Peripheral Arterial Disease

Peripheral arterial disease (PAD) is caused by blockage of the arteries or blood vessels that supply blood to the legs. The most common symptom is intermittent claudication—cramping pain, or fatigue in the leg or hip muscles while walking or climbing stairs. The pain typically goes away with rest and returns when one starts walking again. Other signs and symptoms of PAD include leg numbness or weakness, cold feet, sores on the feet or legs that do not heal, and hair loss on the feet or legs.

Eight to 12 million people are affected by PAD, and almost 75 percent of them do not experience any symptoms. Many people with PAD also have diseased arteries in other locations including the heart, aorta and brain. As a result, they have an increased risk of heart attack, aortic aneurysm and stroke.

Your risk of having PAD is increased if you have coronary artery disease or disease in other arteries. It is also increased if you have diabetes, high blood pressure or high cholesterol. Smoking is a major risk factor for PAD. One research study showed that 69 percent of PAD is attributable to one of these risk factors, with smoking being the most important factor.

If your doctor suspects PAD based upon your history and risk factors, he or she may notice decreased pulses in the arteries of your legs. He or she may also hear bruits (whooshing sounds over diseased arteries). In addition, a physical exam may reveal poorly healing wounds in the area supplied by the diseased artery.

PAD can be diagnosed by simple, noninvasive testing. The ankle-brachial index (ABI) compares the blood pressure in your arm with the blood pressure in your leg. The pressure in your ankle is typically higher than your arm pressure, but if it is too low, it can be an accurate indicator of intermittent claudication. Sometimes this test involves walking on a treadmill with blood pressure readings obtained before and after exercise to determine the severity of artery blockage. Increasingly, magnetic resonance angiography–a special kind of MRI–is used to take pictures of the blood vessels in the legs, particularly if certain kinds of treatment are considered.

The first step in treating PAD is to address risk factors and lifestyle changes. People with diabetes, high blood pressure or high cholesterol should get these problems under control, usually by using medications. If you smoke, you should quit. Exercise rehabilitation involves walking until you experience pain, stopping for pain relief and walking again after the pain has gone away. This approach increases the formation of new blood vessels–collateral blood vessels–that bypass the area of blockage and allow more blood to reach your legs.

While aspirin may not significantly decrease PAD symptoms, your doctor may recommend it to prevent heart disease and stroke. Plavix and Pletal suppress platelet aggregation and are often used for the treatment of intermittent claudication. These medications have been shown to increase the distances that patients can walk without pain. Ticlid is a similar drug that was used in the past but has some severe side effects, so it is not used much anymore. Trental is a medication which reduces the thickness of the blood. It is sometimes used to reduce intermittent claudication symptoms but is generally less effective than Pletal. Gingko biloba has been studied for the treatment of PAD and may be somewhat effective. However, it may have interactions with the antiplatelet drugs commonly prescribed for PAD and should only be taken after a discussion with your doctor.

Some patients with PAD do not receive adequate relief with lifestyle modification, exercise and medications. They may need to consider more invasive procedures like angioplasty with stent placement or vascular surgery.

Dr. Kelly McMahon, a graduate of Yale University and the University of Pittsburgh School of Medicine, is board certified in Internal Medicine. She is a member of the American College of Physicians and the Allegheny County and Pennsylvania Medical Societies. She is in solo practice in the North Hills of Pittsburgh.