Definition Peripheral arterial disease includes conditions that reduce blood flow to the arms and legs to such a degree that the person has symptoms. Peripheral arterial disease is most commonly caused by Arteriosclerosis, or hardening of the arteries. Only about 3% of persons under the age of 60 have peripheral arterial disease, compared with more than 20% of people over age 75.
What is going on in the body? arteriosclerosis is a condition in which fatty deposits form inside blood vessel walls. This causes the walls to become thick and less elastic. The thickened areas are called plaques. When these plaques grow large enough or break apart, they can block the flow of blood through the arteries. The tissues that receive blood from these arteries then begin to suffer damage from a lack of oxygen. Peripheral arterial disease can also cause symptoms from narrowed arteries to the brain.
What are the signs and symptoms of the disease? Symptoms of peripheral arterial disease include:
periods of discomfort or pain in the buttocks, leg, or foot caused by exercise or exertion
pain at rest
decreased or absent pulses
paleness of the skin
hair loss on the arms or legs
redness or blueness of the affected limb
What are the causes and risks of the disease? The factors that increase the risk of peripheral arterial disease include:
Persons who have peripheral arterial disease have a risk of heart disease and stroke 3 to 6 times higher than others without the condition. Those who do not take steps to prevent the condition can expect it to get worse over time.
What can be done to prevent the disease? A person may reduce his or her risk for developing arteriosclerosis and peripheral arterial disease by:
controlling high blood pressure
controlling blood cholesterol
How is the disease diagnosed? Peripheral arterial disease is usually diagnosed by a medical history and physical examination. The doctor may detect weakened or absent pulses in the affected arm or leg. With a stethoscope the doctor can often hear a bruit, the sound of blood moving through a narrowed artery. Doppler ultrasound, a special imaging method using sound waves, can show the reduced blood flow through such arteries. If the diagnosis is in doubt or if surgery is being considered, an angiogram may be performed. In this procedure, special imaging shows the inside of the affected artery. From this, a doctor can determine how narrowed the artery is.
What are the long-term effects of the disease? Over time, peripheral arterial disease can result in a loss of sensation or weakness in the affected arm or leg. The artery can become so narrowed that the person has pain at rest. When the artery becomes very narrow or blocked, tissue death can set in. This is known as necrosis or gangrene.
What are the risks to others? This condition is not contagious.
What are the treatments for the disease? Exercise - even walking for an hour a day, 3 days a week - can double the amount of exertion a person can take before he has pain. Such exercise should be done under a doctor's supervision.
Several drugs have been tried for peripheral arterial disease, but they have not been shown to help much.
For severe narrowing of arteries, several procedures are helpful. These include angioplasty, stent placement, and bypass surgery.
Angioplasty is a procedure in which a tube with a balloon is inserted into the blocked artery and inflated. This is 90% successful in re-opening the artery and allowing blood to flow. After 5 years, however, almost half of these arteries close up again.
Stents are rigid tubes like tiny drinking straws. They can be placed at the re-opened area of the artery and reduce the rate of re-narrowing.
Surgery can also be done to bypass the narrowed area. Bypass operations are 70% to 85% successful. Their success depends on the artery being bypassed and the specific method used to bypass it.
What are the side effects of the treatments? The side effects depend on the drug or procedure being used. Side effects of drugs can include nausea, rash, increased bleeding, and increased risk of ulcers. Any procedure can cause bleeding, infection, and even death.
What happens after treatment for the disease? Exercise can usually help improve symptoms. The person can often walk twice as far before experiencing any pain. Drugs often provide little benefit. The procedures described above can help people who are otherwise healthy function without pain. Amputation requires a long period of rehabilitation and physiotherapy.
How is the disease monitored? Persons with peripheral vascular disease often need close follow up to monitor the condition. If a procedure is performed, persons are often able to resume everyday activities once they have recovered but will still need follow up with their doctor.
Author: William M. Boggs, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
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