohol.

Treatable or partly treatable risk factors:

  1. Hypertension (high blood pressure).
  2. High cholesterol blood level.
  3. High triglyceride (fat) blood level.
  4. Diabetes.
  5. Kidney diseases causing diminished kidney function.

Fixed risk factors - ones that you cannot alter:

  1. A strong family history.
  2. Being male.
  3. An early menopause in women.
  4. Age. The older you become, the more likely you are to develop atheroma.
What are the symptoms of peripheral arterial disease?

The typical symptom is pain which develops in one or both calves when you walk or exercise and is relieved when you rest for a few minutes. This pain varies between cases and you may feel aching, cramping or tiredness in your legs. This is called intermittent claudication.

If an artery higher upstream is narrowed, such as the iliac artery or aorta, then you may develop pain in your thighs or buttocks when you walk.

If the blood supply to the legs becomes worse, the following may be found by a doctor who examines you:

  • Poor hair growth below your knee and poor toenail growth.
  • Cool feet.
  • Weak or no pulses in the arteries of your feet.
Severe cases

If the blood supply is very much reduced, then you may develop pain even at rest, particularly at night when the legs are raised in bed. Typically, rest pain first develops in the toes and feet rather than in the calves. Ulcers (sores) may develop on the skin of your feet or lower leg if the blood supply to the skin is poor.

How is peripheral arterial disease diagnosed?

The diagnosis is usually made by the typical symptoms. A simple test that your doctor or nurse may do is to check the blood pressure in your ankle and compare this to the blood pressure in your arm. This is called the ankle brachial pressure index (ABPI). Sophisticated tests may be done if the diagnosis is in doubt, or if surgery is being considered (which is only in the minority of cases). For example, a CT scan, an MRI scan or an ultrasound scan of the arteries can build up a map of your arteries and show where they are narrowed.

What is the outlook (prognosis) for peripheral arterial disease?

Symptoms remain stable or improve in about 15 out of 20 cases. Symptoms gradually become worse in about 4 out of 20 cases. Symptoms become severe in about 1 out of 20 cases. So, in most cases, the outlook for the legs is quite good.

What self-help measures can I do?
  • Stop smoking
  • Exercise regularly
  • Walking is the best exercise if you have PAD. Regular exercise means a walk every day, or on most days. Walk until the pain develops, then rest for a few minutes. Carry on walking when the pain has eased. Keep this up for at least 30 minutes each day, and preferably for an hour a day. You should try to do at least two hours of exercise per week. The pain is not damaging to the muscles.

  • Lose weight if you are overweight
  • You should eat a healthy diet
  • Alcohol
  • Some research suggests that drinking a small amount of alcohol helps to reduce the risk of developing cardiovascular diseases such as PAD. The exact amount is not clear, but it is a small amount.

  • Take care of your feet
  • Try not to injure your feet. Do not wear tight shoes or socks which may reduce blood supply. Tell your doctor if you have any foot injury, pain in a foot when you are resting, or any marked change in skin color or temperature in either of your feet.

What are the treatments for peripheral arterial disease?

Medicines

  • Aspirin is usually advised. A daily low dose (75 mg) is usual. This does not help with symptoms of PAD, but helps to prevent blood clots (thromboses) forming in arteries.
  • A statin medicine is usually advised to lower your cholesterol level. This helps to prevent a build-up of atheroma.
  • If you have diabetes then good control of your blood glucose level will help to prevent PAD from worsening.
  • If you have high blood pressure then you will normally be advised to take medication to lower it.
  • Other medicines are sometimes used to try to open up the arteries - for example, cilostazol and naftidrofuryl.
Surgery

Most people with PAD do not need surgery. There are three main types of operation for PAD:

  1. Angioplasty is where a tiny balloon is inserted into the artery and inflated at the section that is narrowed. This widens the affected segment of artery. This is only suitable if a short segment of artery is narrowed.
  2. Bypass surgery is where a graft (like a flexible pipe) is connected to the artery above and below a narrowed section. The blood is then diverted around the narrowed section.
  3. Amputation of a foot, or lower leg, is needed in an extremely small number of cases. It is only offered when all other options have been considered. It is needed when severe PAD develops and a foot becomes gangrenous due to a very poor blood supply

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