Peripheral artery disease can be a silent threat

Not all cardiovascular problems have clear symptoms. Case in point: Peripheral artery disease (PAD — pronounced P.A.D.). It may start with leg discomfort or muscle fatigue that stops when you are resting.

But below the surface, the peripheral arteries – which carry oxygen-rich blood to the legs, stomach, arms and head – may be constricting, causing dangerous blockages.

PAD is similar to coronary artery disease (CAD).  Both are caused by fatty materials (plaque) that narrow and block arteries in various critical regions of the body. It affects about 8.5 million Americans age 40 and older, and it becomes more common later in life. People with PAD have a higher risk of coronary artery disease, heart attack or stroke.

The whole circulatory system, including your heart and brain, are at risk when arteries are blocked and narrowed. Fatty deposits also increase the risk for vascular inflammation and blood clots that can block the blood supply and cause tissue death.

Without adequate blood flow, vital organs, legs, arms and feet, and your brain, suffer damage. Left untreated, the tissue can become infected or die, a condition called gangrene.  And, in the worst cases, it may result in the need for amputation.

What are the symptoms of PAD?

It’s important to learn the facts about PAD. The more you understand, the more likely you’ll be able to help your health care provider make an early diagnosis and start treatment. Many people with PAD never have any symptoms at all or mistake their symptoms for something else.
The most common symptom of peripheral artery disease in the lower extremities is a painful muscle cramping in the hips, thighs or calves when walking, climbing stairs or exercising.
The pain of PAD often goes away when you stop exercising, although this may take a few minutes. Working muscles need more blood flow. Resting muscles can get by with less.
If there’s a blood-flow blockage due to plaque buildup, the muscles won’t get enough blood during exercise. The “crampy” pain (called “intermittent claudication”), when caused by PAD, is the muscles’ way of warning the body that it isn’t receiving enough blood during exercise to meet the increased demand.
Other symptoms of PAD include:

• Leg pain that does not go away when you stop exercising
• Foot or toe wounds that won’t heal or heal very slowly
• Gangrene or dead tissue
• A marked decrease in the temperature of your lower leg or foot, particularly compared to the other leg or to the rest of your body
• Poor nail growth on the toes or hair growth on the legs
• Erectile dysfunction, especially in men with diabetes

Understanding leg pain

Many people dismiss leg pain as a normal sign of aging. You may think it’s arthritis, sciatica or just “stiffness” from getting older. For an accurate diagnosis, consider the source of your pain. PAD leg pain occurs in the muscles, not the joints.

Those with diabetes might confuse PAD pain with a neuropathy, a common diabetic symptom that is a burning or painful discomfort of the feet or thighs. If you’re having any kind of recurring pain, talk to your health care professional and describe the pain as accurately as you can.

The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs.

Typically, this pain goes away with rest and returns when you walk again.

Risk factors for PAD

Certain risk factors for PAD can’t be controlled.  These uncontrollable risk factors include aging, personal or family history of PAD, cardiovascular disease or stroke. However, you can control the following risk factors:

• Tobacco smoke — Stop smoking and avoid exposure to secondhand smoke. Smokers may have four times the risk of PAD than nonsmokers.
• Diabetes mellitus — Manage diabetes and blood sugar levels. Having diabetes puts you at greater risk of developing PAD as well as other cardiovascular diseases.
• High blood pressure — Manage your blood pressure. It’s sometimes called “the silent killer” because it has no symptoms. Work with your health care providers to monitor and control your blood pressure.
• High blood cholesterol — Managing cholesterol levels is an essential part of preventing and treating PAD. High cholesterol contributes to the build-up of plaque in the arteries, which can reduce the blood’s flow.

Controlling obesity and getting regular physical activity also may help to reduce the risk of PAD and other cardiovascular diseases and stroke.

Choose more than one target to improve! Taking care of only one risk factor is not as effective as taking care of all those within your control. Develop a heart-healthy lifestyle and work with your health care providers to reduce your risk.

How is PAD diagnosed?

PAD may go undiagnosed because so many people either aren’t having symptoms, or attribute PAD symptoms to something else. If you have any of the risk factors for PAD, you should talk to your health care provider.

PAD diagnosis begins with a physical exam. Your health care provider will ask about symptoms you may be experiencing. They will check for weak pulses in the legs. Depending on what they find, an ankle-brachial index (ABI) test may be done. The results of the ABI may warrant further tests.

How is PAD treated?

Treatment for PAD focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and medications are enough to slow the progression or even reverse the symptoms.

Physical activity

Regular physical activity is often an effective treatment for PAD symptoms. Your doctor may recommend a program of supervised exercise training, also known as cardiac rehabilitation. You may have to begin slowly.  But simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms.

When PAD causes pain while walking, the exercise program takes that into account.  It alternates activity and rest in intervals to build up the amount of time you can walk before the pain sets in. Other exercises such as upper body ergometry (using a machine built for you to pedal with your arms), cycling and pain-free or low-intensity walking also can improve walking and function.

It’s best if this exercise program is undertaken in a rehabilitation center and monitored. But if that isn’t possible, your health care provider may recommend a structured community or home-based program best suited to your situation.

Medication

You may be prescribed high blood pressure medications and/or cholesterol-lowering medications, as well as medicine to help prevent blood clots. It’s important to make sure that you take the medication as recommended by your health care provider. Not doing so increases your risk for PAD, as well as heart attack and stroke. 

In addition, people with PAD should have an annual flu vaccination.

Procedures

For a small number of patients, the above recommendations and treatments aren’t enough, and minimally invasive treatment or surgery may be needed.

Visit heart.org/PAD for more information on procedures for treating PAD.