Do your legs hurt?
Peripheral artery disease is a condition of the
blood vessels that leads to narrowing and
hardening of the arteries that supply the legs
and feet. The narrowing of the blood vessels
leads to decreased blood flow, which can
injure nerves and other tissues.
Risk Factors for PAD
- age over 50 - one in every twenty Americans have peripheral arterial disease - most of them go undiagnosed
- smoking - this increases your risk of a heart attack, a stroke, and developing PAD
- diabetes - 80% of diabetics die of cardiovascular disease - heart attack, stroke, or PAD. many have amputations
- high blood pressure - untreated, this can cause damage to blood vessels and increase risk of developing PAD
- presence of coronary artery disease - where there's smoke, there is fire. if you have vascular disease in one area of your body, you are much more likely to have vascular disease in other locations in your body
- obesity - this increases your risk of heart disease, stroke, diabetes, high blood pressure, renal failure, and PAD
The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of your feet, calves, or thighs. These symptoms usually appear during walking or exercise and go away after several minutes of rest.
At first, these symptoms may appear only when you walk uphill, walk faster, or walk for longer distances.
Slowly, these symptoms come on more quickly and with less exercise.
Your legs or feet may feel numb when you are at rest. The legs also may feel cool to the touch, skin may look pale.
When peripheral artery disease becomes severe, you may have:
- Pain and cramps at night
- Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful
- Pain that is worse when you raise the leg and improves when you dangle your legs over the side of the bed
- Skin that looks dark and blue
- Sores that do not heal
Diagnosing peripheral artery disease
If our cardiologist suspects that you have peripheral heart disease, he will likely order an ultrasound, as well as bloodwork to look for high cholesterol and high homocysteine levels.
Doppler and Ultrasound (Duplex) imaging is a non-invasive method that visualizes the artery with sound waves and measures the blood flow in an artery to indicate the presence of a blockage.
Angiography (peripheral artery catheterization) is advised if your arterial duplex shows a high grade blockage. During an angiogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, arteries in the legs and to pinpoint degree of blockage, and to perform balloon angioplasty and stenting to open the blockage.
Undiagnosed or untreated PAD can be dangerous because it can lead to painful symptoms,amputation, increased risk of coronary artery disease and carotid atherosclerosis. Because people with PAD have this increased risk for heart attack and stroke, the American Heart Association encourages people at risk to discuss PAD with their healthcare professional to ensure early diagnosis and treatment.
What are the treatment options for peripheral artery disease?
The most effective treatment is regular physical activity. For mild PAD, we may recommend a program of supervised exercise training for you. One may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs three times a week can result in decreased symptoms in just four to eight weeks.
Exercise for intermittent claudication takes into account the fact that walking causes pain. The program consists of alternating activity and rest in intervals to build up the amount of time you can walk before the pain sets in. It's best if this exercise program is undertaken in a rehabilitation center on a treadmill and monitored.
Many patients have elevated cholesterol levels. A diet low in saturated fat, trans fat and cholesterol can help lower blood cholesterol levels, but medication may be necessary to maintain the proper cholesterol levels.
Tobacco smoke greatly increases your risk for PAD and your risk for heart attack and stroke. Smokers may have four times the risk of developing PAD than nonsmokers. Stop smoking. It will help to slow the progression of PAD and other heart-related diseases.
One may be prescribed high blood pressure and/or cholesterol-
lowering medications. It's important to make sure that one takes
the medication as recommended by a healthcare professional.
Not following directions increases risk for PAD, as well as heart
attack and stroke.
Dr. Saxena may prescribe medications to help improve the
distance you can walk include cilostazol and Aggrenox. In addition,
one may be prescribed antiplatelet medications (aspirin, prasugrel,
brilinta, clopidogrel) to help thin the blood.
Some particular cases are stubborn and don't respond to the
other treatments, thus angioplasty or surgery may be needed.
If we detect severe disease on arterial duplex, we will schedule
During this procedure, done in the catheterization lab, Dr. Saxena
will use various catheters, tubes, wires, and a rotating plaque cutting
device called atherectomy to remove plaque and improve blood flow
to your leg. In our clinic, he can show you samples of the plaque he
removed from leg arteries. By using a stent, which is a wire scaffold
that props open the artery after we balloon it open, we can keep the
arteries open longer. If he puts a stent in your leg, you will need
a platelet blocking agent like Plavix or Effient.