What Is Peripheral Arterial Disease?
Peripheral arterial disease affects the arteries of the legs, kidneys and other body parts besides the brain and heart. It narrows or blocks arteries, reducing blood flow. An estimated 202 million people worldwide are living with the disease.1 Since many people are not aware of the disease, it is often not recognized in time and therefore treated too late.
The most important cause of peripheral arterial disease is the accumulation of fatty plaque in the arteries, called arteriosclerosis. The plaque is made of cholesterol, blood fats, cellular waste products, calcium and a sticky protein called fibrin. By narrowing or even closing the arteries, the plaque reduces normal blood flow (ischemia). Without enough oxygen-rich blood, organs and tissue stop working. The most common type of peripheral arterial disease is critical limb ischemia. Fifty to seventy-five percent of peripheral arterial disease patients also suffer from cerebral and/or coronary arteriosclerosis, which may cause stroke or heart attack.2
- Age (those over 50 are at higher risk)
- Family history of heart or vascular disease
- High blood pressure (140/90 or higher)
- High level of cholesterol (total blood cholesterol over 240 milligrams per deciliter)
- High level of blood fat
- Sedentary lifestyle and lack of physical activity
- Obesity (body mass index over 30)
Some risk factors such as age and a family history of the disease are uncontrollable. Others, such as smoking, weight and activity level, can be changed.
In the beginning, the circulatory disorder causes discomfort in half of patients.
- Tired and weak arms and legs
- Leg pain (usually in the calves)
- Arm or buttocks pain (less common)
- Burning or tingling sensation in the feet
- Numbness in the hands and feet
- Cold skin and/or changes in skin color (reddish, bluish or pale)
- Sore legs and feet, or poor wound healing
- Intermittent and severe pain while walking that subsides with rest (claudication)
- Erectile dysfunction
Symptoms including chest pain, headache, vertigo and sight disturbances can indicate cerebral and/or coronary circulatory disorders.
Patients with risk factors should regularly undergo check-ups. These tests are used to confirm peripheral arterial disease:
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- Ankle-brachial index (ABI): a physician measures blood pressure in the ankle and in both arms. Usually, blood pressure in the ankles is the same or slightly higher than blood pressure in the arms. If blood pressure in the ankles is significantly lower or higher than in the arms, there is strong evidence for peripheral arterial disease. If the result is unclear, measurements are repeated before and after physical activity (exercise stress test).
- Ultrasonography: an ultrasound exam that shows narrowed or blocked blood vessels and evaluates blood flow through the arteries.
- Magnetic resonance imaging (MRI): Very high-quality 3D-images show vessels and existent lesions in a non-invasive exam
- Computed tomography (CT): X-ray scans show the arteries from different angles.
- Angiography: a contrast dye is injected in the arteries before X-rays are taken. Angiography is a minimally invasive method that provides detailed information on the location and extent of arterial blockage.
1 Fowkes F, Gerald R, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. The Lancet. 2013; 382 (9901): 1329–1340. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961249-0/abstract
3 Olin Jeffrey W et al. Peripheral Artery Disease: Current Insight Into the Disease and Its Diagnosis and Management. Mayo Clin Proc. 2010; 85(7): 678-692.
2 Hallett John W. Peripheral Arterial Disease. Merck Manuals Professional Edition. 2014.http://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-arterial-disorders/peripheral-arterial-disease