Peripheral Artery Disease

Peripheral Artery Disease (PAD) occurs when arteries in the legs narrow, reducing or cutting off blood flow. Symptoms of PAC range from people who have pain, fatigue, or heaviness in their limbs when moving to those who experience pain at rest.

People with claudication (see graphic) — have a condition that is neither life- nor limb-threatening.

However, individuals with limb-threatening ischemia (see graphic), have leg or foot pain while resting, in addition to other life- or limb-threatening symptoms. Limb-threatening ischemia can lead to amputation if untreated.

When not treated early, PAD is a leading cause of non-trauma amputations. One in 20 adults aged 50+ have PAD; it is more common after age 65.

Symptoms of PAD

The following symptoms are often associated with PAD, but PAD is not their only cause:

• Leg pain while walking that stops when at rest.
• One foot feels colder than the other.
• One foot or leg becomes pale, blue, or discolored.
• A foot or leg may feel like “pins and needles.”
• A leg may feel weak or numb.
• Toenails and leg hair stop growing
• Leg, foot, or toe wounds may heal slowly or not at all, possibly leading to gangrene.

Diagnosis and Prognosis of PAD

PAD is diagnosed using an Ankle Brachial Index (ABI) test. This painless test involves measuring brachial (arm) and ankle blood pressures (found in the foot) using a blood pressure cuff, a handheld Doppler, and ultrasound gel.

Results are calculated using the blood pressure numbers. Note: If the vessels are too calcified, they cannot be compressed with accuracy to yield a valid result.

• Normal ABI: 1.0–1.4
• Mild PAD: 0.70–0.89
• Moderate PAD: 0.50–0.69
• Severe PAD: below 0.5 (significant risk of amputation)

If an ABI reveals a patient has PAD but has no symptoms, then treatment is not necessary.

Risk Factors of Limb-Threatening Ischemia

Most of these risk factors are within an individual’s ability to treat with the help of a healthcare professional or control through lifestyle changes.

• Smoking
• Diabetes
• High Blood Pressure
• High Cholesterol
• Being Overweight or Obese
• Sedentary Lifestyle
• Family History of Atherosclerosis or Claudication

Interventions

1. If you are a smoker, stop smoking. Smoking damages blood vessels.
2. Follow a heart-healthy diet.
3. If you do not exercise, consider walking either on your own or in a supervised setting. Walking will encourage your leg to grow new blood vessels, improving circulation.
4. Some medications make platelets less sticky, and some dilate vessels, but medications are not perfect. Before trying something invasive, specialists often first try medications.
5. Invasive interventions surgically unblock or bypass vessels.

Takeaways

If you have family history of any cardiovascular disease, notify your primary care provider, who will refer you to a specialist if symptoms appear.

If you smoke, stop smoking. There is a direct link between smoking and vascular disease.

To learn more about vascular services at Trinity Health, visit TrinityHeatlhMichigan.org/Vascular.