Arterial pain

What are the symptoms of peripheral arterial disease?

PAD can build up over a lifetime, and the symptoms may not become obvious until later in life. For many people, the outward symptoms will not appear until the artery has narrowed by 60 percent or more.

The first noticeable symptom of PAD may be intermittent claudication -- leg discomfort, pain or cramping that develops with activity, is relieved with rest, and recurs upon resuming activity. The pain is often noticed in the calf, but may also be felt in the buttocks or thighs. Intermittent claudication symptoms may also include numbness, weakness, heaviness or fatigue in the leg muscles when walking that are relieved at rest. The pain can be severe enough to interfere with normal walking. This type of cyclical pain is caused by reduced blood flow to the leg muscles and goes away at rest because the muscles require less blood flow at rest.

Other symptoms of advanced PAD may include:

A burning or aching pain in the feet and toes while resting, especially at night while lying flat
Cool skin in the feet
Redness or other color changes of the skin
Increased occurrence of infection
Toe and foot sores that do not heal

Many people with PAD do not have any symptoms.

How is PAD detected?

Talk to your doctor if you are having symptoms of PAD so the cause of your symptoms can be identified and treatment can be initiated as soon as possible. Early detection of PAD is important so the right treatments can be provided before the disease becomes severe enough to lead to complications, such as heart attack or stroke.

A physical exam will be performed and your medical history and risk factors will be reviewed. Your doctor may order certain tests to help diagnose PAD and determine the severity of the disease.

The ankle/brachial index (ABI) is a measurement of the blood pressure in the lower legs compared to the blood pressure in the arms. During this test, blood pressure cuffs are placed on the arms and legs. The cuffs are inflated, while a hand-held device (called a Doppler) is used to listen to the blood flow. The ABI screening helps evaluate the amount of blood flow to the legs and feet, which is decreased in a person with PAD. It is a highly accurate method for detecting PAD.
A pulse volume recording(PVR) is a noninvasive test that measures the blood volume changes that occur in the legs. During this test, a blood pressure cuff is placed on the arm and multiple cuffs are placed on the legs. The cuffs are inflated slightly while the patient is lying down. As blood pulses through the arteries, the blood vessels expand, causing an increase or decrease in the volume of air within the cuff. A recording device displays these pulse volume changes as a waveform on a monitor. Blood pressures are measured before and after exercise on a treadmill and help define if the pain is due to PAD or other causes. The PVR test also helps locate the area of blockages in the legs.
A vascular ultrasound is a noninvasive test used to examine blood circulation. During a vascular ultrasound, a transducer (small hand- held device) is placed on the skin over the artery to be examined. The transducer emits sound waves that bounce off the artery. These sound waves are recorded, and an image of the vessel is created and displayed on a monitor. This test may be used to detect a blockage in an artery.

Overview

Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication).

Peripheral artery disease is also likely to be a sign of a more widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.

You often can successfully treat peripheral artery disease by quitting tobacco, exercising and eating a healthy diet.

Symptoms

While many people with peripheral artery disease have mild or no symptoms, some people have leg pain when walking (claudication).

Claudication symptoms include muscle pain or cramping in your legs or arms that's triggered by activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common location.

The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe claudication can make it hard for you to walk or do other types of physical activity.

Peripheral artery disease symptoms include:

Painful cramping in your hip, thigh or calf muscles after certain activities, such as walking or climbing stairs (claudication)
Leg numbness or weakness
Coldness in your lower leg or foot, especially when compared with the other side
Sores on your toes, feet or legs that won't heal
A change in the color of your legs
Hair loss or slower hair growth on your feet and legs
Slower growth of your toenails
Shiny skin on your legs
No pulse or a weak pulse in your legs or feet
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If peripheral artery disease progresses, pain may even occur when you're at rest or when you're lying down (ischemic rest pain). It may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

When to see a doctor

If you have leg pain, numbness or other symptoms, don't dismiss them as a normal part of aging. Call your doctor and make an appointment.

Even if you don't have symptoms of peripheral artery disease, you may need to be screened if you are:

Over age 70
Over age 50 and have a history of diabetes or smoking
Under age 50, but have diabetes and other peripheral artery disease risk factors, such as obesity or high blood pressure

Causes

Peripheral artery disease is often caused by atherosclerosis. In atherosclerosis, fatty deposits (plaques) build up in your artery walls and reduce blood flow.

Although the heart is usually the focus of discussion of atherosclerosis, this disease can and usually does affect arteries throughout your body. When it occurs in the arteries supplying blood to your limbs, it causes peripheral artery disease.

Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure.

Risk factors

Factors that increase your risk of developing peripheral artery disease include:

Smoking
Diabetes
Obesity (a body mass index over 30)
High blood pressure
High cholesterol
Increasing age, especially after reaching 50 years of age
A family history of peripheral artery disease, heart disease or stroke
High levels of homocysteine, a protein component that helps build and maintain tissue

People who smoke or have diabetes have the greatest risk of developing peripheral artery disease due to reduced blood flow.

Complications

If your peripheral artery disease is caused by a buildup of plaques in your blood vessels (atherosclerosis), you're also at risk of developing:

Critical limb ischemia. This condition begins as open sores that don't heal, an injury, or an infection of your feet or legs. Critical limb ischemia occurs when such injuries or infections progress and can cause tissue death (gangrene), sometimes requiring amputation of the affected limb.
Stroke and heart attack. The atherosclerosis that causes the signs and symptoms of peripheral artery disease isn't limited to your legs. Fat deposits also build up in arteries supplying your heart and brain.

Prevention

The best way to prevent claudication is to maintain a healthy lifestyle. That means:

Quit smoking if you're a smoker.
If you have diabetes, keep your blood sugar in good control.
Exercise regularly. Aim for 30 minutes several times a week after you have gotten your doctor's OK.
Lower your cholesterol and blood pressure levels, if applicable.
Eat foods that are low in saturated fat.
Maintain a healthy weight.

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