What is peripheral artery disease? — Peripheral artery disease (PAD) is a condition that can cause leg pain that is worse with activity. Muscle pain that is worse with activity and better with rest is called “claudication.” PAD involves blood vessels called “arteries” that bring blood to the legs.
Normally, blood flows easily through arteries to all parts of the body. But sometimes, fatty clumps called “plaques” build up inside the walls of arteries (figure 1). Plaques can cause arteries to become narrow or blocked. This prevents blood from flowing normally. When muscles do not get enough blood, symptoms can occur.
Some people have a greater chance of getting PAD, such as those who:
- Have diabetes
- Have high cholesterol
- Have high blood pressure
What are the symptoms of PAD? — PAD often causes pain in the back of the lower leg. The pain is usually worse with walking and exercise, and gets better with rest. PAD can also cause pain in the feet, thighs, or buttocks. People who have leg pain can have other symptoms, too, such as:
- Trouble walking up stairs
- Trouble getting an erection (in men) or trouble with sexual arousal (in women)
Symptoms of PAD can be mild or severe, depending on:
- Which arteries are affected
- How narrow the arteries are
- How much activity a person does
Is there a test for PAD? — Yes. Your doctor or nurse can do different tests to make sure that you have PAD, and to check if your PAD is mild or severe. He or she might:
- Take the blood pressures in your arm and ankle at rest and with exercise, and compare them
- Take the blood pressures in your thigh or lower leg
- Order an ultrasound, CT scan, or other imaging test – Imaging tests create pictures of the inside of the body.
How can I help treat my PAD? — To help treat your PAD and prevent it from getting worse, you can:
- Stop smoking
- Get your diabetes, high blood pressure, and high cholesterol under control (if you have these conditions)
- Exercise – Doctors recommend that most people with PAD exercise each day. Ask your doctor or nurse which type of exercise is right for you.
What other treatments might I have? — Along with exercise and getting medical conditions under control, most people are treated with medicines. Doctors can try different types of medicines to reduce symptoms and increase blood flow to the legs. Medicines can also help people walk farther without having pain. Most doctors prescribe a medicine called cilostazol (sold as Pletal®) at first. But people who have certain heart problems cannot take cilostazol. They will need to take a different medicine.
If you have severe PAD or if you still have symptoms after taking medicines, your doctor will talk with you about the possibility of having a procedure. Different types of procedures can be done to increase blood flow to the legs and feet. Procedures can include:
- Angioplasty and stenting – A doctor will use a small needle to put a wire into a blood vessel in the groin area. For angioplasty, a doctor threads a deflated balloon over the wire to the narrowed or blocked area. Once there, he or she inflates the balloon. This opens the blood vessel. The balloon is then deflated and removed. A stent is a wire mesh tube that stays in the body. It is used to keep the opened vessel from closing again.
- Surgery – A doctor can do surgery, called “bypass,” that creates a way for blood to flow around the blocked artery. During bypass, a doctor sews a tube called a “graft” around the blocked artery. A graft can be a vein from another part of the body, or it can be manmade.
What should I know about the different procedures? — Angioplasty and stenting are used to treat 1 or 2 blocked areas. Surgery works best to treat more than 2 blocked areas. People who have the fewest long-term problems after bypass surgery include those who are younger than 70, do not have diabetes, and do not have PAD below the knee.
Your doctor might recommend a procedure for you, depending on your symptoms, age, and medical problems. But many people can choose which procedure to have. If your doctor offers you a choice, ask:
- What are the benefits of each procedure for me?
- What are the downsides of each procedure for me?
- What happens if I do not have any procedure?