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Peripheral Artery Disease

Peripheral vascular disease (PVD) is a general term for the narrowing of blood vessels (arteries and veins) outside of your heart. Arteries carry blood to body parts and veins carry blood back to the heart. PVD that affects only the arteries is referred to as peripheral artery disease (PAD).

PAD develops most commonly as a result of a hardening of the arteries called atherosclerosis. This occurs when cholesterol and scar tissue build up to form a substance called plaque, which narrows and clogs the arteries. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking and eventually gangrene and amputation.

People with PAD are at increased risk for heart disease and stroke. PAD is also a marker for diabetes, hypertension and other conditions.

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Risk Factors

General risk factors for PAD include:

  • Smoking
  • High blood pressure
  • Atherosclerosis
  • Diabetes
  • High cholesterol
  • Age (older than 60)

Prevention

Lifestyle changes can help prevent PAD, including:

  • Stop smoking. Smoking increases the risk of PAD and worsens the symptoms of PAD.
  • Exercise. Physical activity and exercise are important for preventing PAD and improving symptoms of PAD.
  • Eat well. A healthy diet can help control weight, blood pressure and cholesterol.

Signs and Symptoms

People with PAD may experience a range of symptoms, including:

  • Leg pain when walking or exercising that stops when resting
  • Foot or toe wounds that won't heal or heal slowly
  • Coldness in the lower legs and feet
  • Poor nail growth on the toes or hair growth on the legs
  • Erectile dysfunction, especially in men with diabetes

Detection and Diagnosis

Several diagnostic tests can detect PAD, including:

  • Ankle-Brachial Index — This is a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. An abnormal difference may indicate PAD.
  • Doppler Ultrasound — This noninvasive method visualizes the artery with sound waves and measures the blood flow in an artery to indicate blockages.
  • Computed Tomographic Angiography (CTA) — A CTA is a noninvasive test that can show the arteries in your abdomen, pelvis and legs. It can be useful for patients with pacemakers or stents.
  • Magnetic Resonance Angiography (MRA) — This noninvasive test gives information similar to that of a CT without using X-rays.
  • Angiogram — During an angiogram, also called an arteriogram, a contrast agent is injected into the artery and X-rays are taken to show blood flow, the arteries in the legs and to pinpoint any blockages that may be present.

Treatment

Treatment options include:

  • Lifestyle changes such as quitting smoking, eating a healthy diet and exercising
  • Medication, including cholesterol and blood pressure medications
  • Angioplasty to restore blood flow to the artery
  • Bypass surgery