Peripheral artery disease is caused by arteriosclerosis or “hardening” of arteries. This occurs when fatty material (plaque) builds up on the walls of the arteries which causes the arteries to become narrower. The walls of the arteries also become stiffer and cannot widen (dilate) to allow greater blood flow when needed. The narrowing of the blood vessels leads to decreased blood flow to the limbs, which can injure tissues.
As a result, when the muscles of the legs are working harder (such as during exercise or walking) they cannot get enough blood and oxygen. Eventually, there may not be enough blood and oxygen, even when the muscles are resting.
Peripheral artery disease is a common disorder that usually affects men over age 50. People are at higher risk if they have a history of
- Abnormal cholesterol.
- Diabetes
- Heart disease (coronary artery disease)
- High blood pressure (hypertension)
- Kidney disease involving hemodialysis
- Smoking
- Stroke (cerebrovascular disease)
The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of the feet, calves, or thighs.
These symptoms usually appear during walking or exercise and go away after several minutes of rest.
At first, these symptoms may appear only while walking uphill, walking faster, or walking for longer distances. Slowly, these symptoms come on more quickly and with less exercise. Legs or feet may feel numb even at rest. The legs also may feel cool to the touch, and the skin may look pale. When peripheral artery disease becomes severe, one may have
- Impotence
- Pain and cramps at night
- Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful
- Pain that is worse when the leg raised and improves when the leg is dangled over the side of the bed
- Skin that looks dark and blue
- Sores that do not heal
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Majority of the blocks can be diagnosed by simple clinical examination-inability to feel the pulses in the foot.
Arterial blocks can be diagnosed by color Doppler a noninvasive painless method.
Angiogram provides a road map of the arterial tree and it helps to plan the method of treatment.
It is important for the high risk population-smokers, those with diabetes, high blood pressure and high cholesterol-to have periodic check-ups of the peripheral arterial system, to pick up vascular blocks early so that corrective measures can be taken before complications set in.
Medical: All patients with mild blocks can be treated medically.
Stopping smoking and all forms of tobacco is the most important step towards recovery. Regular exercises and walking help improve blood flow and control sugar and cholesterol. Proper footwear and foot care, blood thinners like aspirin and clopidogrel, and control of risk factors like blood sugar, blood pressure etc. help. Those who have advanced blocks presenting with gangrene or severe pain require intervention. If the block is long, bypass surgery can be done. Most often patient’s own vein is used for the bypass. Artificial grafts can be used if the vein is not available.