By Amy Reed, M.D.
Arteries carry blood rich in oxygen and nutrients from your heart to the rest of your body. When the arteries in your legs become blocked, your legs do not receive enough blood or oxygen, leading to a condition called peripheral artery disease (PAD).
PAD can cause discomfort or pain when you walk. The pain can occur in your hips, buttocks, thighs, knees, shins, or upper feet. Leg artery disease is considered a type of peripheral arterial disease because it affects the arteries and blood vessels that carry blood away from your heart to your limbs.
Arteries are normally smooth and unobstructed on the inside. As you age, a sticky substance called plaque can build up in the walls of your arteries, a process called atherosclerosis. As more plaque builds up, your arteries narrow and stiffen. Eventually, enough plaque builds up to reduce blood and oxygen flow to your leg arteries. You may feel well and still have leg artery disease or similar blockages in other arteries, such as those leading to the heart or brain. It is important to treat this disease not only because it may place you at a greater risk for limb loss but also for having a heart attack or stroke.
What are the symptoms of PAD?
The most common early symptom is intermittent claudication (IC). IC is discomfort or pain in your legs that happens when you walk and goes away when you rest. You may not always feel pain; instead you may feel a tightness, heaviness, cramping, or weakness in your leg with activity. IC often occurs more quickly if you walk uphill or up a flight of stairs. Over time, you may begin to feel IC at shorter walking distances.
Critical limb ischemia is a symptom that you may experience if you have advanced PAD. This occurs when your legs do not get enough oxygen even when you are resting. With critical limb ischemia, you may experience pain in your feet or in your toes even when you are not walking.
What causes PAD?
Six main risk factors to developing PAD are: history of smoking, high cholesterol, diabetes, high blood pressure, obesity, and a family history of heart and vascular disease.
What tests will I need?
Your physician will want to know when your symptoms occur and how often. As part of the physical exam, your physician will conduct pulse tests, which measure the strength of your pulse in arteries behind your knees and feet.
If peripheral artery disease is suspected, one or more of the following will be performed:
–Ankle-brachial index (ABI), which compares the blood pressure in your arms and legs
–Blood tests for cholesterol or other markers for artery disease
–Duplex ultrasound, which uses high-frequency sound waves to measure real-time blood flow and detect blockages or other abnormalities in the structure of your blood vessels
How is PAD treated?
Lifestyle Changes: If your PAD is detected early, you can make lifestyle changes to help you manage the disease.
Medication: Your physician may also recommend medication to treat conditions that worsen or complicate leg artery disease. These medications may include cholesterol-lowering drugs (statins), aspirin or blood pressure-lowering medications. You may also need to take medications that reduce blood clotting to minimize the chances of clots blocking your narrowed arteries.
Exercise: Exercising and walking regularly, at least 30 minutes three times each week, may help improve your symptoms.
In more severe cases of leg peripheral disease, lifestyle changes and medication may not be enough to improve your symptoms. Also, if your disease has advanced, your physician may recommend surgical or minimally invasive treatments. The choice of the treatment depends upon the pattern and extent of the blockages as well as other factors, such as your general health and the presence of other medical conditions.
Angioplasty and stenting: This procedure is considered to be minimally invasive, and is most effective for more localized blockages in the larger arteries. A catheter is guided through your arteries to the blocked area. A balloon, which is attached to the catheter, is inflated and deflated several times. The balloon pushes the plaque in your artery against your artery walls, widening the vessel. In some circumstances a tiny mesh-metal tube, called a stent, is placed in the narrowed area of your artery to keep it open.
Bypass Surgery: Bypass surgery creates a detour around a narrowed or blocked section of a leg artery, using a vein or a tube from man-made materials.
To learn more about diseases of the veins and arteries and treatment options, attend Reed’s community lecture at Penn State Hershey Medical Group—Camp Hill at 6:30 p.m. on Thursday, Feb. 23. More information is available at PennStateHershey.org/westshore.
Amy Reed, M.D., is program director of vascular surgery, Penn State Hershey Heart and Vascular Institute, and associate professor of surgery, Penn State College of Medicine.