Peripheral Artery Disease
What is peripheral artery disease?
Your arteries are normally smooth and unobstructed on the inside but, as you age, they can become blocked through a process called atherosclerosis, also called “hardening of the arteries.” A sticky substance called plaque can build up in the walls of your arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue, causing your arteries to narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow to your leg arteries. Doctors call this condition peripheral arterial disease (PAD).
What are the symptoms?
When the arteries that carry blood to your legs become narrowed or blocked, your leg muscles may not receive enough of the blood and oxygen they need to support physical activity. Doctors call this lack of oxygen ischemia. Initially, your legs may receive enough blood while you are at rest so that you do not experience any discomfort without activity.
When you exercise, your muscles require more oxygen and if the arteries in your legs are narrowed to the point that too little blood reaches your muscles, you may feel leg pain when you walk. You may not always feel pain and instead may experience a sensation of tightness, heaviness, cramping or weakness in one or both of your legs. This pain is referred to as claudication, which doctors also call intermittent claudication because it happens infrequently. It is a serious warning symptom because people who have it are also at increased risk of experiencing a heart attack or stroke.
What causes peripheral artery disease?
Claudication is caused by atherosclerosis, the build-up of plaque in the artery walls. This plaque can build up as a result of:
- High cholesterol levels in the blood
- High blood pressure
- Having a family history of heart or vascular disease
How is peripheral artery disease diagnosed?
Your doctor will start by asking you about your medical history and carry out a physical examination to check your overall health. If they suspect that a patient may be experiencing the symptoms of peripheral artery disease, they may request additional tests such as the following:
- Ankle-brachial index: compares the blood pressure in your arms and legs
- Duplex ultrasound
- Blood tests: for cholesterol, high blood sugar or other indicators of artery disease
- Magnetic resonance angiography
- Computerised tomographic angiography
Doctors usually begin with the non-invasive tests and reserve more invasive tests, such as angiography, for people with more severe forms of the condition, requiring intervention or surgery.
What is the treatment for this condition?
Although your doctor will treat your claudication, they will also treat the underlying causes of your peripheral artery disease, such as high cholesterol or high blood pressure. Treatment for these issues include lifestyle changes, medication, and, if necessary, surgery.
Exercise therapy is often the initial treatment for claudication. Your doctor will develop an exercise plan specifically for you. The plan may include what type of exercise to do, how hard you should exercise, how long, and how many times per week you should exercise. Therapeutic exercise recommendations for claudication generally consist of walking for periods of one hour or more, three or more times per week, for at least three to six months, ideally under medical supervision. The aim is to increase the amount of time that you can walk without reproducing severe pain in your legs. You will gradually accomplish this by walking for longer periods.
Your doctor may prescribe medications such as cilostazol (pletal), which can sometimes help to improve the distance you are able to walk without discomfort or pain. This medication may not be helpful, however, if you have certain heart conditions. Your doctor will help you decide what is best for your particular situation. If appropriate, your doctor may also suggest medications such as statins, to help control your blood lipid (fat) levels, medication to control high blood pressure, and/or medication for diabetes.
Lifestyle changes that help you manage your peripheral artery disease include:
- Quit smoking
- Maintaining your exercise programme
- Managing diabetes by maintaining healthy blood sugar levels
- Lowering high cholesterol
- Lowering high blood pressure
- Eating foods low in saturated fats and calories
- Maintaining your ideal body weight