Thursday, May 21, 2009

Peripheral Arterial Disease of the Legs - Overview

What is peripheral arterial disease of the legs?

Peripheral arterial disease (PAD) is narrowing or blockage of arteries that results in poor blood flow to your arms and legs. When you walk or exercise, your leg muscles do not get enough blood and you can get painful cramps.

Peripheral arterial disease is also called peripheral vascular disease. This topic focuses on peripheral arterial disease of the legs, the area where it is most common.

What causes PAD?

The most common cause is the buildup of plaque on the inside of arteries. Plaque is made of extra cholesterol, calcium, and other material in your blood. Over time, plaque builds up along the inner walls of the arteries, including those that supply blood to your legs.

If plaque builds up in your arteries, there is less room for blood to flow. Every part of your body needs blood that is rich in oxygen. But plaque buildup prevents that blood from flowing freely and starves the muscles and other tissues in the lower body.

This process of plaque buildup usually happens at the same time throughout the body. It is called atherosclerosis or hardening of the arteries. If you have this problem in your legs, you most likely will have it in the arteries that supply blood to your heart and brain. This increases your chance of having a heart attack or stroke.

Plaque builds up bit by bit over a lifetime, but symptoms often do not start until after age 65. High cholesterol, high blood pressure, and smoking make you more likely to get atherosclerosis and peripheral arterial disease.

What are the symptoms?

Many people who have PAD do not have any symptoms.

But if you do have symptoms, you may have a tight, aching, or squeezing pain in the calf, thigh, or buttock. This pain, called intermittent claudication, usually happens after you have walked a certain distance. For example, your pain may always start after you have walked a block or two or after a few minutes. The pain goes away if you stop walking. As PAD gets worse, you may have pain in your foot or toe when you are not walking.

How is PAD diagnosed?

Your doctor will talk with you about your symptoms and past health and will do a physical exam. During the exam, your doctor will check your pulse at your groin, behind your knee, on the inner ankle, and on the top of your foot. Your pulse shows the strength of blood flow. An absent or weak pulse in these spots is a sign of PAD. Your doctor may also look at the color of your foot when it is higher than the level of your heart and after exercise. The color of your foot can be a clue to whether enough blood is getting through your arteries.

You will likely have a test that compares the blood pressure in your legs with the blood pressure in your arms. This test is called an ankle-brachial index. A test called an arterial Doppler ultrasound may be done to check the blood flow in your arteries.

Blood tests to check your cholesterol and blood sugar can tell whether you may have other problems related to PAD, such as high cholesterol and diabetes.

How is it treated?

One of the most important things you can do for PAD is to quit smoking. If you need help quitting, talk to your doctor about programs and medicines that can help you stop. These can increase your chances of quitting forever.

There are also products that gradually wean you off nicotine. These include nicotine patches, chewing gums, nasal sprays, inhalers, and lozenges. These treatments help people have better success in the long term.1

Your doctor may tell you to eat healthy foods and to get more exercise. You may need to take aspirin and medicines to lower your cholesterol and control your symptoms. If you have diabetes, you will need to carefully control your blood sugar.

Combined, these measures can help control your symptoms and reverse the blockage of your arteries. Keeping your arteries open can help lower your risk of heart attack and stroke. And it may also improve the quality and length of your life.

If your leg pain does not get better after a few months of treatment, your doctor may prescribe a medicine called cilostazol (Pletal) to help with the pain when you walk.

If you still do not get better, you may need a procedure called angioplasty or bypass surgery to open narrowed arteries or reroute blood flow around them. These treatments are usually used for severe peripheral arterial disease.

In rare cases, advanced PAD can cause tissues in the leg or foot to die because they do not get enough oxygen as a result of poor blood flow. If this happens, part of the leg or foot must be removed (amputated). This is more common in people who also have diabetes.

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