Peripheral arterial disease (PAD)
Peripheral arterial disease (PAD) has no cure; however, it can be managed with medications and surgery.

Peripheral arterial disease (PAD) is a common illness in which fatty deposits (plaque) form on the inner side of the walls of arteries, narrowing them. Peripheral vascular disease or peripheral vascular occlusive disease are other terms for PAD.

  • PAD causes arteries, other than those that supply the heart and brain, to become abnormally narrow, resulting in compromised blood supply to the organs they supply. 
  • The arteries of the legs are typically affected by PAD, resulting in a reduction in blood supply to the leg muscles.
  • Other arteries, such as those in the arms, neck, and kidneys, could be involved as well.

PAD has no cure, but it can be managed with medications and surgery. Furthermore, complications can be prevented with lifestyle changes, medication, surgery, and other medical procedures.

What causes PAD?

Atherosclerosis, a slow buildup of fat and cholesterol that forms plaques in the walls of the arteries, narrowing them, is the cause of the peripheral arterial disease (PAD). The walls of the arteries stiffen and become difficult to dilate. Blood flow in peripheral arteries, which carry blood out from the heart to various regions of the body is therefore compromised.

Risk factors

PAD is a moderately common condition that primarily affects adults older than 65 years.

If a person has any of the following conditions and habits, they are at a higher risk:

What are the signs and symptoms of PAD?

Most patients have no symptoms; however, peripheral artery disease (PAD) can cause the following symptoms:

  • Intermittent claudication (muscle soreness or cramping in the calf, thigh, or hip that goes away with rest and when walking or ascending stairs)
  • Severe PAD causes pain in the toes or feet at rest
  • Tingling or a pins-and-needles sensation in the lower legs or feet
  • Leg numbness or weakness
  • Hair loss on the legs
  • Colder legs than arms or one leg that is cooler than the other
  • Leg or foot sores or ulcers that do not heal or heal slowly
  • Brittle toenails
  • Toenail growth is slow
  • Leg skin becomes lustrous, pale, or bluish
  • Leg pulse is sluggish
  • Erectile dysfunction in men

What are the complications of PAD?

A common complication of peripheral arterial disease (PAD) is unhealed open sores, ulcers, or infections in the feet or legs. When an ulcer or infection progresses and tissue death ensues, critical limb ischemia occurs. Amputation of the diseased limb may be necessary in some cases.

Atherosclerosis, which causes peripheral arterial disease, can also develop blockages in the arteries that carry blood to the heart and brain. Cerebrovascular disease is caused by narrowing in the brain, whereas coronary artery disease is caused by constriction in the heart, resulting in stroke and heart attack, respectively.

How is PAD diagnosed?

Early detection and management of peripheral arterial disease (PAD) can aid in the treatment of symptoms and the prevention of significant consequences. Medical and family history, a physical exam, as well as tests and procedures, are used to diagnose PAD.

The following tests and techniques can be used to diagnose PAD:

  • Ankle-brachial index (ABI) test: This test compares the blood pressure in the ankle and the arm.
  • Blood works: Help determine cholesterol, homocysteine, and C-reactive protein levels.
  • Doppler ultrasound (duplex) imaging: This test uses sound waves to see the artery.
  • Computed tomography angiography (CTA): This procedure involves taking X-rays after injecting a specific dye into the patient's arteries. It is effective in individuals who have stents or pacemakers.
  • Magnetic resonance angiography (MRA): This test determines the location and extent of blockages in blood vessels. People who have metal implants in their bodies should avoid MRA.
  • Catheter-based angiography: In this procedure, a catheter or tube is placed into a groin artery and guided to the afflicted area. X-rays are taken after a specific dye is released through the catheter.

How is PAD treated?

Medications, surgery, medical treatments, and lifestyle changes may all be part of the treatment approach, depending on the severity of peripheral arterial disease (PAD) and its consequences.

Medications

To treat PAD and avoid its consequences, the following medications may be recommended:

  • Blood pressure medications, such as angiotensin 2 receptor blockers (ARBs) or antihypertensive medicines (angiotensin-converting enzyme inhibitors or ACE inhibitors) to help with endothelial dysfunction and cause vessel dilatation.
  • Statins, which are used to decrease cholesterol levels and keep plaques in control.
  • To make walking easier for people with intermittent claudication, cilostazol and pentoxifylline may be prescribed.
  • Clopidogrel helps prevent blood clots from developing and further narrowing the arteries.
  • Blood clots can be prevented by using anticoagulants or blood thinners, such as aspirin.

Procedures and surgery

If drugs do not work, PAD may require surgery or other medical procedures.

  • Angioplasty: Angioplasty is a procedure that opens blocked or constricted arteries. To flatten the plaque, a tiny balloon is inflated in the artery. To prevent the artery from narrowing again, a tiny mesh tube called a stent may be implanted. The balloon may be coated with drugs to aid in arterial healing.
  • Gastric bypass surgery: When angioplasty is unlikely to function, bypass surgery is undertaken. To establish a passage around the blocked artery in the leg, the doctor uses one of the patient's other blood vessels or an artificial vessel.

Lifestyle modifications to manage PAD

A healthy lifestyle can manage PAD, reduce the risk of complications and prevent PAD.

  • Leg exercises: Three times a week, walking regimens, treadmill training, and leg exercises programs help reduce symptoms in a matter of weeks.
  • Regular physical activity lowers risk factors, such as high cholesterol, high blood pressure, and obesity.
  • Dietary adjustments and changes: Lowering blood cholesterol levels is easier with a diet rich in fruits, vegetables, and whole grains and low in saturated fat, trans fat, and cholesterol.
  • Stopping smoking lowers the risk of PAD.
  • Stress management: Getting enough sleep and dealing with challenges might help a person feel better emotionally and physically.

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Medically Reviewed on 12/2/2021
References
Image Source: iStock Images

Stephens E. Peripheral Vascular Disease. Medscape. https://emedicine.medscape.com/article/761556-overview

Gul F, Janzer SF. Peripheral Vascular Disease. [Updated 2021 Apr 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. https://www.ncbi.nlm.nih.gov/books/NBK557482/

Joosten MM, Pai JK, Bertoia ML, Rimm EB, Spiegelman D, Mittleman MA, Mukamal KJ. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA. 2012 Oct 24;308(16):1660-7. https://jamanetwork.com/journals/jama/fullarticle/1386609