Peripheral Arterial Disease

What is peripheral arterial disease(PAD)?

Peripheral arterial disease (PAD) is a condition that occurs when the arteries supplying blood to the limbs, usually the legs, become narrowed or blocked due to atherosclerosis. This buildup of fatty deposits (plaques) can reduce blood flow, leading to symptoms like leg pain during walking (claudication), weakness, numbness, or even sores that don't heal.

What causes peripheral arterial disease (PAD)?

Peripheral arterial disease (PAD) is primarily caused by atherosclerosis, a condition where fatty deposits (plaque) build up in the arterial walls, narrowing the arteries and reducing blood flow. Several risk factors contribute to the development of PAD, the major risk factors including:

1. Smoking: Significantly increases the risk of atherosclerosis.

2. Diabetes: High blood sugar can damage blood vessels and accelerate plaque buildup.

3. High blood pressure: Can damage arteries and contribute to plaque formation.

4. High cholesterol: Elevated levels can lead to plaque accumulation.

What are symptoms of peripheral arterial disease?

Peripheral arterial disease (PAD) can cause a variety of symptoms due to reduced blood flow to the limbs. Common symptoms include:

1. Intermittent Claudication: Pain or cramping in the legs or buttocks during physical activity, such as walking or climbing stairs, which typically goes away with rest.

2. Leg Weakness or Numbness: Feelings of weakness or numbness in the legs, particularly during activity.

3. Coldness in the Lower Leg or Foot: A noticeable difference in temperature compared to the other leg or foot.

4. Sores or Wounds: Non-healing sores or wounds on the toes, feet, or legs.

5. Changes in Skin Color: Pale or bluish skin on the legs or feet.

6. Decreased Pulse or Weak Pulse: Weaker pulse in the legs or feet compared to other areas.

7. Hair Loss or Slower Hair Growth: Hair loss on the legs and feet or a reduction in hair growth.

8. Erectile Dysfunction: In men, PAD can sometimes lead to erectile dysfunction.

How is peripheral arterial disease treated?

Peripheral arterial disease (PAD) is treated through a combination of lifestyle changes, medications, and sometimes procedures or surgeries, depending on the severity. Here are the main approaches:

1. Lifestyle Changes:

• Quitting Smoking: Essential for improving circulation.

• Diet: Eating a heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can help.

• Exercise: Regular, supervised exercise programs can improve symptoms and overall cardiovascular health.

2. Medications:

• Antiplatelet Agents: Such as aspirin or clopidogrel to reduce the risk of blood clots.

• Statins: To lower cholesterol and reduce cardiovascular risk.

• Medications for Blood Pressure and Diabetes: To manage underlying conditions that can worsen PAD.

3. Procedures:

• Angioplasty and Stenting: A catheter is used to open narrowed arteries, often with a stent placed to keep the artery open.

• Bypass Surgery: Creating a detour around blocked arteries using a graft.

4. Supervised Exercise Therapy: Structured programs that focus on walking and improving endurance can significantly help with symptoms.

We tailor the treatment plan based on the patient’s symptoms and overall health.

What are the risks and potential complications?

Risks are generally low but can include further vessel injury, bleeding or thrombosis. Always discuss potential risks with your healthcare provider.

Case example:

63 y/o female with history of diabetes and high blood pressure with severe thigh cramping, atrophy of musculature and difficulty ambulating to her mailbox. Work up for peripheral arterial disease revealed severe bilateral common iliac artery narrowing. These were then treated with stents and the patient now ambulates without difficulty.