Peripheral arterial disease (PAD) refers to blockage of leg arteries by atherosclerosis (hardening of the arteries), so legs have poor blood flow. In atherosclerosis, cholesterol plaques block arteries. PAD occurs in men and women equally. It likely affects 8 to 10 million people in the United States.
Fatty deposits build up inside arteries and make them narrower. Tobacco, diabetes, cholesterol, and high blood pressure make PAD likely. PAD isn’t contagious or passed from parents to children.
About half of people don’t have symptoms. The most common symptoms are pain, cramping, aching, and numbness in the affected area. Others are heavy or tight feeling, cold skin, pale or bluish skin, pulse that’s hard to feel, and sores or ulcers that don’t heal. Aching or cramping leg pain often occurs during exercise and goes away during rest (intermittent claudication). If blood flow is completely blocked, the leg gets very painful and hard to move. In men, impotence can occur if vessels leading to the penis are affected.
The health care provider makes a preliminary diagnosis from your symptoms, a physical examination, fasting blood tests, and by measuring the ankle-brachial index (ABI). The health care provider gets the ABI by dividing the highest ankle blood pressure by the highest arm blood pressure. ABI values less than 1 are abnormal.
A treadmill test, Doppler ultrasound, angiography (a kind of x-ray with dye), and magnetic resonance angiography (MRA) may also be done to evaluate the extent of the disorder and areas of blockage.
Treatment goals are to reduce pain and prevent damage to the affected area. Measures include avoiding tobacco, eating a healthy diet, and restricting salt. Diabetics should follow the American Diabetes Association (ADA) diet. Exercise such as walking 30 to 60 minutes per day helps walking distance and quality of life.
Medicines can help blood flow, thin blood, dissolve clots, lower blood pressure, and lower cholesterol levels.
The health care provider may suggest angioplasty for a severely narrowed vessel. The health care provider puts a wire (catheter) into the artery and inflates a tiny balloon to open the blocked artery. The health care provider may put a small metal or mesh tube (stent) into the vessel to keep it open.
People sometimes need bypass surgery to get around the blockage. A procedure called percutaneous atherectomy can also be performed to remove the blockage by inserting a “plaque-eating” device in the blocked artery and shaving off the plaque. In the most advanced stages, PAD may lead to amputation.
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