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Peripheral Vascular Disease

Severe cases can make it hard for you to walk or do other types of physical activity.

Peripheral Vascular Disease (Claudication)

While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (claudication).

Claudication symptoms include muscle pain or cramping in your legs or arms that’s triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location.

The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity.

Peripheral Artery Symptoms

  • Painful cramping in your hip, thigh or calf muscles after certain activities, such as walking or climbing stairs (claudication)
  • Leg numbness or weakness
  • Coldness in your lower leg or foot, especially when compared with the other side
  • Sores on your toes, feet or legs that won’t heal
  • A change in the color of your legs
  • Hair loss or slower hair growth on your feet and legs
  • Slower growth of your toenails
  • Shiny skin on your legs
  • No pulse or a weak pulse in your legs or feet
  • Erectile dysfunction in men

If peripheral artery disease progresses, pain may even occur when you’re at rest or when you’re lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

When to see a Doctor

If you have leg pain, numbness or other symptoms, don’t dismiss them as a normal part of aging. Call your doctor and make an appointment.

Even if you don’t have symptoms of peripheral artery disease, you may need to be screened if you are:

  • Over age 70
  • Over age 50 and have a history of diabetes or smoking
  • Under age 50, but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure

Development of Atherosclerosis

Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up in your artery walls and reduce blood flow.

Although the heart is usually the focus of discussion of atherosclerosis, this disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease.
Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.

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Risk Factors: What Causes Peripheral Artery Disease?

Factors that increase your risk of developing peripheral artery disease include:

  • Smoking
  • Diabetes
  • Obesity (a body mass index over 30)
  • High blood pressure
  • High cholesterol
  • Increasing age, especially after reaching 50 years of age
  • A family history of peripheral artery disease, heart disease or stroke
  • High levels of homocysteine, a protein component that helps build and maintain tissue
  • People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.

Complications

If your peripheral artery disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you’re also at risk of developing:

Critical limb ischemia – This condition begins as open sores that don’t heal, an injury, or an infection of your feet or legs. Critical limb ischemia occurs when such injuries or infections progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.

Stroke and heart attack – The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn’t limited to your legs. Fat deposits also build up in arteries supplying your heart and brain.

Treatments

Treatment for peripheral artery disease has two major goals:

1. Manage symptoms, such as leg pain, so that you can resume physical activities.

2. Stop the progression of atherosclerosis throughout your body to reduce your risk of heart attack and stroke.

You may be able to accomplish these goals with lifestyle changes.
If you smoke, quitting is the single most important thing you can do to reduce your risk of complications.

If lifestyle changes are not enough, you will need additional medical treatment.
Your doctor may prescribe medicine to prevent blood clots, lower blood pressure and cholesterol, and control pain and other symptoms.

Medications

Cholesterol-lowering medications – You may take a cholesterol-lowering drug called a statin to reduce your risk of heart attack and stroke.

The goal for people who have peripheral artery disease is to reduce low-density lipoprotein (LDL) cholesterol, the “bad” cholesterol, to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L). The goal is even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.

High blood pressure medications – If you also have high blood pressure, your doctor may prescribe medications to lower it.

The goal of this therapy is to reduce your systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mm Hg) or lower and your diastolic blood pressure (the bottom number) to 90 mm Hg or lower. If you have diabetes, your blood pressure target is under 130/80 mm Hg.

Medication to control blood sugar – If you also have diabetes, it becomes even more important to control your blood sugar (glucose) levels. Talk with your doctor about what your blood sugar goals are and what steps you need to take to achieve these goals.

Medications to prevent blood clots – Because peripheral artery disease is related to reduced blood flow to your limbs, it’s important to improve that flow.

Your doctor may prescribe daily aspirin therapy or another medication, such as clopidogrel (Plavix).

Symptom-relief medications – The drug cilostazol (Pletal) increases blood flow to the limbs both by keeping the blood thin and by widening the blood vessels. It specifically helps treat symptoms of claudication, such as leg pain, for people who have peripheral artery disease. Common side effects of this medication include headache and diarrhea.

An alternative to cilostazol is pentoxifylline (Trental); however, it’s generally less effective. But side effects are rare with this medication.

Angioplasty and Surgery

In some cases, angioplasty or surgery may be necessary to treat peripheral artery disease that’s causing claudication:

  • Angioplasty – In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow.
  • Atherectomy – In this procedure a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. Once inside a device is used to remove or obliterate the blockage that is affecting blood flow. After this is completed angioplasty is performed and your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.
  • Bypass surgery – A surgeon may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.

Supervised Exercise Program

In addition to medications or surgery, your doctor may prescribe a supervised exercise training program to increase the distance you can walk pain-free. Regular exercise improves symptoms of PAD by a number of methods, including helping your body use oxygen more efficiently.

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