Peripheral Artery Disease (PAD): Symptoms, Causes and Treatment

Peripheral arterial disease (PAD) is a slow, progressive, and sometimes life-threatening vascular disease that is caused by narrowing or blockage of the arteries in the peripheral circulation of the arteries in the limbs. A buildup of plaque in the blood vessels can obstruct blood flow to the limbs, leading to a number of health issues, including limb amputations in the most severe case. Greater awareness will help educate those who do not know much about PAD, and underdiagnosis and undertreatment of this disease are widespread.

What is peripheral arterial disease (PAD)?

A condition characterised by plaque accumulating in leg arteries that carry oxygen and nutrients from your heart to your arms and legs is known as a peripheral arterial disease (PAD). It also has different names and is called peripheral vascular disease, peripheral artery disease, or peripheral artery disease.

Blood clots are prevented and blood flow is maintained by the smooth lining of the arteries. When you have peripheral artery disease, plaque (made up of fat, cholesterol, and other chemicals) gradually forms inside the artery walls, narrowing the artery. This condition is known as atherosclerosis.

Most plaque deposits have a hard outer surface and a softer inner surface. Cracks or tears on this hard surface can cause platelets (disc-shaped particles in your blood that help it clot) to come into contact with the wound. Plaques can cause blood clots to form around them, making your arteries narrower.

A blood clot or plaque blockage narrows or blocks arteries, so blood cannot get to organs and other tissues. The tissues below the blockage suffer damage and eventually die (gangrene). You are most likely to experience this on your feet and toes.

Every person’s PAD progresses at his or her own rate, depending on many factors, such as where the plaque forms in the body and their overall health.

Risk factors for peripheral arterial disease

PAD is highly associated with smoking. Over 80% of people with PAD are smokers or were smokers in the past. A person with one or more of these risk factors is at risk of developing peripheral arterial disease regardless of their gender:

• The most powerful risk factor is using tobacco products.
• Diabetic.
• Senior citizens.
• Being African-American.
• Knowing someone with a blood vessel or heart condition.
• Having high blood pressure (hypertension).
• Having high cholesterol (hyperlipidemia).
• Having abdominal obesity.
• Having a blood clotting disorder.
• Kidney disease

How does this condition affect my body?

It refers to pain in the legs associated with walking or exercising that disappears after resting. The reason for this is that your leg muscles don’t receive enough oxygen.

This condition poses far more dangers than walking difficulty and can have far more serious consequences than being unable to shop for groceries or play golf. Peripheral artery disease may cause non-healing sores on the foot or leg. It is possible that sores caused by PAD may eventually result in gangrene (dead tissue) and you will need to have your foot or leg amputated.

As a result of the body’s interconnected circulatory system, PAD can affect more than one part of the body at a time. Your legs are likely to be affected by atherosclerosis that spreads throughout the body. In addition to peripheral arterial disease putting people at risk for heart attacks, strokes, transient ischemic attacks (mini-strokes), and kidney (renal) artery problems, peripheral arterial disease also causes people to lose their vision.

The following health problems can develop in people with PAD if the disease is left untreated:

• A heart attack results in permanent damage to your heart muscle due to an extended lack of blood supply to your heart.
• Having a stroke is the result of a disruption in your brain’s blood supply.
• A transient ischemic attack (TIA) is the result of a temporary blood supply interruption to your brain.
• An artery that supplies blood to your kidneys is narrowed or blocked by renal artery disease or stenosis.
• People with diabetes often have to have amputations of at least a part of their foot or leg (rarely their arm as well).

What are the signs and symptoms of PAD?

Peripheral vascular disease is a silent disease with no symptoms for half of the people who have it. The most common symptom is leg pain. Feelings of weakness or fatigue are also associated with it. There may be involvement of your calves, legs, or buttocks.

The symptoms of PAD may not be apparent for decades. In many cases, outward symptoms of an artery narrowing won’t appear until the artery is about 60% narrow.

Early symptoms

In the early stages of PAD, leg discomfort, pain, or cramping may occur that:

• Developing with activity.
• Resolving with rest.
• Returning when activity is resumed.

Pain in your calf might be noticeable, but it may also be felt in your buttocks or thighs. Your leg muscles might experience these symptoms with intermittent claudication:

• Numb
• Weak
• Heavy
•  Tired

Golfing or chasing your grandchildren can be difficult when you are suffering from pain that is severe enough to interfere with your daily activities.

These cyclical pains are caused by a reduced flow of blood to your leg muscles, which disappears at rest since your muscles need less blood at rest.

Advanced symptoms

PAD may cause the following symptoms:

• Especially at night when you lie flat on your back, you may experience burning or aching in your feet and toes.
• You may also experience cool skin on your feet.
• You may also experience redness.
• You may also experience infections more frequently.
• Chronic sores on your feet and toes.

What causes PAD?

Peripheral arterial disease occurs when there is atherosclerosis in the arteries of the legs or the arms. Peripheral vascular disease is caused by fatty plaque buildup on the walls of blood vessels, similar to atherosclerosis in your heart’s arteries. You develop narrowing blood vessels as plaque builds up until eventually they become blocked.

How is PAD detected?

As soon as you notice symptoms of PAD, speak with your doctor so you can identify the cause and start treatment. The earlier PAD can be detected, the more likely it is that the right treatments will be available before complications, such as stroke or heart attack, can occur.

A physical examination and an examination of your medical history and risk factors will be performed. PAD can be diagnosed and measured through certain tests ordered by your doctor.

• ABI refers to the difference in blood pressure between the lower leg and the upper arm based on the blood pressure in your legs. Your arms and legs will be fitted with cuffs to measure blood pressure. Inflating the cuffs and monitoring your flow of blood with a Doppler device allow your blood pressure to be measured. People with PAD have less blood flow to their feet and legs, which is evaluated through the ABI screening. An ABI is an effective way of detecting PAD.
• Pulse volume recordings (PVR) measure the changes in blood volume in your legs without invasive procedures. You are placed on your knees with multiple blood pressure cuffs and a blood pressure cuff on your arm during this test. You can slightly inflate the cuffs while lying on your back. The volume of air within the cuff increases or decreases as blood pulses through your arteries. This waveform is displayed on a monitor when a recording device records pulse volume changes. During and after treadmill exercise, blood pressures are measured to determine if the pain is due to PAD or another cause. In addition, the PVR test can help identify the location of blockages in your legs.
• An ultrasound examination of the vascular system is a noninvasive procedure designed to examine blood circulation. The transducer (a small hand-held device) is placed on your skin over the artery you want to examine during a vascular ultrasound. A sound wave is emitted by the transducer and bounces off your artery. In order to create an image of the vessel, these sound waves are recorded and displayed on a monitor. During this test, a blockage in your artery may be detected.

What is the treatment for PAD?

The two main goals of treating PAD are:

• Preventing strokes and heart attacks.
• Reducing the pain associated with walking.

You can stop PAD from getting worse by detecting it early, making lifestyle changes, and receiving treatment. According to some studies, you can reverse the symptoms of peripheral vascular disease by exercising and carefully managing your cholesterol level and blood pressure.

In the event, you are at risk or have already been diagnosed with this disease, consult your primary care physician, vascular medicine specialist, or cardiologist so that you can begin a prevention or treatment process right away.

You can treat your PAD with lifestyle changes, medicines, and interventions.

Lifestyle changes

Lifestyle changes are essential to reducing your PAD risk factors during the initial treatment phase. You can make the following changes to manage your disease:

• Tobacco products should be stopped. Contact your healthcare provider for information about local programs to stop smoking.
• Ensure your diet is high in fibre, low in fat, and low in sodium. Do not consume more than 30% of your daily calories from fat. You should consume no more than 7% of your calories from saturated fat. Among the products to avoid are those with partially hydrogenated or hydrogenated vegetable oils. Leptin, a statin drug, reduces your total cholesterol and raises HDL (good) cholesterol when you’re overweight. You can make dietary changes with the help of a registered dietitian.
• Exercise can help. Try walking regularly. PAD can be cured by walking regularly. Regular walking will improve the distance that people can walk before their legs hurt.
• Take care of other health problems, such as high blood pressure, diabetes, or high cholesterol.
• Reduce your stress levels. Yoga, meditation, and exercise may help with this.
• Prevent infection by taking good care of your feet and skin.

How Can I Prevent PAD?

In order to reduce the symptoms of PAD or to prevent its progression, one should reduce its symptoms. A lifestyle change is usually required to do this. Being physically active regularly is often helpful. In addition to a low-fat diet, your doctor may recommend you start on a program to gradually improve your health and lifestyle. PAD and other heart-related issues are prevented and slowed by quitting smoking. The doctor may also prescribe medicine to lower your high blood pressure and prevent blood clots.

In some cases, lifestyle changes aren’t enough to restore blood flow to patients’ affected limbs, and they may need minimally invasive therapy instead. Amputation rates have decreased due to angioplasties. A minor balloon catheter is inserted through the arm or groin into an artery to improve blood flow to the limb. The balloon is inflated once it has been positioned near the blockage, creating more space in the narrowed artery. Stents, wire tubes that keep an artery open, may then be implanted by your physician. When you are aware of where you are on the PAD progression, you can determine the next steps.

Consult your health care provider regularly if you have been diagnosed with PAD to find out how you can best treat the condition. A supervised exercise program or medication is often effective when treating patients with back pain; interventional treatment may be required when cases are severe.  In many cases, amputation can be prevented through early intervention, and the consequences can be devastating.

Omni Hospital offers speciality vascular care, vascular and endovascular surgery, cardiology, and other specialists in order to provide exactly the care you need. The facility has specialists in vascular diseases on its staff who offer expertise and optimal care.

The experts are all in one place, concentrating on you, so you get more than one opinion – all team members participate in your care. It is possible to choose the most appropriate treatment for you based on a coordinated appointment schedule and the results of your tests are available quickly. Cardiovascular specialists with experience in your condition can consult together regarding your treatment options.

Because of this collaborative approach, your doctor will often be able to determine your condition and develop a treatment plan within two or three days.