Peripheral artery disease is a condition in which the peripheral arteries of the extremities undergo lumen stenosis due to arteriosclerosis, resulting in the ischemic state of the affected limbs. In recent years, peripheral arterial diseases associated with arteriosclerosis have rapidly increased due to the advent of an aging society and changes in lifestyle, including eating habits. The prevalence of the disease in Europe and the United States is 3 to 10% and reaches 15 to 20% in people over 70 years old.(1)
What Are The First Symptoms Of Peripheral Artery Disease?
Changes in blood vessels leading to peripheral artery disease proceed slowly without being noticed. At the early stage, it is said that it is difficult to notice abnormalities such as coldness and slight numbness and no noticeable symptoms, and even if you feel pain in your legs when walking, the pain subsides after a while resting. Therefore, it is not uncommon for the peripheral artery disease to be diagnosed after the symptoms have deteriorated.
It is necessary to find and start treatment as soon as possible to avoid situations in which the disease progresses and makes daily life difficult.
Symptoms of peripheral artery disease in the foot can be broadly divided into four stages according to the severity.
- I Degree: Cold feet, numb feet, pale skin
- II Degree: After a short walk, your legs hurt and you cannot walk, but after a short break, you can walk again (intermittent claudication).
- III Degree: Your legs hurt even if at rest
- IV Degree: The skin of the foot is sore (ulcer) or necrotic.
Also, in areas with poor blood flow, it may be difficult for nutrients to reach the muscles, resulting in loss of weight. Be especially careful if the belly of your toes and fingers are crushed.
How Do You Test For Peripheral Artery Disease?
A simple examination such as inquiry and palpation and a detailed examination such as angiography is performed before the diagnosis.
This is a test to check the temperature of the foot, whether it has a strong pulse, and how it reacts to touches. Next, an ABPI measurement is performed to measure and compare the blood pressure in the legs and the blood pressure in the arms. Poor blood flow in the legs causes blood pressure in the legs to be significantly lower than blood pressure in the arms.
If peripheral artery disease is assumed by the above tests, further examinations like ultrasonography and angiography will be conducted, and diagnosis will be confirmed after that.
The “Leg-elevation” and “leg-drop examination” are the first simple diagnostics used to confirm blood flow insufficiency in your lower limbs.
Leg-elevation Diagnosis: After lying on your back, lift both the legs to around 60-degree angles, followed by stretching or bending the joints for approximately 30 to 60 seconds. In case the flow of blood is weak, your legs might turn pale and painful.
Leg-drop Examination: After this leg-elevation examination, you should raise the upper portion of your body while keeping the lower limbs in the hanging position. The healthy feet will turn reddish quickly. But if you have peripheral artery disease, the low blood flow means the feet will take more time to turn reddish.(3)
Once peripheral artery disease is assumed the ankle and brachial blood pressure is then measured using a device such as the Doppler Blood-flow Meter or pulse wave monitor. This test can be done easily and there is no pain. In a healthy individual, the arm and leg blood pressure remain almost similar, but if there is stenosis or blockage in the arteries of the lower limbs, the leg blood pressure falls.
By measuring the ratio of the arm and leg blood pressure (ABPI), the diagnosis of blood circulation disorder and its severity can be determined. When the ratio is 0.9 (corresponds to 90%) or lower, the possibility of some type of obstructive lesions is suspected.
Also, by performing blood flow measurement, thermography, intravascular ultrasonography, MRI, CT scan, arterial contrast examination, angioscopy, etc. Doctors will investigate the clogged areas and the state of blood vessels and blood flow throughout the body.
In peripheral artery disease, there is a high possibility that atherosclerosis has progressed to other areas as well, so it is also important to check for the presence of heart diseases such as angina or cerebrovascular disorders such as cerebral infarction.(4)
- Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in peripheral artery disease after revascularization. New England Journal of Medicine. 2020.
- Kullo IJ, Rooke TW. Peripheral artery disease. New England Journal of Medicine. 2016;374(9):861-871.
- Itoga NK, Minami HR, Chelvakumar M, et al. Cost-effectiveness analysis of asymptomatic peripheral artery disease screening with the ABI test. Vascular Medicine. 2018;23(2):97-106.
- Hinchliffe R, Brownrigg J, Apelqvist J, et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes. Diabetes/metabolism research and reviews. 2016;32:37-44.
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