What is Peripheral Arterial Disease (PAD)?
Peripheral artery disease (PAD) is a narrowing of the peripheral arteries that carry blood away from the
heart to other parts of the body. The most common type is lower-extremity PAD, in which blood flow is reduced to the legs and feet. Upper-extremity PAD (arms, hands, and fingers) is less common but affects about 10% of the population.
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Clogged arteries from PAD are like pinched garden hoses. Less water (blood) reaches your legs and feet, which can cause problems. If left untreated, the lack of blood flow can lead to:
Infection and tissue death (gangrene): This can be serious and might require limb amputation.
Increased risk of heart attack and stroke: PAD damages your blood vessels, making them more prone to problems elsewhere in your body.
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Imagine PAD as a warning light on your car dashboard. It tells you there's a problem with the arteries in your legs, but it also means there's a chance of similar problems elsewhere in your body, like your heart or brain. Therefore, PAD is important to manage, to avoid those other problems.
PAD diagnosis begins with a medical history and physical examination. Your healthcare provider will also ask about your symptoms and check the pulses in your legs. Your provider might require further testing such as:
PVR/ABI: This painless exam compares the blood pressure in your lower legs to the blood pressure in your arms. It takes only a few minutes and can be performed by your healthcare provider as part of a routine exam.
Arterial US: The non-invasive test visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
CT Scan: The non-invasive test uses X-ray and contrast agent (dye) to create pictures of blood vessels in the arteries in your abdomen, pelvis, and legs.
Angiography: During an angiogram, also called an arteriogram, a contrast dye is injected into the artery and X-rays are taken to show blood flow in the leg arteries to locate any blockages.
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Increasing age
o Age 65 and older
o Age 50 to 64 with risk factors for atherosclerosis
o Less than 50 with Type 2 diabetes and at least one other risk factor for
atherosclerosis
Personal or family history of PAD, cardiovascular disease or stroke
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Cigarette smoking
Smokers have nearly three times the risk of PAD than nonsmokers.
Type 2 diabetes
Having diabetes puts you at greater risk of developing PAD as well as other cardiovascular diseases.
High blood pressure
High blood pressure is called “the silent killer” because it has no symptoms. It is necessary to work with your health care provider to monitor and control your blood pressure.
High blood cholesterol
High cholesterol contributes to the build-up of plaque in the arteries (atherosclerosis), which can significantly reduce the blood flow. Managing your cholesterol levels is essential to prevent or treat PAD.
Physical activity
A lack of physical activity in your lifestyle increases the chances of developing PAD. Supervised exercise programs are therefore one of the treatments for PAD patients. An active lifestyle helps decrease the risk of PAD, heart attack, and stroke.
You can choose more than one risk factor to improve. Controlling only one isn’t as effective as making an effort to care for all factors that you have the power to control.
PAD Diagnosis
Magnetic Resonance Angiography (MRA)
The test provides cross-sectional images like a CT without using X-rays.
Angiography
During an angiogram, also called an arteriogram, a contrast dye is injected into the artery and X-rays are taken to show blood flow in the leg arteries to locate any blockages.
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Remember that PAD often goes undiagnosed. Untreated PAD can lead to painful symptoms or loss of a leg, and people with PAD have an increased risk of coronary artery disease, stroke and heart attack.
This is why the American Heart Association encourages people at risk to discuss PAD with their healthcare provider to ensure early diagnosis and treatment.
Peripheral artery disease diagnosis begins with a medical history and physical examination. Your healthcare provider will also ask about your symptoms and check the pulses in your legs.
Your physical exam may include:
Ankle-brachial index (ABI)
This painless exam compares the blood pressure in your lower legs to the blood pressure in your arms. It takes only a few minutes and can be performed by your healthcare provider as part of a routine exam. A normal ABI is 1.00 to 1.40. A value less than or equal to 0.90 is considered abnormal, and, in severe disease, it’s less than 0.5. If your ABI results are normal or borderline (.91 to .99), an exercise treadmill ABI and/or a toe-brachial index (TBI) test also may be done.
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If your ABI is abnormal, you may need more testing. Your doctor may recommend one of these tests:
Duplex Ultrasonography
The non-invasive test visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
Computed Tomographic (CT) Angiography
The non-invasive test uses X-ray and contrast agent (dye) to create pictures of blood vessels in the arteries in your abdomen, pelvis, and legs. This test is particularly useful in patients with pacemakers or stents.
PAD Treatment
1. Smoking cessation
Smoking tobacco is a major risk factor for PAD and increases your risk for heart attack and stroke. If you smoke, take steps to quit. Effective tools include behavior modification programs, nicotine replacement medicines and other quit-smoking medications. Quitting smoking will help slow the progression of PAD and other heart-related diseases.
Visit the smoke free website and you will find multiple resources to help you quit smoking:
3. Diet
Many people with PAD have elevated cholesterol levels. A diet low in saturated and trans fat can help lower blood cholesterol levels. Cholesterol-lowering medication may also be needed.
Aim for a healthy diet that emphasizes vegetables, fruits and whole grains. Include low-fat dairy products, poultry, fish, legumes, nuts, seeds and non-tropical vegetable oils such as olive oil.
Try to limit sodium, saturated and trans fats, added sugars, sugar-sweetened beverages and red meat.
4. Medication
It’s important to take the medication that your health care professional prescribes. Not taking these medications can increase your risk for PAD, as well as heart attack and stroke.
Medications that may be prescribed include:
Antiplatelet agents (such as aspirin and/or clopidogrel) to prevent blood clots.
Cholesterol-lowering medications (such as statins).
High blood pressure medications (in people with PAD and high blood pressure, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers are recommended).
Oral anticoagulants (such as warfarin or rivaroxaban) to decrease the tendency for blood
clots to form.
If you have claudication, you also may be prescribed medication (cilostazol) to help improve your walking distance.
Talk to your healthcare professional about what medications you may need based on your condition and other risk factors.
How Do I Manage My Medicines? (PDF)
6. Procedures
For some patients, the above recommendations and treatments aren’t enough. So minimally invasive treatment or surgery may be needed.
Minimally invasive revascularization:
Angioplasty, atherectomy, or stent placement are procedures which can be performed by making a small incision through which a catheter is inserted to reach the blocked artery.
A tiny balloon is inflated inside the artery to open the clog. A tiny wire mesh cylinder called a stent may also be inserted at this time to help hold the artery open.
Sometimes medicine can be administered through the catheter, or a special device can be inserted through it to remove a clot that’s blocking the artery.
If a long portion of artery in your leg is completely blocked and you’re having severe symptoms, bypass surgery may be needed. A vein from another part of the body is used to “bypass” and reroute blood flow around the closed artery.
Your health care professional will discuss your treatment options and help choose the best one procedure for you.
2. Physical Activity
An effective treatment for PAD symptoms is regular physical activity. Your doctor may recommend supervised exercise training, also known as supervised exercise therapy (SET). You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms.
Exercise for intermittent claudication (pain affecting the calf, and less commonly the thigh and buttock, that is induced by exercise and relieved by rest) takes into consideration that just walking causes pain.
The program consists of alternating activity and rest in intervals to build up the amount of time you can walk before the pain sets in. It’s best if this exercise program is done in a rehabilitation center on a treadmill and monitored. If it isn’t possible to go to a rehabilitation center, your healthcare provider may recommend a structured community or home-based program.
5. Managing Diabetes
Type 2 diabetes increases the risk of poor outcomes among people with PAD. Achieving glucose control benefits all people with diabetes and can reduce limb-related complications in people with PAD.
Work with your healthcare team to create a coordinated care plan including:
Healthy diet to reduce your cholesterol and manage diabetes
Reaching and maintaining a healthy weight
Medications for glucose management
Managing other cardiovascular risk factors
Foot care and ulcer prevention