Diseases & Conditions


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Peripheral Arterial Disease


Blood flow to the legs (and sometimes the arms) can be reduced when their arteries are affected by peripheral arterial disease (PAD). Narrowing of the peripheral arteries occurs because of buildup of plaque (a mixture of fat, cholesterol, blood platelets, and blood vessel wall damage) within the arteries themselves. Plaque can block blood flow partially or totally. Poor circulation due to PAD can cause leg pain with walking and poor wound healing, which decrease quality of life and may lead to severe complications such as leg amputation. PAD is associated with several chronic medical problems, such as diabetes, high blood pressure, and high cholesterol. Persons who smoke have a much higher chance of developing PAD. Having PAD may signal the presence of heart disease, cerebrovascular (blood vessels in the brain) disease, or major arterial disease (thoracic or abdominal aortic aneurysms). It is important to understand that vascular disease anywhere is a marker for blood vessel disease in all other parts of the body. SIGNS AND SYMPTOMS Cramping of leg muscles that may stop a person from doing normal daily activities or exercise. The occurrence of leg cramping or pain in the calf muscles that starts with walking and stops with rest is called claudication Leg pain, especially tingling pain. Pain at rest may be a symptom of severe PAD Sores on the legs or feet that do not heal Changes in skin color or texture Many people with PAD have no leg symptoms DIAGNOSIS AND TESTING A medical history and physical examination evaluate signs and symptoms of PAD and associated medical problems. A simple test, called the ankle-brachial index, measures the ratio of blood pressure at the ankle to blood pressure in the arm. A low ratio indicates poor blood flow in the lower extremity. Further testing may include ultrasound examinations, exercise testing, and angiography (tests to show blood flow). TREATMENT Stop smoking. This is the most important part of treating peripheral arterial disease. Control diabetes, high blood pressure, and cholesterol. Eat a healthy, low-fat diet rich in fruits, vegetables, and whole grains. Avoid high-sodium, high-fat, and processed foods. Exercise regularly. Medications such as aspirin that interfere with platelet function or blood clotting may help protect patients with PAD against heart disease and stroke. FOR MORE INFORMATION National Heart, Lung, and Blood Institute http://www.nhlbi.nih.gov Vascular Disease Foundation http://www.vdf.org Peripheral Arterial Disease Coalition http://www.padcoalition.org Source: JAMA. 2009;301(2):236.