Narrowing in the arteries of the legs can cause peripheral artery disease, limiting the blood flow to legs and feet. This restriction in blood flow can cause non-healing sores, pain in the legs while walking, and, in some cases, amputation.

PAD affects 8 to 12 million people in the United States, especially those over the age of 50, and can increase the risks for heart attack and stroke. It is a chronic disease that cannot be cured. It requires lifelong management to prevent disease progression and recurrence of symptoms.

Risk Factors

  • Smoking increases the risk of PAD and worsens symptoms
  • Diabetes: one-third of patients over the age of 50 with diabetes likely has PAD
  • High cholesterol
  • High blood pressure
  • Obesity
  • Age over 60
  • More common in males
  • Family history of PAD

Symptoms

  • Cooler temperature of one leg compared to the other
  • Non-healing sores or infections
  • Claudication: cramping, fatigue, and pain or discomfort in the leg (calf, thigh, or buttocks)
  • Pain in the legs or feet that disturb sleep
  • Color changes in the skin, including a pale, reddish, or bluish color
  • Decreased hair growth on legs and toes

How is PAD diagnosed?

Diagnosis of PAD begins with a detailed review of medical history and a thorough physical exam. Your physician will inspect your legs and feet for abnormalities and will ensure adequate pulses throughout the lower extremities. If there is a question or concern for PAD, diagnostic imaging or testing will be recommended.

 

Methods to evaluate PAD

 

Ankle brachial index (ABI)

This simple, non-invasive test compares blood pressures in the arms and ankles. A significant difference in the pressures is considered abnormal and further testing may be warranted.

Pulse volume recordings (PVRs)

This non-invasive test compares blood pressures in the arms to segmental pressures in the thighs, calves, ankles, and toes. The use of ultrasonography helps to obtain additional information about the presence, severity, and location of PAD.

Arterial ultrasound

This is a painless test where sound waves are used to visualize the flow of blood through the arteries to look for blockages.

Computed tomography (CT) and Magnetic resonance angiogram (MRA)

Contrast dye is given through an intravenous (IV) catheter prior to scan, creating three-dimensional images of your lower extremity arterial system. With these images, your physician can better assess the level of disease and formulate the most appropriate care plan.
 

Management of PAD

Treatment options are based on the severity of the symptoms and overall health. For most patients with claudication, a walking program is initially recommended. Most people notice improvement of their symptoms after exercise and lifestyle changes are made.

Exercise

A regular walking program will help improve not only your symptoms, but also your overall cardiovascular health. It is recommended to walk at least 30 minutes a day, five days a week, or a total of 150 minutes weekly. To maximize results, walk as much as you can with pain before stopping. Stop only long enough for the pain to improve before starting again. If you develop an ulcer or wound on your feet, notify your vascular specialist right away.

Saint Luke’s Cardiac Rehab department offers structured supervised exercise therapy to help maximize symptom improvement with PAD. Your physician will help determine if you are a good candidate for this program.

Nutrition

A heart-healthy diet rich in fish, nuts, olive oil, and other forms of lean protein will reduce your risk of progressive atherosclerosis and other complications. Diets high in saturated fat (red meat, butter, cheese, ice cream) and trans fats (e.g., partially hydrogenated oils) will increase risk of cardiovascular complications. Eating right, along with regular exercise, will reduce your risk of heart attack, stroke, and progression of PAD.

Smoking cessation

Smoking is a major factor contributing to the occurrence and progression of many vascular diseases, including heart disease, stroke, and PAD. Ask your physician for information about Saint Luke’s smoking cessation program to help quit smoking for good.

Medication

Take medications as recommended to control high blood pressure, high cholesterol, diabetes, and kidney failure. Your physician may recommend that you begin a cholesterol medication, even if you do not have high cholesterol. This will help prevent further buildup of plaque in your arteries and reduce your risk of heart attack and stroke.

Some medications, including Cilostazol (Pletal), may help reduce leg pain when walking or climbing stairs. Other medications can help prevent cardiovascular complications. Talk to your physician to see what medications are right for you.

Surgical Procedures and Surgical Treatments for PAD

Arteriogram

This is a procedure in which a thin, hollow tube is placed into an artery, usually through the femoral artery in your groin. Contrast dye is injected into the artery allowing for direct evaluation of blockages. If treatment of a blockage is needed, it is often done at this time.

Angioplasty and stenting

This treatment involves threading a small catheter through the blockage. A small balloon on the catheter is inflated to open the blockage, allowing increased blood flow through the artery. In some instances, a stent is then inserted to keep the blockage open.

Atherectomy

This is a widely used procedure designed to remove plaque from arteries.

Endarterectomy or surgical bypass

This is a surgical option for peripheral artery disease that removes plaque within the artery through a small incision. Your physician may also recommend a surgical bypass, where a graft is used to redirect blood flow around a blocked or narrowed artery. The graft can be created using your own vein, or synthetic material may be used.

Atherosclerosis

What is atherosclerosis?

Atherosclerosis thickening or hardening of the arteries. It is caused by a buildup of plaque in the inner lining of an artery. 

Normal artery and artery with plaque buildup
 

Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. As it builds up in the arteries, the artery walls become thickened and stiff.

Atherosclerosis is a slow, progressive disease that may start as early as childhood. However, it can progress rapidly.

What causes atherosclerosis?

It's not clear exactly how atherosclerosis starts or what causes it. However, a gradual buildup of plaque or thickening due to inflammation occurs on the inside of the walls of the artery. This reduces blood flow and oxygen supply to the vital body organs and extremities.

What are the risk factors for atherosclerosis?

Risk factors for atherosclerosis, include:

  • High cholesterol and triglyceride levels
  • High blood pressure
  • Smoking
  • Type 1 diabetes
  • Obesity
  • Physical inactivity
  • High saturated fat diet

How is atherosclerosis treated?

Your healthcare provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

Treatment may include:

Lifestyle changes

You can change some risk factors for atherosclerosis such as smoking, high cholesterol levels, high blood sugar (glucose) levels, lack of exercise, poor dietary habits, and high blood pressure.

Medicines

Medicines that may be used to treat atherosclerosis include:

  • Antiplatelet medicines. These are medicines used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel, ticlopidine, and dipyridamole are examples of antiplatelet medicines.
  • Anticoagulants. Also called blood thinners, these medicines work differently from antiplatelet medicines to decrease the ability of the blood to clot. Warfarin and heparin are examples of anticoagulants.
  • Cholesterol-lowering medicines. These are medicines used to lower fats (lipids) in the blood, particularly low density lipid (LDL) cholesterol. Statins are a group of cholesterol-lowering medicines. They include simvastatin, atorvastatin, and pravastatin among others. Bile acid sequestrants—colesevelam, cholestyramine and colestipol—and nicotinic acid are other types of medicine that may be used to reduce cholesterol levels. Your doctor may also prescribe fibrates to help improve your cholesterol and triglyceride levels.
  • Blood pressure medicines. Several different groups of medicines act in different ways to lower blood pressure.

Coronary angioplasty

With this procedure, a long thin tube (catheter) is thread through a blood vessel to the heart. There, a balloon is inflated to create a bigger opening in the vessel to increase blood flow. Although angioplasty is done in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. There are several types of PCI procedures, including:

  • Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.
  • Atherectomy. The blocked area inside the artery is shaved away by a tiny device on the end of a catheter.
  • Laser angioplasty. A laser used to vaporize the blockage in the artery.
  • Coronary artery stent. A tiny mesh coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
Coronary angioplasty

Coronary artery bypass

Most commonly referred to as bypass surgery, this surgery is often done in people who have angina (chest pain) due to coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a healthy vein from elsewhere in the body and attaching it above and below the blocked area of a coronary artery. This lets blood flow around the blockage. Veins are usually taken from the leg or from the chest wall. Sometimes more than one artery needs to be bypassed during the same surgery.

What are the complications of atherosclerosis?

Plaque buildup inside the arteries reduces the blood flow. A heart attack may occur if the blood supply is reduced to the heart. A stroke may occur if the blood supply is cut off to the brain. Severe pain and tissue death may occur if the blood supply is reduced to the arms and legs.

Can atherosclerosis be prevented?

You can prevent or delay atherosclerosis by reducing risk factors. This includes adopting a healthy lifestyle.  A healthy diet, losing weight, being physically active, and not smoking can help reduce your risk of atherosclerosis. A healthy diet includes fruits, vegetables, whole grains, lean meats, skinless chicken, seafood, and fat-free or low-fat dairy products. A healthy diet also limits sodium, refined sugars and grains, and solid fats.

If you are at risk for atherosclerosis because of family history, or high cholesterol, it is important that you take medicines as directed by your healthcare provider.

When should I call my healthcare provider?

If your symptoms get worse or you have new symptoms, let your healthcare provider know.

Key points of atherosclerosis

  • Atherosclerosis is thickening or hardening of the arteries caused by a buildup of plaque in the inner lining of an artery.
  • Risk factors may include high cholesterol and triglyceride levels, high blood pressure, smoking, diabetes, obesity, physical activity, and eating saturated fats.
  • Atherosclerosis can cause a heart attack, stroke, aneurysm, or blood clot.
  • You may need medicine, treatments, or surgery to reduce the complications of atherosclerosis.

 

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.