PERIPHERAL ARTERY DISEASE

General Information:

What is peripheral artery disease? Peripheral artery disease, or PAD, is a condition that affects the arteries outside the heart and brain. Affected arteries include the aorta (largest artery) and arteries of the upper and lower limbs (arms and legs), neck, and organs. Arteries are blood vessels that carry blood with oxygen from your heart to the rest of your body. PAD occurs when blood flow to a body part is decreased or stopped. When blood flow slows or stops, oxygen cannot get to that body part. Over time, lack of oxygen may lead to body organ or tissue damage.

What causes peripheral artery disease? PAD may happen when the artery becomes narrowed, weakened, or blocked. Atherosclerosis (hardening of the arteries) is the most common cause of PAD. This usually occurs when fatty deposits, called plaques, build up along the walls of your arteries. The following changes in the arteries are other possible causes of PAD:

• Abnormal development: This means that your artery may have grown abnormally, such as with a condition called fibromuscular dysplasia (FMD). With FMD, artery walls in the kidneys thicken, making the artery narrow.
  
  
• Aneurysms: These are small sac-like pouches that bulge outward through weak spots in the wall of an artery. These may form due to increased pressure inside the artery. They may later rupture (burst) and cause bleeding.
  
  
• Inflammation: The condition where the arteries become inflamed (swollen) is called arteritis. This may be due to an infection or weak immune system. The immune system is the part of your body that fights infection. A problem with the immune system sometimes makes your body attack even its own cells.
  
  
• Loss of elasticity: With age, the arteries in the body may lose some of their elasticity. Certain disorders may also make the walls of your arteries lose the ability to stretch. These include neurofibromatosis or cystic medial necrosis, where arteries become thin and eventually necrose (die).
  
  
• Presence of clots: A clot may form or travel inside the artery. This may block and prevent blood flow to body parts and cause serious damage.

What increases my risk of having a peripheral artery disease? The following may put you at higher risk of having PAD:

• Age of 50 years old, and older.
  
  
• Cigarette smoking.
  
  
• Diabetes (high blood sugar levels).
  
  
• Having a close family member with atherosclerotic disease.
  
  
• High blood cholesterol (fat).
  
  
• Hypertension (high blood pressure).
  
  
• History of heart attack, heart failure, transient ischemic attack (TIA) or stroke.
  
  
• Being overweight.

What are the signs and symptoms of peripheral artery disease? Signs and symptoms depend on what part of the body was affected and how much damage was done. The legs and feet are the first, and most common parts of the body affected by PAD. You may have any of the following:

• Changes in the skin color, hair growth, or nails. Gangrene may also be present. This happens when body tissue dies, and the skin turns cold and brown or black.
  
  
• Muscle pain or cramping in your hip, thigh, calf, or foot. This usually occurs with walking or exercising and goes away with rest. Over time, pain may happen even at rest, especially while lying down.
  
  
• Numbness or weakness of the leg. You may also feel your legs getting tired easily.
  
  
• Sores that do not heal on your legs or feet.

How is peripheral artery disease diagnosed? Your caregiver will take a detailed health history from you, including diseases or procedures you may have had. You may need any of the following tests:

• Angiography: This test looks for problems with your arteries in any of your extremities (hands, arms, feet, and legs). A dye is used to help the arteries show up better on the pictures. Pictures may be taken using an x-ray, magnetic resonance imaging (MRI), or a computed tomography (CT) scan. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to shellfish, dyes, or any medicines.
  
  
• Ankle brachial index: This test is also called ABI. This checks how well blood is flowing through the arteries in your legs. While you lie on your back, your caregiver will take blood pressure readings on your arms and legs. A stethoscope or a small machine called a doppler is used to hear your blood pressure. The blood pressure in both your arms and legs may be checked. Blood pressure differences may be a sign of PAD.
  
  
• Arterial doppler: An arterial doppler test is done to check blood flow through an artery. A small metal disc with gel on it is placed on your skin over the artery. You can hear a "whooshing" sound when the blood is flowing through the artery. An "X" may be marked on your skin where caregivers feel or hear the blood flowing best. Caregivers may need to check blood flow more than once.
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Treadmill test: This test will help caregivers learn how far you can walk. It is also called your maximal walking distance (MWD). It also helps them learn your pain-free walking distance (PFWD). This tells caregivers about the condition of arteries in your legs, and how well your treatment is working.

How is peripheral artery disease treated? 

• Risk factor modification: Caregivers may tell you to avoid things that may worsen your PAD. These may include smoking and eating fatty, salty, or sweet foods. They may treat other health problems that you have, such as diabetes, hypertension, heart disease, and high cholesterol.
  
  
• Exercise rehabilitation: This is an exercise program designed to help ease your leg pain. This treatment may include exercises, such as walking, performed on a track or a treadmill. Exercise rehabilitation is done three or more times in one week, for at least 12 weeks. Each session may last for 30 minutes to one hour.
  
  
• Medicines:
  
  
  • Blood thinners: These are also called antiplatelet medicines. These medicines interact with platelets to prevent clots from forming in your blood. Platelets are a type of blood cell that join to form clots.
    
    
  • Clot busters: This medicine helps break apart clots. It is given IV and may be given at the same time as other blood thinners. This medicine could save your life because blood clots in the heart, lungs or brain can kill you. Be careful because you may bleed or bruise easily.
    
    
  • Others: Certain medicines may be given to widen blood vessels and keep clots from forming. These medicines may help ease pain when walking by increasing blood flow to the legs. They may help you to walk longer and further without pain. Ask your caregiver if these medicines can be given to you.
  
  
• Procedures: You may need certain procedures depending on how bad your PAD is. A blocked artery may be opened up and a stent placed inside to keep it open. Surgery to send blood around a blocked part by placing a new blood vessel may be done. If the bone becomes affected because of the poor blood flow, a type of bone surgery may be done. Some tissues around the bone may need to be removed.

How can peripheral artery disease be prevented? 

• Do not smoke cigarettes or any form of tobacco. Talk to your caregiver about information on how to stop smoking if you are having trouble quitting.
  
  
• Exercise regularly for at least 30 minutes, three times every week. This prevents narrowing of the blood vessels and improves blood flow in your body.
  
  
• If you have diabetes, monitor and keep your blood sugar at a normal, steady level. Check your blood sugar often. Ask caregivers if you should make changes to your diet, exercise, or medications.
  
  
• Keep your blood cholesterol level in a normal range. Eat foods low in fat to decrease the risk of developing plaque in your blood vessels. If you have high blood cholesterol levels, talk to your caregiver about ways to lower it.
  
  
• Take your high blood pressure medicine regularly. Learn to relax by deep breathing, meditating, or doing other activities when you are under stress.

Where can I find support and more information? Having a peripheral artery disease may be life-changing for you and your family. Accepting that you have PAD may be hard. You and those close to you may feel angry, sad, or frightened. These feelings are normal. Talk to your caregivers, family, or friends about your feelings. Contact the following for more information:

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• American Heart Association National Center
  7272 Greenville Avenue
  Dallas, TX75231-4596
  Phone: 1-800-242-8721
  Web Address: http://www.americanheart.org
  

• LEGS FOR LIFE®
  Web Address: www.legsforlife.org