Peripheral Artery Disease

• Pain
• Coldness
• Muscle Fatigue
• Discoloration
• Leg or foot ulcer

These symptoms start during exercise and go away after several minutes of rest. At first, these symptoms may be present only when you walk uphill, walk faster, or walk for longer distances. Slowly, these symptoms come more quickly and with less exercise.

Your legs or feet may feel numb when you are at rest. They also may feel cool to the touch, and the skin may appear pale. When peripheral artery disease becomes severe, you may develop:

• Pain or tingling in the foot or toes, which can become severe.
• Pain that is worse when the leg is elevated and improves when you dangle your legs over the side of the bed.
• Ulcer or sore which heals slowly or doesn’t heal at all.

• Walk or do another activity to improve circulation. Always talk to the doctor before starting an exercise program.
• Stop smoking. Smoking constricts arteries and decreases the blood’s ability to carry oxygen.
• Eat a low-cholesterol and low-fat diet.
• Medications may be indicated to help control the disorder. Some of these include:
  • Aspirin or a medicine called clopidogrel (Plavix), which keeps your blood from forming clots in your arteries
  • Cilostazol, a medication to improve the viscosity of blood.
• Angioplasty and stent placement of the peripheral arteries (a similar technique to that used to open the coronary arteries) can be successful in many cases to open blocked leg arteries.  This procedure can usually be performed in most people regardless of age or medical condition since it is done under local anesthesia and in our office.  Most patients can go back to normal activities right away.
• Lower extremity bypass surgery may be necessary if angioplasty and stent placement is not successful.  This surgery has to be performed in the hospital and under general anesthesia and cannot be performed on those patients with major health issues.  A long period of time for healing and recuperation is also required.

Peripheral artery disease is caused by arteriosclerosis, or “hardening of the arteries.” This problem occurs when fatty material and a substance called plaque build up on the walls of your arteries. This 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.

As a result, when the muscles of your legs are working harder (such as during exercise) they cannot get enough blood and oxygen. Eventually, there may not be enough blood and oxygen, even when the muscles are resting.  This can cause pain, coldness and discoloration as well as possible ulcers and ultimately gangrene.

This is a common disorder that typically affects more men than women, especially over age 50. People are at higher risk if they have a history of:

• Smoking
• Diabetes
• Abnormal cholesterol
• Heart disease (coronary artery disease)
• High blood pressure (hypertension)
• Family history of PAD or heart disease
• Kidney disease involving hemodialysis
• Stroke

During an examination, your health care provider may find:

• Weak or absent pulses in the limb (a hand-held Doppler can be used)
• Decreased blood pressure in the affected limb
• Loss of hair on the legs or feet
• A whooshing sound with the stethoscope over the artery (arterial bruits)

When PAD is more severe, findings may include:

• Paleness of the skin or bluish color in the toes or foot (cyanosis)
• Calf muscles that decrease in size
• Hair loss over the toes and feet
• Ulcers (sores) on the feet or toes that are slow to heal
• Gangrene of toes
• Blood tests may show high cholesterol or diabetes.

Tests for peripheral artery disease:

• Blood pressure measured in the legs as compared to arms for comparison (PVR study)
• Ultrasound (Sonogram) exam of the extremity’s arteries
• Angiography of the arteries in the legs (arteriogram)
• Magnetic resonance angiography or CT angiography

You can usually control peripheral artery disease of the legs with treatment. Angioplasty and stent placement are usually successful when they are required.  If left untreated PAD can result in foot or leg amputation.  You may be at increased risk for coronary artery disease and stroke.

• Leg or Foot ulcers
• Gangrene
• Limb Loss
• Coronary artery disease
• Impotence

Call your health care provider if you have:

• Symptoms of arteriosclerosis of the extremities
• New sores/ulcers
• A leg or foot that becomes cool to the touch, pale, blue, or numb
• Leg pain after walking short distances
• Leg pain that does not go away, even when you are not walking or moving (called rest pain)
• Legs that are red, hot, or swollen

If you experience acute leg or foot pain and you cannot contact your health care provider right away call 911 and seek immediate medical help.