Peripheral Artery Disease (PAD): What happens when blood can’t flow to your legs

Heart Health

by John F. Eidt, MD, RVT, RPVI, FACS

Sep 29, 2020

Peripheral Artery Disease (PAD) is one of the most common circulatory issues for Americans. According to the American Heart Association, more than 8.5 million people have PAD. People with the worst form of PAD are at risk for an amputation.

“Peripheral” refers to “away from the heart, in the outer regions,” such as the legs. In this case, PAD most commonly affects arteries in the legs.

Nearly half of people with PAD don’t have symptoms, so the condition often goes undiagnosed.

Both PAD and coronary artery disease are caused by atherosclerosis, or so-called “hardening of the arteries.” This is a narrowing — and possibly a blocking — of arteries in critical regions of the body. Atherosclerosis is chronic fatty deposits that build up in the arteries and prevent blood from flowing freely to the extremities.

The condition is dangerous if left untreated. If blood is not flowing to your limbs, organs and brain, tissue can be damaged permanently. Infection may also occur in the legs, as wounds may not heal properly without the blood flow. This situation can lead to loss of limbs, heart attack or stroke.

Who gets peripheral artery disease?

Men are slightly more likely to develop PAD than women. People with diabetes and those who smoke have a much higher incidence of PAD. In fact, PAD is the leading cause of disability among those 60 years of age and older and among diabetics.

Here is a list of risk factors for PAD:

If you have several of these factors, you are at an even greater risk for PAD and should consider bringing it up with your physician.

Peripheral artery disease symptoms

Nearly half of people with PAD don’t have symptoms, so the condition often goes undiagnosed.

Generally, patients with PAD in their lower extremities experience painful muscle cramping in their hips, thighs or calves when walking, climbing stairs or exercising. Those with severe PAD may experience leg pain or foot pain at rest. Patients with severe PAD may develop wounds on the feet or toes that heal slowly or not at all.

PAD specialists, including vascular surgeons, use a variety of diagnostic techniques, including:

  • Treadmill exercise tests
  • Ankle-brachial index (ABI), a simple, painless exam that compares the blood pressure in your feet to the blood pressure in your arm to calculate the rate of blood flow through your body
  • Doppler and ultrasound (Duplex) imaging, a non-invasive imaging technique that uses sound waves to visualize your arteries and measure blood flow
  • Computed tomographic angiography (CT), a non-invasive X-ray imaging technique that uses injected contrast dye to show the arteries in your abdomen, pelvis and legs
  • Magnetic resonance angiography (MRI), a non-invasive imaging technique similar to CT but without the use of radiation
  • Angiography, an imaging technique that uses a contrast agent that is injected into the artery combined with X-rays to show blood flow and locate any blockages. This technique is generally used in conjunction with vascular treatment procedures such as placement of a stent

Peripheral artery disease treatment options

The best peripheral artery disease treatment includes a combination of lifestyle changes and the use of appropriate medications. In terms of medications, we may prescribe high blood pressure medicine, cholesterol-lowering medicine (statins) and/or blood-thinning medicine to help prevent the formation of blood clots. Treatment options should be discussion with your specialist.

A non-invasive approach is generally the best first option for PAD treatment, and this includes lifestyle changes, like:

When these approaches are not enough, vascular surgeons can use the same or similar approaches used to treat heart disease. These include:

  • Angioplasty: The use of a tiny balloon-tipped catheter that is deployed through a thin tube inserted into the artery to open up the blocked artery by expanding the balloon. Often, a stent — a wire-mesh tube — is placed in the newly opened artery through the catheter to maintain normal blood flow.
  • Bypass graft: The use of a vein from another part of the body or a synthetic blood vessel that is attached above and below the portion of the blocked artery to provide a new route for blood flow to occur.

If you suspect you may have peripheral artery disease symptoms, or if you have a family history of PAD, see your physician immediately for an accurate diagnosis.

Now, patients in North Texas who have been diagnosed with PAD have an opportunity to start an exercise therapy program called Supervised Exercise Therapy for PAD (SET for PAD for short). This program is offered at the Walter I Berman Cardiovascular Prevention and Rehabilitation Center on the medical campus of Baylor University Medical Center and also at Carter Cardiac and Pulmonary Rehabilitation Center on the campus of Baylor Scott & White All Saints Medical Center – Fort Worth.

Find a specialist who treats PAD.

About the Author

John F. Eidt, MD, RVT, RPVI, FACS, is a vascular surgeon on the medical staff at Baylor University Medical Center and Baylor Scott & White Heart and Vascular Hospital – Dallas. He is also the vice chair of vascular surgery for Baylor Scott & White Heart and Vascular Hospital – Dallas.

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