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By the time you experience the symptoms of peripheral artery disease (PAD), the condition has already advanced to a serious stage. However, most people can prevent PAD or significantly slow down its progression by taking steps to lower their controllable risk factors. Here at Vein Health Clinics, Dr. Obinna Nwobi specializes in assessing your risk for peripheral artery disease. Then he creates a plan that reduces your risk factors and helps you stay active and healthy. Peripheral artery disease explainedPeripheral artery disease most often occurs in the arteries in your legs, but it can sometimes affect arteries in your arms. You develop PAD when cholesterol circulating in your blood sticks to a damaged area on the artery walls. Over time, the cholesterol gradually accumulates and hardens into plaque, which is a condition called atherosclerosis. When the plaque gets too large, it blocks blood flow through the artery, and the tissues served by the clogged artery are deprived of oxygen and nutrients. Chances are you won’t have symptoms until the artery has narrowed by 60% or more. Then you’ll begin to experience:
As the disease progresses, you may have foot pain even when you’re resting or your legs are elevated. Risk factors you can change to prevent peripheral artery diseaseYou can’t do anything about some of the factors that increase your risk of PAD, like your age or having a family history of the disease. However, most risk factors are within your control. If any of these risk factors apply to you, changing them before the disease develops can prevent PAD. Even after cholesterol begins to build up, you can slow down the accumulation or stop the condition from worsening by dealing with the top six risk factors: Cigarette smokingSmoking is the primary risk factor for PAD and the most common preventable cause. In fact, it’s estimated that smokers have four times the risk of PAD compared to nonsmokers. Smoking contributes to the formation of atherosclerotic plaque as chemicals in cigarette smoke damage cells that line blood vessels and cause inflammation. DiabetesHaving diabetes significantly increases your risk for peripheral artery disease, because high blood sugar promotes inflammation and leads to blood vessel abnormalities that cause atherosclerosis. Additionally, patients with diabetes frequently have high levels of fat and cholesterol in their bloodstreams, which is another risk factor for PAD. After PAD develops, diabetes accelerates its progress and increases your risk of a heart attack, stroke, and amputation. High blood pressureWhen you have high blood pressure, artery walls are damaged by the force of blood pushing through the blood vessel. This creates the rough spots that make it easy for cholesterol to accumulate. High cholesterolThe effect of cholesterol in your bloodstream depends on the amount of total cholesterol, high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs). After you consume cholesterol, your small intestine turns the fat into a package that’s wrapped in proteins so that it can travel in your bloodstream. These packages, called lipoproteins, have varying amounts of cholesterol and protein, which is what makes them HDL or LDL. HDL is the so-called good cholesterol, because these lipoproteins remove cholesterol from your blood. On the other hand, LDL is the bad type of cholesterol because it stays in your blood, where the cholesterol it carries can end up clogging your arteries and causing PAD. Overweight and obesityCarrying excess weight leads to high blood pressure and diabetes, which in turn cause PAD. Additionally, being overweight increases system-wide inflammation, including vascular inflammation that contributes to atherosclerotic plaque. Where you carry fat may also make a difference. Extra weight around your waist may increase your chance of PAD more than your total BMI. Sedentary lifestyleStaying active and engaging in routine exercise primarily prevents PAD by lowering other risk factors. Exercise helps you maintain a healthy weight, lowers blood pressure and cholesterol, and helps prevent diabetes. Lifestyle changes to lower your risk for peripheral artery diseaseYou can reduce all the PAD risk factors by making four major changes in your lifestyle, as needed: losing weight, eating a balanced diet, getting regular exercise, and stopping smoking. These changes are all connected, as losing weight depends on your diet, limiting calories, and getting regular exercise. A healthy diet also helps lower blood pressure and cholesterol. There are some differences in the focus of a diet to prevent or manage diabetes compared to one designed to reduce hypertension. But the changes required for both fit perfectly into a sustainable diet that everyone can follow. To learn more about your risk for PAD and to get the help you need controlling risk factors, call one of our offices at Vein Health Clinics or book an appointment online.
Peripheral artery disease, or PAD, is an accumulation of plaque (fats and cholesterol) in the arteries in your legs or arms. This makes it harder for your blood to carry oxygen and nutrients to the tissues in those areas. PAD is a long-term disease, but you can improve it by exercising, eating less fat and giving up tobacco products.
Peripheral arterial disease (PAD), also known as peripheral vascular disease or peripheral artery disease, is plaque buildup in your leg arteries that carry oxygen and nutrient-rich blood from your heart to your arms and legs. Shaped like hollow tubes, arteries have a smooth lining that prevents blood from clotting and promotes steady blood flow. When you have peripheral artery disease, plaque (made of fat, cholesterol and other substances) that forms gradually inside your artery walls slowly narrows your arteries. This plaque is also known as atherosclerosis. Many plaque deposits are hard on the outside and soft on the inside. The hard surface can crack or tear, allowing platelets (disc-shaped particles in your blood that help it clot) to come to the area. Blood clots can form around the plaque, making your artery even narrower. If your arteries become narrowed or blocked with plaque or a blood clot, blood can’t get through to nourish organs and other tissues. This causes damage ― and eventually death (gangrene) ― to the tissues below the blockage. This most often occurs in your toes and feet. The rate at which PAD progresses varies with each person and depends on many factors, including where in your body the plaque forms and your overall health. What are the risk factors for peripheral arterial disease?Smoking is the most important risk factor for PAD. In fact, 80% of people with PAD are people who currently or were former smokers. Regardless of your sex, you’re at risk of developing peripheral arterial disease when you have one or more of these risk factors:
Although PAD is a different condition from coronary artery disease, the two are related. People who have one are likely to have the other. The U.S. National Institutes of Health estimates that a person with PAD has a six to seven times higher risk of coronary artery disease, heart attack, stroke or a transient ischemic attack (mini-stroke) than the general population. A person with heart disease has a 1 in 3 chance of having peripheral artery disease in the legs. Not surprisingly, the two diseases also share some common risk factors. This is because these risk factors cause the same changes in arteries in your arms and legs as they do in your coronary arteries. As in coronary artery disease, many of these risk factors are out of your control. But, according to researchers, tobacco use is the single most important modifiable (changeable) risk factor for PAD and its complications. Tobacco use increases the risk for PAD by 400% and brings on PAD symptoms almost 10 years earlier. Compared with non-smokers of the same age, smokers with PAD are more likely to die of heart attack or stroke, have poorer results with heart bypass surgery procedures on their legs and are twice as likely to have a limb amputation. How common is this condition?PAD is common, affecting between 8 and 12 million Americans. Despite the prevalence of PAD, it’s surprisingly underdiagnosed and undertreated. How does this condition affect my body?The typical symptom of PAD is called “claudication,” a medical term that refers to pain in your leg that comes on with walking or exercise and goes away with rest. The pain occurs because your leg muscles aren’t getting enough oxygen. The dangers of PAD extend well beyond difficulties in walking, and the consequences can be far worse than missing a shopping trip or golf game. Peripheral artery disease increases the risk of developing a non-healing sore of the legs or feet. In cases of severe PAD, these sores can develop into areas of dead tissue (gangrene) that ultimately make it necessary to amputate your foot or leg. Because your body’s circulatory system is interconnected, the effects of PAD can extend beyond the affected limb. People with atherosclerosis of their legs commonly have it in other parts of their bodies. People who have peripheral artery disease are at increased risk for having a heart attack, stroke, transient ischemic attack (mini-stroke) or problems with their kidney (renal) arteries. If left untreated, people with PAD can develop serious health problems, including:
Half of the people who have peripheral vascular disease don’t have any symptoms, but pain or discomfort in their legs is a common symptom. You may also feel weak or tired while walking. Affected parts of your leg may include your calves, thighs or buttocks. PAD can build up over a lifetime, and the symptoms may not become obvious until later in life. For many people, the outward symptoms won’t appear until their artery has narrowed by 60% or more. Early symptomsThe first noticeable symptom of PAD may be intermittent claudication ― leg discomfort, pain or cramping that:
You may notice the pain in your calf, but you may also feel it in your buttocks or thighs. With intermittent claudication, your leg muscles may feel:
The pain can be severe enough to limit your ability to participate in activities you enjoy, such as golfing or chasing after grandchildren. Reduced blood flow to your leg muscles causes this type of cyclical pain, which goes away at rest because your muscles need less blood flow at rest. Advanced symptomsSymptoms of advanced PAD may include:
What causes PAD?Atherosclerosis that develops in the arteries of your legs — or, less commonly, your arms — causes peripheral arterial disease. Like atherosclerosis in your heart (coronary) arteries, an accumulation of fatty plaque in your blood vessel walls causes peripheral vascular disease. As plaque builds up, your blood vessels get narrower and narrower, until they become blocked.
Talk to your doctor if you’re having symptoms of PAD so the cause of your symptoms can be identified and treatment can be initiated as soon as possible. Early detection of PAD is important so the right treatments can be provided before the disease becomes severe enough to lead to complications, such as heart attack or stroke. A physical exam will be performed and your medical history and risk factors will be reviewed. Your doctor may order certain tests to help diagnose PAD and determine the severity of the disease.
The two main goals in the treatment of PAD include:
With early diagnosis, lifestyle changes and treatment, you can stop PAD from getting worse. In fact, some studies have shown that you can reverse peripheral vascular disease symptoms with exercise combined with careful control of cholesterol and blood pressure. If you think you’re at risk for PAD or may already have the disease, talk to your primary care doctor, vascular medicine specialist or cardiologist so you can get started on a prevention or treatment program as soon as possible. Lifestyle changes, medications and interventional procedures can treat your PAD. Lifestyle changesInitial treatment of PAD includes making lifestyle changes to reduce your risk factors. Changes you can make to manage your condition include:
MedicationsMedicines can help you with conditions such as high blood pressure (antihypertensive medications), high cholesterol (statin medications) and diabetes. These drugs treat the risk factors of PAD and decrease your risk of stroke and heart attack. An antiplatelet medication such as aspirin or clopidogrel may reduce the risk of heart attack and stroke. Your healthcare provider may prescribe cilostazol to improve your walking distance. This medication helps people with intermittent claudication exercise longer before they develop leg pain. However, not everyone is eligible to take this medication. Your healthcare provider will tell you if you are. Supervised exercise programsA supervised exercise program will improve the symptoms of pain in your legs with walking (claudication), allowing you to walk farther. A structured program typically includes walking on a treadmill in a supervised setting at least three times per week. People with PAD should also walk at home for a total of at least 30 to 60 minutes every day. The usual prescription is called “Start/Stop” exercise:
For some people with more severe PAD, the claudication symptoms may still cause problems in daily life, even after a few months of exercise and medications. In more severe cases, restoration of blood flow is necessary to relieve pain at rest or to heal a wound. To restore blood flow, the first step is usually an angiogram. A healthcare provider who specializes in invasive vascular procedures can do this. Minimally invasive or surgical treatmentsMore advanced PAD that’s causing severe pain and limited mobility may require endovascular (minimally invasive) or surgical treatment. Some heart disease treatments also treat peripheral artery disease. Treatments include:
Complications of PAD treatmentYou should contact your healthcare provider if you have these issues after your procedure. They could be signs of an infection or other complications.
How long does it take to recover from this treatment?You may have soreness for a few days where your healthcare provider had to cut into your skin. It can take six to eight weeks to recover completely from the surgery. You may only need a few days to recover from your atherectomy.
Being aware that you have risk factors for PAD may motivate you to take action to prevent PAD from developing. The same advice for maintaining a healthy heart applies to maintaining healthy circulation overall:
If you have heart disease, you should discuss your risk factors for PAD with your healthcare provider and report any symptoms you’re having, such as pain, weakness or numbness in your legs.
Like most health conditions, PAD is more treatable when your healthcare provider finds it early. Peripheral vascular disease progresses at different rates depending on many factors, including where the plaque formed in your body and your overall health. Outlook for this conditionPeripheral artery disease is a condition you’ll have for the rest of your life. Although there’s no cure for PAD, it’s treatable. You can help keep peripheral vascular disease from progressing in several ways:
It’s very important that you take especially good care of your feet to prevent non-healing sores. Foot care for people who have PAD includes:
In some cases, your healthcare provider may refer you to a podiatrist (foot expert) for specialized foot care ― especially if you have diabetes. A podiatrist can help you with corns, calluses or other foot problems. When should I see my healthcare provider?Contact your healthcare provider if you:
When should I go to the ER?Get immediate help if you can’t feel or move your foot or if it looks different from your other foot’s skin color. This means you’ve lost blood flow to your leg without warning. What questions should I ask my doctor?
A note from Cleveland Clinic You have the ability to prevent PAD or keep it from getting worse by making lifestyle changes. Keep all of your follow-up appointments with your healthcare provider and vascular specialist, and take the medicines they prescribe for all of your conditions. Knowing the warning signs of PAD complications helps you know when to ask for help, too.
Last reviewed by a Cleveland Clinic medical professional on 01/19/2022. References
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy |