Peripheral Vascular Disease (Peripheral Arterial Disease)

Peripheral arterial disease (PAD) is a narrowing or blockage of arteries that results in poor blood flow to the arms and legs. Peripheral arterial disease is also called peripheral vascular disease.

Like coronary artery disease, which affects the arteries that supply the heart, PAD is commonly caused by hardening of the arteries due to the buildup of plaque. 

The presence of PAD indicates a higher risk of having heart attack or stroke, which is why diagnosis and treatment are so important.  Advanced peripheral arterial disease can also result in gangrene and eventual amputation of a limb.

Risk Factors

Risk factors for peripheral arterial disease include:

• Elevated cholesterol levels and lipids
• High blood pressure (hypertension)
• Smoking
• Obesity
• Lack of exercise
• Aging (risk increases past age 50)

Symptoms

Only about half of the individuals with peripheral vascular disease have symptoms. PAD symptoms can range from mild discomfort to severe cases that can cause gangrene or ulcerations with poor or no healing.

The most common symptom of peripheral vascular disease in the legs is "intermittent claudication," which is pain in the calf, foot, thigh or buttock that occurs during exercise, such as walking up a steep hill or a flight of stairs. This pain usually occurs after the same amount of exercise, intensifies until exercise becomes impossible and is relieved by rest.  While several types of intermittent claudication exist, arterial intermittent claudication is the most common form. 

Additional symptoms can include:

• Weak or tired legs
• Difficulty walking or balancing
• Cold and numb feet or toes
• Sores that are slow to heal
• Foot pain while you are at rest
• Erectile dysfunction

Diagnosis

It is important to determine whether leg pain is caused by arterial disease or some other condition. In addition to a thorough physical exam with medical history, there are several procedures available to diagnose PAD:

• Ankle-brachial index (ABI) test: This commonly-used exam compares blood pressure in the ankle to blood pressure in the arms to determine how well blood is flowing. If the pressure in the ankle is reduced, this can indicate blockages of the arteries in the legs. 
• Ultrasound imaging: This non-invasive method uses sound waves to measure the blood flow in an artery to indicate the presence of a blockage.
• Contrast angiogram:  In this test, a dye known as contrast is injected into the arteries. An X-ray is then used to obtain images of the arteries and veins, along with any blockages.  

Treatment Options

Treatment for PAD can range from simple lifestyle changes to surgery, depending on the extent of artery blockage and the severity of symptoms. 

Lifestyle Changes

• Quitting smoking
• Medications to control blood pressure, LDL (bad) cholesterol and blood glucose
• Regular exercise such as walking for 30 minutes at least 3 or 4 times per week
• Following a heart-healthy diet that's low in fat and includes lots of fruits and vegetables

Surgical Options

Surgical options include open (traditional) bypass surgery and endovascular (minimally invasive) techniques.

• Endovascular surgery: If the narrowing affects a limited part of the artery, then an endovascular approach can be utilized.  In this minimally invasive procedure, treatment is performed within the blood vessel itself, using catheters inserted into the vein. The most common endovascular therapy is a balloon angioplasty, in which a balloon is inflated and deflated multiple times in the artery, which pushes plaque out of the way and improves blood flow.  Often, you'll be able to go home the same day as the procedure. Depending on which artery is being treated, a stent may be inserted during the angioplasty.  A stent is a metallic mesh tube that is placed at the site of the narrowing to open the artery up and keep it open. 
• Bypass surgery: In bypass surgery, the obstructed portion of the artery is bypassed using either a synthetic graft or healthy veins harvested from other parts of the body. During the surgery, the graft is attached above and below the obstructed area,  creating a new path for the blood flow. Recovery time is longer than for endovascular techniques, usually involving a few days in the hospital until you can walk on your own.