Peripheral Artery Disease

PAD usually affects arteries that take blood to the legs. The symptoms primarily affect one limb, but both limbs can be impacted, with the intensity of the symptoms often different in each limb. Pain or cramping in the leg that is triggered by activity such as walking, is the most common symptom of PAD. The discomfort will likely subside when the leg is at rest. 

Other symptoms may include:

• Numbness of the affected limb when at rest,
• A tingling sensation in the affected limb,
• Weakness in the affected limb, or
• A weak or absent pulse in the affected limb.

A sore or ulcer that will not heal may develop on the foot or leg in more severe cases.

As people age, the normal flow of blood through the arteries can be affected by the buildup of plaque inside the arteries. 

Over time, plaque continues to grow on arterial walls as cholesterol circulates in the blood. As the plaques enlarge, the arteries become narrow and stiffened. The plaque buildup thickens the walls of the arteries and narrows the space through which the blood flows. When this happens, it reduces the circulation of blood through the area of the body that gets its blood from the artery.

Factors that increase a person’s risk for PAD include:

• Smoking
• High cholesterol levels or lipid disorders - High levels of cholesterol in the blood can increase the risk of plaque buildup. High triglycerides, a type of fat (lipid) in the blood, may raise the risk of coronary heart disease, especially for women.
• High blood pressure - Uncontrolled high blood pressure can result in hardening and thickening of the arteries, narrowing the channel through which blood can flow.
• Family History – The risk is higher if other family members have heart disease. 
• Age, greater than 50.
• Gender – Men are generally at greater risk; however, the risk for women increases after menopause.
• Sedentary lifestyle
• Obesity 
• Unhealthy diet 
• Diabetes

To diagnose PAD, the physician will first obtain a detailed description of the patient’s symptoms. The physician may use a stethoscope to listen to the arteries of the affected limb to detect a decreased or absent pulse or listen for a “bruit” or “whooshing” sound caused by turbulent blood flow in a narrowed artery.

Depending on the results of the patient’s history and findings from the physical exam, the physician may order the following tests:

• Ankle Brachial Index – This is a combination of a traditional blood pressure device and Doppler ultrasound to compare the blood pressure in a person’s arms to the blood pressure in their legs. 
• Duplex Ultrasound – With this test, special ultrasound waves can help doctors evaluate blood flow through the arteries and identify narrowed or blocked arteries. 
• Arteriogram – Also called angiogram, this test uses an injection of dye (contrast material) into an artery in combination with imaging techniques (x-ray, MRI or CT scan), resulting in detailed images that can show narrowing or blockages.

Medications that lower cholesterol or high blood pressure, improve walking distance (cilostazol), or prevent blood clots, may be prescribed by a physician.

For more severe cases, a physician may recommend other treatment methods such as minimally invasive procedures or surgical procedures, including:
An angioplasty balloon catheter inside an artery.

• Angioplasty and Stenting - During this non-surgical procedure, a balloon attached to a small catheter is inflated within an artery to flatten the plaque against the artery wall, increasing the artery's diameter. In most cases, a stent, a metal-mesh tube, is expanded and left inside the artery to support the expansion and maintain blood flow.
• Thrombolysis - Also called clot-busting therapy, thrombolysis breaks up a blood clot with specialized catheters that either mechanically break up the clot or directly deliver drugs to dissolve blood. This is used when the blockage is caused by a blood clot.
• Thrombectomy - A procedure used when symptoms are caused by a blood clot. In thrombectomy, the physician inserts a balloon catheter past the site of the blood clot, inflates it, and removes the balloon, pulling the clot with it.
• Bypass Surgery - A physician replaces, or bypasses, the blocked artery with a healthy blood vessel harvested from the person or made from a synthetic fabric. 

Lifestyle Changes

Changes in lifestyle may be enough to slow or stop the progression of PAD for most people. Some of the lifestyle changes that a physician may recommend include:

• Quitting smoking,
• Controlling high blood pressure,
• Lowering cholesterol,
• Exercising,
• Losing weight, and 
• Controlling diabetes.