Peripheral artery disease

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VOL 112 / NO 3 / SEPTEMBER 2002 / POSTGRADUATE MEDICINE

Normally, blood moves smoothly and swiftly through our blood vessels, which include arteries and veins, and travels throughout our body. Arteries supply blood rich in oxygen from the heart to the body's outermost area, or periphery (per-if-er-ee), such as feet and hands. Veins return blood from this area to the heart.

Sometimes, the channel inside a person's arteries becomes narrow as, over time, blood clots and fat attach to the channel's lining and form a hard buildup called plaque. Like parked cars that limit the area for cars to travel down a city street, this buildup blocks the path for adequate blood flow. The name for this condition is peripheral artery disease (PAD).

Who is at risk for PAD?
Persons who smoke are at highest risk for PAD. In addition, those with diabetes, high blood pressure, high cholesterol, or a history of blood vessel disease in other parts of the body have an increased risk of the disease.

Age adds to the chance of having PAD. Persons aged 70 or older have a greater risk than younger people. Risk of PAD is also higher in someone aged 50 or older who has diabetes, is a smoker, or feels leg pain during exercise.

What are the symptoms of PAD?
PAD can cause several symptoms (see box below). Often, the key symptom that causes a person to see a doctor is pain in the leg, hip, or buttock muscles during exercise, particularly while walking. Because the diseased arteries limit blood flow to these areas, the muscles receive less oxygen than usual and begin to cramp when they are used.

Unfortunately, by the time PAD causes such pain, it already may have cut the blood flow in arteries by 60% or more. Many people have no symptoms of PAD, and it often goes undetected for many years.

How is PAD discovered?
Several tests can show whether you have PAD. One common test is the ankle-brachial (brake-ee-el) index, which can be done in about 15 minutes during an office visit. It uses a blood pressure cuff, like the one normally used to read blood pressure in an arm, and a Doppler ultrasound instrument, which measures blood pressure with sound waves. A pressure reading is taken in both the arms and ankles, and the readings are compared to see how near they are to normal.

Other ways of finding PAD include the treadmill exercise test and the arteriogram (ar-tear-ee-o-gram), in which a dye is injected into an artery and its movement tracked using x-ray views taken as the dye flows through the artery. In this way, your doctor can see where and by how much the flow is blocked.

What is the treatment for PAD?
PAD treatment includes making choices about how you live your life, such as stopping smoking, getting regular exercise (especially walking), controlling diabetes, and eating a low-cholesterol diet. Another treatment involves taking a drug to lower your cholesterol or blood pressure, or both. Medications that help improve blood flow to the feet and hands may also be used, as well as aspirin, which helps prevent blood clots.

Your doctor may consider surgery as an option for you. For example, this step may involve guiding a tiny balloon into the artery and filling the balloon with air. As the balloon expands, it gets rid of the blockage. Or surgery may involve rerouting blood flow past part of a leg artery where blood flow is blocked and through a blood vessel taken from another part of your body and placed in the affected leg.

If you have pain while walking or if you smoke or have diabetes, high blood pressure, or high cholesterol, ask your doctor about PAD.

Symptoms of peripheral artery disease

Someone with peripheral artery disease (PAD) may have various symptoms, including the following:

• Painful cramping in buttocks, hip, or leg that occurs while walking but goes away while resting
• Foot and toe sores that take a long time to heal
• Shininess and changes in skin color, especially on feet
• Coolness in certain areas of feet or legs
• Weakness, numbness, or a feeling of heaviness in legs
• Aching or burning in toes and feet during rest and especially while lying flat, which may be a sign of more serious PAD

For further information

The following organizations offer more information about peripheral artery disease:

American Heart Association
800-242-8721
http://www.americanheart.org

Society of Cardiovascular and Interventional Radiology
800-488-7284
http://www.scvir.org/patients/plbs/pvdout.shtml

Society of Interventional Radiology
800-488-7284
http://www.sirweb.org/patPub/patientsAndPublic.shtml

Vascular Disease Foundation
303-949-8337
http://www.vdf.org/PAD.shtml

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste