Peripheral arterial disease (PAD)

What is peripheral arterial disease?

Peripheral arterial disease (PAD) is a condition where there's a build-up of fatty deposits made of cholesterol and other waste substances in your arteries. This narrows the arteries and limits the amount of blood supply that can reach the leg muscles.

This is called atherosclerosis, and it's the same process that happens in the heart with coronary heart disease.

You may also hear PAD called peripheral vascular disease or peripheral artery disease.

Peripheral arterial disease symptoms

While some people with PAD get no symptoms, those who do usually find their legs are affected.

'Intermittent claudication' is a common symptom where you experience pain in your legs when you're walking. The pain may feel like a cramp, and it can range from being mild to severe, but it usually eases after a few minutes' rest.

Other symptoms may include:

• Numb or weak legs

• Pale or blue skin on your legs

• Hair loss on your legs

• Brittle toenails

In severe cases, it can also cause the following problems to your feet:

• Pain

• Ulcers

• Gangrene

Many people dismiss leg pain during exercise, but it's worth getting it checked by your doctor if you experience this regularly.

Peripheral arterial disease risk factors

The following factors can increase your risk of developing PAD:

• Smoking

• Diabetes

• High blood pressure

• High cholesterol

• Older age

Diagnosis for peripheral arterial disease

PAD is usually diagnosed by checking symptoms, doing a physical examination and taking an ankle-brachial pressure index (ABPI) score.

The ABPI test checks whether your circulation is healthy by measuring your blood pressure in your ankles and your upper arms with a Doppler probe. This is a handheld ultrasound device that measures blood flow in the arteries. The doctor might ask you to exercise on a treadmill or an exercise bike first so they can see how this affects your circulation.

In healthy circulation, both readings should be the same or very close. In PAD, the ankle's blood pressure reading will be lower, indicating a lack of blood supply in this part of the body.

If it's still unclear whether you have PAD, you may need further tests. These could include:

• Ultrasound – A scan that uses sound waves to get a picture of the arteries in your legs.

• Angiogram, CT scan and MRI scans – In an angiogram, a liquid is injected into a vein in your arm. You then have a CT scan or MRI scan to show up the liquid, giving a detailed image of the arteries.

Peripheral arterial disease treatment

While there's no cure for PAD, a combination of medication and making changes to your lifestyle usually helps to control the symptoms and reduce your risk of other cardiovascular diseases, like a heart attack or stroke. In rare cases, doctors may recommend surgery.

Medication

You may need to take one or more of the following medications:

• Antihypertensives – To treat high blood pressure. If these cause severe and persistent side effects, an angiotensin-2 receptor antagonist may be recommended instead.

• Statins – Help lower the level of low-density lipoprotein (LDL) cholesterol – also known as 'bad cholesterol' – in the blood.

• Blood-thinning medicine – PAD puts you at higher risk of developing a blood clot inside an artery that supplies the heart, which can lead to a heart attack or stroke. Blood-thinning medicines help to thin the blood and reduce the risk of clotting.

• 5HT2 receptor antagonists – If your leg pain is triggered by exercising, this medicine can improve blood flow in the legs.

Lifestyle changes

Making positive changes to your lifestyle can have the most significant impact on your health and your recovery.

The following self-help measures could make a real difference to your PAD symptoms and also help to lower your risk of developing other health complications:

• Exercise regularly – Research shows this has a positive impact on PAD symptoms.

• Stop smoking – People who stop smoking after being diagnosed with PAD are less likely to have a heart attack. They are also less likely to die from a heart disease complication than people who carry on smoking.

• Eat a healthy diet that's low in saturated fat

• Maintain a healthy body weight

• Limit the amount of alcohol you drink

Surgery

If other treatment doesn't help or your leg pain is so bad it affects your daily life, revascularisation surgery may be recommended to improve blood flow in the arteries in your legs.

The two types of revascularisation surgery are:

• Angioplasty – This procedure uses a small balloon to push the arteries' walls outwards and improve the blood flow.

• Artery bypass graft – This involves using a blood vessel from elsewhere in your body to bypass (or get around) the part of the coronary artery that's too narrow.