Peripheral artery disease or PAD develops when arteriosclerosis occurs in the blood vessels of the legs, and the blood vessels become thin or clogged, causing insufficient blood to flow to the legs. This can lead to numbness, pain, and coldness when walking.
As the disease progresses, you may be unable to walk (intermittent claudication), or your legs may hurt even if you are standing. Further worsening Peripheral artery disease can cause ulcers and necrosis in the feet and severe cases may require surgery on the feet.
Also, since arteriosclerosis progresses systemically, arteriosclerosis in the legs leads to arteriosclerosis in the heart and brain, which may lead to angina, myocardial infarction, and stroke.(1)(2)
Does Peripheral Artery Disease Affect Both Legs?
It varies among patients. The pain can vary from moderate to extreme, and typically disappears a couple of minutes after resting the legs. Usually, both legs get simultaneously affected but there may be more intense pain in one leg.(2)
Should You Elevate Your Legs If You Have PAD?
It is often thought that raising the feet may help ease the pain. Rest generally helps, but it can make the pain worse by raising your legs – like when you’re lying in bed.
Causes Of Peripheral Artery Disease
As people get older, blood vessels become hard and brittle, but if you have lifestyle-related diseases such as diabetes, hypertension, and hyperlipidemia, cholesterol will accumulate inside the arteries (lumen) and the blood vessels will be burdened. It will continue to become harder and more brittle with further cholesterol accumulation.
Eventually, the inside of the blood vessel narrows, causing poor blood flow and a condition called “arteriosclerosis”.
When arteriosclerosis causes poor blood flow, the organs and muscles may suffer from oxygen deficiency and nutritional disorders, resulting in injury. Atherosclerosis can occur in any artery throughout the body, and the foot is no exception.
Among the arteries of the whole body, the arteries that mainly deliver blood to the limbs are called “peripheral arteries”. When arteriosclerosis develops in this peripheral artery, poor circulation occurs in the limbs.
As a result, numbness, pain, and worsening intermittent claudication can lead to ulcers and, in severe cases, necrosis. Peripheral artery disease with these symptoms is the most common type of peripheral vascular disease.(1)
Clinical Symptoms Of Peripheral Artery Disease
Lower limb pain after walking and the ability to walk again after a short rest (intermittent claudication) is a characteristic symptom, which accounts for about 70 to 80% of the main complaints of patients. In fast walking, walking on slopes and stairs, ischemic symptoms are more likely to occur earlier because of the oxygen demand of tissues increases.
Furthermore, if ischemia progresses and collateral circulation is not well developed, symptoms will appear at rest. Special attention is required when the ulcer or gangrene of the lower extremity is complicated by infection or trauma of the lower extremity, and the symptoms rapidly deteriorate.(3)
Diagnosis Of Peripheral Artery Disease
Doppler stethoscope is a useful tool to evaluate peripheral arterial blood flow than by palpation. The ankle-brachial pressure index (ABI) is the most commonly used evaluation method, and the normal value is 1.0 to 1.3. Below 0.9, some ischemia is suspected and below 0.4 is severe.
The most important things to distinguish are thrombo-angiitis obliterans (Buerger’s disease) and cauda equina neuropathy associated with lumbar spinal canal stenosis.
Treatment For Peripheral Artery Disease
It is important to improve the symptoms of the lower limbs, maintain their function, prevent the progression to severe ischemia, and reduce the risk of cardiovascular events such as myocardial infarction and cerebral infarction. Therefore, the aim is to improve smoking habits, control hypertension, and control of dyslipidemia and improve lifestyle habits and drug therapy.
Although β-blockers have been refrained from use in patients with Peripheral artery disease due to concerns about worsening lameness, they have not been proven to be worse in randomized trials, and are used for the treatment of hypertension in Peripheral artery disease patients with coronary artery disease in anticipation of a cardioprotective effect.
Also, regular exercise is recommended because it is expected to increase blood flow in the lower limbs due to collateral circulation development. Antiplatelet drugs, especially aspirin, reduce cardiovascular events. Cilostazol is known to decrease the recurrence of numbness and improve the quality of life.(4)
- Fowkes FGR, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nature Reviews Cardiology. 2017;14(3):156.
- Fonarow GC, Teltsch DY, Cohen A, et al. Incidence, Prevalence, Characteristics, and Outcomes in Patients With Newly-Diagnosed Coronary Artery Disease or Peripheral Artery Disease in Real-World Population of the United States. Circulation. 2018;138(Suppl_1):A16575-A16575.
- Kullo IJ, Rooke TW. Peripheral artery disease. New England Journal of Medicine. 2016;374(9):861-871.
- Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in peripheral artery disease after revascularization. New England Journal of Medicine. 2020.
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