Blockages in arteries of the body’s vascular system occurring outside the heart can lead to a condition called peripheral arterial disease or PAD. Most commonly, PAD affects the lower extremities, sometimes turning simple activities like walking to the mailbox into painful or impossible tasks. Take symptoms of PAD seriously because they may indicate the presence of heart disease.
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What Is PAD?
Peripheral arterial disease, also called peripheral vascular disease, affects millions of Americans—most often men over age 50. Like coronary artery disease, it’s a form of arteriosclerosis or hardening of the arteries.
In healthy individuals, the inner lining of arterial blood vessels is smooth, allowing the easy flow of oxygen-rich blood. PAD damages the vessel lining with a buildup of plaque—fatty deposits such as cholesterol—which narrows or totally closes the artery. Over time, serious damage results from the insufficient supply of oxygen to muscles and tissues.
What Causes PAD?
PAD results from the same risk factors that cause blocked arteries in the heart:
- Family history of heart disease or stroke
- Lack of physical activity
- High blood pressure
- High blood cholesterol
Cigarette smoking is, by far, the most important risk factor, especially for anyone who smokes more than 15 cigarettes a day. African-Americans are also at increased risk, with a two- to three-fold chance of developing PAD.
PAD impairs the vessel’s ability to allow increased blood flow to muscles when needed, such as during exercise. The reduced blood flow may cause pain in the hips, buttocks or calves while walking or during physical activity that subsides when at rest. Other symptoms of PAD affecting the lower extremities include:
- Decreased hair growth
- Shiny skin
- Ulcers or sores
- Tingling or numbness
- Coolness in the affected leg or foot
- Shrinking of the calf muscle
- Thickened toenails
An ankle-brachial index (ABI), the standard screening test for PAD, uses a special ultrasound stethoscope to compare blood pressure in the arm to blood pressure in the ankle. Lower blood pressure in the ankle implies a blockage between the heart and the leg and could indicate PAD. If an ABI points to peripheral arterial disease, a noninvasive ultrasound test can provide images of vessel anatomy and blood flow to verify diagnosis.
Lifestyle changes can often slow the progression of PAD. Medication may also help in managing the disease. Of the 2.5 million cases diagnosed, 2.1 million are managed medically. Severe cases may require intervention.
Before an artery can be cleared, the exact location of the blockage/narrowing must be determined with an arteriogram. After inserting a small needle and catheter into the artery, a safe dye is injected. Images are recorded as the dye flows down each leg, providing a roadmap of normal and abnormal arteries, which helps the physician determine the best therapy. Treatment options are:
- Angioplasty, which uses a small balloon to dilate a narrow segment of an artery and is sometimes followed with stenting, which inserts a tiny metal cylinder (stent) into the vessel to support and hold it open
- Surgical bypass graft, which uses a vein grafted from another part of the body or a graft from artificial material to create a detour around a blocked artery
The best treatment for peripheral arterial disease depends on several factors, including overall health, location of the affected artery and the size and cause of the blockage or narrowing.
Learn more about peripheral artery disease in our online Health Library.