Peripheral artery, or arterial, disease, also called PAD, is similar to coronary artery disease in that blood no longer flows normally through blood vessels. In the case of peripheral artery disease, the affected arteries are located in areas of the body other than the heart and brain. Eight million people in the United States have peripheral artery disease, according to the American Heart Association.
Causes
Peripheral artery disease is typically caused by a build up of plaque in arteries in the legs. Plaque is composed primarily of fat and cholesterol. As the amount of plaque in arteries increases, atherosclerosis occurs. In this condition a weak plaque may rupture and cause the release of cells called platelets that clump together to repair injured blood vessels. As the artery narrows from the build up of plaques and the clots of platelets, blood flow becomes more constricted or completely blocked, and muscles and tissues can no longer receive oxygen and nutrients. This leads to a variety of symptoms in the legs and feet.
Symptoms
Peripheral artery disease often goes undiagnosed. Some individuals may not experience any symptoms; others may attribute the symptoms to another condition. The American Heart Association notes that the most common symptom is leg pain. For example, climbing stairs or exercise may cause leg pain and cramping that subside when the activity ends. This pain is an indication that muscles are not receiving adequate blood supply from nearby arteries. As the disease progresses, individuals may experience constant leg pain. In addition, they may notice wounds that don't seem to heal, and one leg or foot may seem noticeably colder than the other. MayoClinic.com lists additional symptoms of the disease, including loss of hair on the leg and shiny skin. Individuals experiencing any of these symptoms should visit their physician who can easily test for the disease.
Diagnosis
A physician will first perform a physical exam to search for weak pulses in the legs, detect dramatic temperature discrepancies between both legs, and inspect the presence of ulcers or other persistent wounds. If peripheral artery disease is suspected, the physician will use a test called the ankle-brachial index that is similar in appearance and function to the blood pressure cuff used on the arm. The test takes just a few minutes and tells the physician whether the blood pressure at the ankle is significantly lower than in the arm. According to the National Heart, Lung, and Blood Institute, sometimes a physician will do an ankle-brachial index before and after a patient walks on a treadmill to determine symptom severity.
Several other tests may be required to search for the location of clots or perform additional measurements of blood flow through leg arteries. These tests include ultrasound, computer tomographic angiography and magnetic resonance angiography.
Treatment
If diagnostic tests confirm peripheral artery disease, individuals are given treatment to decrease pain and prevent the buildup of more plaques. For the most part, the disease is manageable with a combination of drugs and lifestyle changes. An individual may be prescribed drugs to lower "bad" cholesterol, called low-density lipoproteins, and blood pressure. In addition, individuals may take an over the counter medicine like aspirin which can help block the actions of platelets. A drug called cilostazol may be prescribed to promote the flow of blood in the limbs and reduce leg pain. In severe cases an individual may undergo surgery so that a stent--a small cylinder made of wire mesh--can be placed inside an artery to prop it open and aid blood flow.
Expert Insight
Lifestyle changes are a necessary part of treatment. In fact, the American Heart Association states that exercise is the most effective way to treat peripheral artery disease. Just walking three times each week can improve symptoms within a couple of months. According to MayoClinic.com, how far a patient can walk pain-free is frequently how physicians measure treatment success. In addition to exercise, eating a healthier diet that is vitamin-rich, contains plenty of fiber and incorporates foods high in omega-3 fatty acids--the kind found in some fish and nuts--can prevent plaque build up. Individuals should quit smoking and avoid over-the-counter drugs that contain pseudoephedrine because they can restrict blood flow.
