Patient education: Peripheral artery disease and claudication (The Basics)

What is peripheral artery disease? — 

Peripheral artery disease, or "PAD," is a condition that affects the blood vessels (called arteries) that bring blood to the legs. PAD can cause muscle pain that gets worse with activity and better with rest. This is called "claudication." PAD can also cause leg wounds to heal more slowly than usual. This article is only about the leg pain related to PAD.

Normally, blood flows easily through arteries to all parts of the body. But sometimes, fatty clumps called "plaque" build up inside the walls of the arteries (figure 1). This causes the arteries to become narrow or blocked, which prevents blood from flowing normally. When muscles do not get enough blood, symptoms can happen.

Some people have a greater chance of getting PAD, such as those who:

●Smoke

●Have diabetes

●Have high cholesterol

●Have high blood pressure

People with PAD have a higher risk of serious problems, like heart attack or stroke.

What are the symptoms of PAD? — 

PAD often causes pain in the back of the lower leg. The pain usually gets worse with walking or other exercise, and gets better with rest. PAD can also cause pain in the buttocks, thighs, or sometimes the feet.

People who have leg pain can have other symptoms, too, such as:

●Trouble walking up stairs

●Trouble with sexual arousal

Symptoms of claudication can be mild or severe, depending on:

●Which arteries are affected, and how many

●How narrow the arteries are

●How much activity the person does

Is there a test for PAD? — 

Yes. Your doctor or nurse can do different tests to find out if you have PAD, and to check how severe it is. They might:

●Measure the blood pressure in your arm and lower leg (just above your ankle) – This is done at rest and right after exercise. Then, the numbers are compared.

●Measure the blood pressure in other places in your leg, like your thigh

●Order a blood vessel imaging test, such as an ultrasound – This creates pictures of your arteries that bring blood to your leg.

How is PAD treated? — 

To help treat your PAD and prevent it from getting worse, you should:

●Quit smoking, if you smoke. Your doctor or nurse can help.

●Manage your other health conditions – If you have diabetes, high blood pressure, or high cholesterol, it's important to keep these under control. This might involve medicines, lifestyle changes, or both.

●Walk – Doctors recommend most people with PAD walk each day. Ask your doctor or nurse how best to begin a walking program.

Doctors can also prescribe medicines for people with PAD and claudication. These include:

●Medicines to lower the risk of heart attack or stroke – These help prevent blood clots. They include aspirin, clopidogrel (brand name: Plavix), and rivaroxaban (brand name: Xarelto).

●Other medicines – These include cilostazol (brand name: Pletal) and naftidrofuryl. They can relieve symptoms and help you walk longer distances without pain.

Can procedures help with PAD? — 

Yes. If you still have severe symptoms after trying medicines, your doctor might suggest a procedure to increase blood flow to your legs and feet. Your options might include:

●Angioplasty or stenting – The doctor inserts a thin tube with a balloon at the end of it into the part of the artery that is blocked. Then, they inflate the balloon to open the blockage. Sometimes, the doctor might need to prop open the artery using a tiny mesh tube called a "stent," which stays in the body.

●Open patch angioplasty – This involves cutting open the artery, cleaning out the plaque, then closing or "patching" the cut.

●Bypass surgery – The doctor removes a piece of a vein from another part of the body. Then, they reattach that piece (called a vein graft) above and below the area that is blocked. This re-routes blood around the blocked area, and lets it get to the part of the leg that was not getting enough blood. Sometimes, instead of taking a vein from another part of the body, the doctor can use an artificial graft.

Your doctor will talk to you about your situation and options. In general, angioplasty, stenting, and patch angioplasty work best for treating short blocked areas. Surgery works better long term for treating long blocked areas.

Your doctor might recommend a procedure based on your symptoms, age, and health. But many people can choose which procedure to have. If your doctor offers you a choice, ask:

●What are the benefits of each procedure for me?

●What are the downsides of each procedure for me?

●What happens if I do not have any procedure?

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