Peripheral arterial disease

Peripheral arterial disease (PAD) is a condition in which there is narrowing of the blood vessels (arteries) leading to reduced blood flow. The term PAD refers to arteries outside the heart and brain, but is most often used to refer to the arteries to the legs.

The narrowing is most commonly due to atherosclerosis, where there is a build-up of fatty deposits in the inner wall of the artery. Blood clots can also cause narrowing or complete blockage of an artery.

Risk factors for peripheral arterial disease

Factors that can increase your risk of developing PAD include:

  • smoking;
  • diabetes;
  • increasing age;
  • high cholesterol levels;
  • high blood pressure;
  • obesity; and
  • family history.

Peripheral arterial disease symptoms

If the disease is mild, there may be no symptoms at all.

Those who have symptoms most commonly complain of pain or cramping in the legs that occurs with walking but disappears with rest (‘intermittent claudication’). As the blood supply gets worse, there may be pain even when resting.

Other symptoms and signs in the legs and feet may include:

  • numbness or weakness;
  • changes in skin colour and temperature;
  • infections that won’t heal; and
  • ulcers.

In severe cases, gangrene may develop (where the tissue dies due to a lack of blood supply).

Tests

Tests for peripheral arterial disease may include the following.

Ankle brachial index

Measuring the blood pressure in the ankle and comparing it with the blood pressure in the arms.

Duplex ultrasound

Using ultrasound waves to show where and how severely the arteries may be narrowed.

Angiography

Using X-rays to follow the flow of an injection of dye through the arteries to see where and how severe any narrowing or blockage may be.

Treatment for peripheral arterial disease

Treatment will depend on the severity of the disease, but in all cases management of risk factors is very important. This may include quitting smoking, controlling diabetes, treating high blood pressure and lowering high cholesterol levels.

Treatment of mild disease may involve regular exercise and modifying risk factors. An anti-clotting medicine, such as aspirin or clopidogrel (e.g. Iscover, Plavix), may also be prescribed to help prevent blood clots.

More severe disease may require balloon angioplasty/stenting or surgery.

In balloon angioplasty, a thin tube is inserted into the blood vessel and the balloon is inflated to open up the artery. A mesh tube called a stent is often inserted at the site of the blockage to keep the artery open.

Surgical procedures include:

  • Endarterectomy — opening up the artery and removing the plaque.
  • Bypass surgery — placing a graft (either a blood vessel from elsewhere in the body or a synthetic graft) that allows the blood to flow around and bypass the blockage in the artery.

Your doctor will advise you as to the most appropriate treatment in your case.

Last Reviewed: 25 January 2012
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References

1. Atherosclerotic peripheral arterial disease (revised June 2008). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2011 Nov. http://online.tg.org.au/complete/ (accessed Jan 2012).
2. Mayo Clinic.com. Peripheral artery disease (PAD) (last updated 21 Apr 2010). http://www.mayoclinic.com/health/peripheral-arterial-disease/DS00537 (accessed Feb 2012).
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