Peripheral Artery Disease

Signs & symptoms

While many patients with peripheral artery disease (PAD) have mild symptoms or no symptoms at all, about one in 10 experiences painful cramping or fatigue in the legs, hip, thigh or calf muscles after walking or climbing stairs, which is relieved by a short period of rest. This condition is called intermittent claudication.

Other symptoms include:

• Change in the color of the legs
• Changes in the toenails
• Coldness in the lower leg or foot, especially compared to the other leg
• Hair loss on the feet and legs
• Leg numbness or weakness
• Sores on the toes, feet or legs that won't heal

Diagnosis

In making a diagnosis of peripheral artery disease (PAD), your doctor will take your complete medical history and conduct a physical exam. You will also have one or more of the following tests to confirm a diagnosis:

• Ankle-brachial index (ABI). is a simple way to measure the blood flow in your legs using an ankle cuff, which the doctor inflates until the beat of your pulse is no longer heard. Pressure is then released from the cuff and your blood pressure is recorded.
• Duplex ultrasound. A test to see how blood moves through your arteries and veins
• Computed tomography (CT). Angiography is used to visualize the arteries bringing blood to your brain, lungs, kidneys, arms and legs.
• Magnetic resonance angiography (MRA). An exam of the blood vessels.

You may also have blood tests to measure your cholesterol, homocysteine, an amino acid in the blood, and certain proteins.

Treatments

Cardiologists, cardiac and vascular surgeons, interventional radiologists and other specialists work together to provide the most effective treatments – many of them developed at UCSF – for peripheral artery disease, or PAD.

Your treatment will depend on the severity of your PAD. Many patients can be managed with non-invasive therapies such as lifestyle changes, medication, or both. If your condition does not respond to these approaches, surgery may be necessary. In the most advanced cases, limb amputation may be required.

Lifestyle changes:

• Smoking cessation
• Diabetes control
• Blood pressure management
• Physical activity
• Diet low in saturated fats
• Cholesterol medication

Medications

• Medications to prevent blood clots, called antiplatelet therapy, such as aspirin or clopidigrel
• Medications to lower your cholesterol, called statins, such as simvastatin, atorvastatin or pravastatin
• Medications that may help you walk, such as cilostazol or pentoxifylline
• Medications to treat your high blood pressure, called ACE inhibitors

Surgery

If your condition worsens or does not improve with lifestyle changes and medications, bypass surgery, endarterectomy or endovascular intervention may be necessary. The type of procedure recommended will depend on the size and location of your blockage.

Bypass surgery creates a detour, or bypass, around the blocked artery so that blood can flow normally. To create this bypass, your vascular surgeon uses a graft, which can be made from part of one of your veins or from a made-made synthetic tube. This bypass is surgically attached to replace the artery that is blocked, creating a new path for blood to flow to your leg tissues.

Endarterectomy is surgical removal of plaque from the blocked artery. During the procedure, your vascular surgeon will make an incision in your artery to remove the plaque in the artery's inner lining, restoring normal blood flow. The effectiveness of endarterectomy depends on the location and severity of your blockage. It may be performed with other procedures, such as bypass surgery.

Endovascular therapies are minimally invasive non-surgical techniques that open or widen arteries that have become narrowed or blocked. In a procedure called balloon angioplasty, a catheter is inserted into a leg or arm artery and fed into the blocked peripheral artery. A balloon, connected to the catheter, is expanded to open the artery. Surgeons may then place a wire mesh tube, called a stent, at the area of blockage to keep the artery open.