Understanding Peripheral Arterial Disease (PAD)

Arteries carry blood rich in oxygen and nutrients from your heart to the rest of your body. If the arteries in your legs become narrowed or blocked, your legs do not receive enough blood or oxygen and you may have a condition called peripheral artery disease (PAD).

In most cases there are no symptoms or the symptoms are dismissed as normal signs of ageing. Patients often feel discomfort or pain when walking. The pain can occur in the hips, buttocks, thighs, knees or shins. You are more likely to develop PAD as you age. One in 3 people age 70 or older has PAD. Smoking or having diabetes increases your chances of developing the disease sooner.

Arteries are normally smooth and unobstructed on the inside but, with age, they can become narrowed or blocked through a process called atherosclerosis, which means hardening of the arteries. A sticky substance called plaque can build up in the walls of the arteries. Plaque is made up of cholesterol, calcium, and fibrous tissue. As more plaque builds up, the arteries narrow and stiffen. Eventually, enough plaque builds up to reduce blood flow to the arteries in the leg. When this happens, the leg does not receive the oxygen it needs, leading to pain on exercising or walking.  If you have PAD, it is very likely that you have similar blockages in other arteries around the heart or brain. This places you at a greater risk of limb loss but also of having a heart attack or stroke.

What are the symptoms?

You may not feel any symptoms from PAD at first. The most common symptom is intermittent claudication (IC). IC is discomfort or pain in your legs on walking which eases with rest. You may not feel any pain; instead there may be tightness, heaviness, cramping, or weakness in the leg. IC often occurs more quickly if you walk uphill or up a flight of stairs. Over time, you may begin to feel IC at shorter walking distances. Less than half the people with PAD experience any symptoms.

Critical limb ischemia occurs when the legs do not get enough oxygen even when  resting. With critical limb ischemia, you may experience continuous pain or discomfort in the feet or toes.

In severe PAD, patients develop painful sores on the toes or feet. If the circulation in the leg does not improve, these ulcers can start as dry, grey, or black sores, and become dead tissue (called gangrene).

What causes PAD?

As you get older, the risk of developing PAD increases. People older than 50 have an increased risk of developing the disease, and men are at greater risk than women. Other factors that increase the chances of developing the disease include:

Smoking
Diabetes
High blood pressure
High cholesterol or triglycerides
High levels of homocysteine, an amino acid in blood
Weighing over 30% more than your ideal weight

How to prevent PAD?

Lifestyle changes that help you manage your peripheral arterial disease include:

In severe cases of PAD, lifestyle changes and medication may not be enough to improve symptoms. Also, if the disease is at an advanced stage, physicians may recommend surgical or minimally invasive treatments. The choice of the treatment depends upon the pattern and extent of the blockages as well as other factors, such as your general health and the presence of other medical conditions.