What is peripheral artery disease?
Peripheral artery disease is a type of atherosclerosis.
Atherosclerosis is a hardening and narrowing of the arteries. The
peripheral arteries are the blood vessels that supply blood to the
arms and legs. In most cases, peripheral artery disease affects
the legs. When the problem becomes severe it causes pain in the
legs or hips when you walk.
How does it occur?
The narrowing of the inside of the arteries occurs when deposits
of cholesterol and calcium build up over time, clogging the
arteries. These deposits on the inner artery walls are called
plaque. The plaque may eventually become so thick that it
completely blocks the flow of blood through the arteries. Clogged
or blocked arteries cannot provide enough oxygen and fuel for the
body.
Several factors can put you at a high risk for developing
peripheral artery disease:
- an inherited (genetic) tendency in your family
- diabetes
- high levels of blood fat, or lipids (for example, cholesterol)
- high blood pressure
- cigarette smoking
- being overweight
- being physically inactive .
What are the symptoms?
The disease progresses silently, without symptoms, until the
arteries have become significantly narrowed.
The first symptom, called claudication, is usually pain or
cramping in the calf muscles when you walk or exercise your legs.
The discomfort quickly goes away when you rest and may come back
soon after you are active again. As the narrowing worsens, the
pain worsens. Pain may be felt in the thighs and buttocks if the
narrowing is in the arteries leading to the thighs. One or both
legs may be affected.
Other possible symptoms are:
- feet that feel cool
- loss of feeling in the feet and toes
- loss of hair on the tops of your feet
- thickened nails
- pale, shiny, or bluish skin
- if you are a man, trouble getting and keeping an erection
- slow healing of cuts and scrapes on the feet and legs.
How is it diagnosed?
Your healthcare provider will examine you and ask about your
symptoms and your personal and family medical history. He or she
will check the pulses in your feet, legs, and groin.
To find the location and degree of arterial narrowing, you may
have an angiogram or Doppler (ultrasound) test.
- For an angiogram, dye is injected into the arteries. The dye
allows the flow of blood to be observed. Your provider can
measure the narrowing of the arteries and find blockages with
this test.
- An arterial Doppler study is a painless procedure that sends
ultrasound waves into your blood vessels. A computer uses
echoes of these high-frequency sound waves to show blood flow
in your blood vessels. A Doppler test does not require any
injections and is helpful as a first test, but it is not as
precise as an angiogram.
How is it treated?
The first important step of treatment is to manage any risk
factors. For example you might need to:
- Stop smoking.
- If you are diabetic, control your blood sugar.
- Reduce your blood pressure to a normal level.
- Lower the levels of fats in your blood.
- Take a small dose of aspirin every day.
Changes in your diet may be necessary. A diet high in complex
carbohydrates (whole grains, such as whole wheat, oatmeal, and
bran), fresh fruits, and vegetables, and low in salt, animal fats,
and refined sugar, is healthy for nearly everyone. It is
especially important in the treatment of diabetes, hypertension,
lipid (blood fat) disorders, and vascular disease.
If you are a smoker, you must stop smoking. One of nicotine's
effects is narrowing of the arteries (vasoconstriction). Each
cigarette you smoke decreases blood flow as the inhaled nicotine
circulates in your blood.
Your healthcare provider may need to adjust or change the
medicines you are taking. Some dosages or drugs restrict blood
flow less than others. Your provider may prescribe new medicine to
try to improve blood flow.
Exercise is vital to improving and maintaining good circulation in
your arteries. Your provider may recommend an exercise program for
you. However, you may need to have surgery first.
Your healthcare provider may recommend surgery for significant
blockages. For example, you may have bypass surgery to remove the
blocked area and replace it with a piece of your own vein (removed
from another part of your body). Sometimes synthetic material is
used for the bypass instead of a vein. If you have blockages in
the arteries that flow into your legs, you may need abdominal
surgery.
In some cases blockages in the peripheral arteries may be treated
with catheterization and balloon dilatation instead of surgery. In
catheterization a small tube is inserted into an artery in the
groin. It allows your healthcare provider to see blockages. The
blockages can sometimes be treated by inflating a balloon at the
tip of the catheter to widen the area around the blockage. In some
cases a stent may be inserted into the artery as part of this
procedure to help keep the artery open. Stents are tiny tubes that
hold the narrowed vessel open.
If your disease is extremely severe or other health problems
prevent surgery, amputation of your foot or leg may become
necessary. Amputation is usually necessary if you have so little
blood flow that the skin and other tissues die and you become
susceptible to life-threatening infection. Amputation is a last
resort, but if peripheral vascular disease is not controlled, it
is a possible complication.
Ask your provider if you need to take medicine to keep blood clots
from forming in your arteries. Blood clots can be a problem when
the arteries become too narrow. Smoking further increases your
risk of blood clots.
How long will the effects last?
Peripheral artery disease is a disease that you will continue to
have and that will get worse unless you get treatment and do
things to lessen your risk.
How can I take care of myself?
- Follow your healthcare provider's instructions on diet,
exercise, and medicine.
- If you are a smoker, stop smoking.
- Take care not to injure the affected leg. Injuries to that leg
will heal much more slowly. Proper shoes, safe terrain, and
safe exercise equipment are important.
- To prevent infection of the feet, inspect and care for them
regularly. Wash your feet and change stockings daily. Wear
comfortable shoes and trim your toenails straight across. If
you have corns or calluses, get help from your healthcare
provider or a podiatrist (foot specialist) to care for them
safely.
- When you are exercising, stop and rest if the pain in your
legs becomes too great. Start walking again when the
discomfort has gone away. It may not seem like it makes sense
to ask someone who has leg pain to walk, but research has
shown that regular exercise can cause new blood vessels to
form around the blocked ones.
- See your healthcare provider right away if your symptoms
suddenly become more severe. The worsened symptoms could
indicate a complete blockage.
What can I do to help prevent peripheral artery disease?
The best way to try to prevent peripheral artery disease is to
maintain all-around fitness.
- Do not smoke.
- Try to reach and keep a normal weight, normal blood pressure,
and normal levels of lipids and sugar in your blood.
- Eat a diet low in fat and refined sugar, and high in complex
carbohydrates and fiber.
- Exercise at least 3 to 4 times a week, striving to walk 20 or
more minutes each time, or according to your healthcare
provider's prescription. Cycling and swimming are good
alternatives to walking, but you should consult with your
provider before you start a more vigorous program.
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
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