Peripheral arterial disease (PAD) is a condition in which arteries become narrowed, blocking circulation and potentially causing serious damage. This can happen in the arteries that supply blood to the abdominal organs, such as the intestines and kidneys, as well as the arteries of the arms and especially the legs and feet. People with diabetes have a higher risk of developing PAD than people who don’t have diabetes. But the good news is that keeping blood glucose levels as close to the normal range as possible and maintaining a healthy lifestyle can do a lot to prevent it — and to improve your cardiovascular health in general. How much do you know about PAD? Take this quiz and find out! (You can find answers later in the article.)
1. Narrowing of the leg arteries can cause which of the following symptoms? (More than one answer may be correct.)
A. Pain in the legs or feet.
B. Dizziness and nausea.
C. Temperature or color changes in the legs or feet.
D. Slow-healing sores.
2. Damage caused by PAD is always permanent.
3. Which of the following are risk factors for PAD? (More than one answer may be correct.)
A. A history of smoking.
B. High blood pressure.
C. High cholesterol.
4. It is possible to have PAD but to have no symptoms of it.
5. PAD can be treated in which of the following ways? (More than one answer may be correct.)
A. Herbal remedies.
B. Oral medicines.
D. Lifestyle changes.
1. A, C, and D. The symptoms of PAD in the legs vary from one person to the next and can change over time. They can include pain in the thighs, buttocks, or calves while walking that is relieved by rest. Decreased circulation to the legs can contribute to poor healing of sores on the feet and legs. Poor circulation can also give a dusky color to the feet and cause decreased hair growth on the feet and legs. While cold feet can be caused by poor circulation, there is a lot of variability in normal foot temperature from person to person, and this symptom alone is usually not very reliable. However, if you notice that the usual temperature of your feet has significantly changed, talk to your doctor.
Dizziness and nausea are not symptoms of PAD.
2. FALSE. The blockage of the large blood vessels that is the cause of PAD is one of the possible results of atherosclerosis (the buildup of plaque, or fatty deposits, in the arteries). While PAD is usually a progressive disease that often must be treated with bypass surgery or angioplasty, management of cholesterol, blood pressure, and blood glucose levels can decrease the disease’s rate of progression. In addition, when the arteries are narrowed but not completely blocked, exercise stimulates growth of small blood vessels to compensate for decreased blood flow and can lead to improvement of circulation and, consequently, symptoms.
3. A, B, and C. Cigarette smoking, high blood pressure, and high cholesterol are all associated with increased risk of developing PAD. Quitting smoking and treating high blood pressure and high cholesterol with medicines, exercise, and/or dietary changes can significantly reduce the risk of developing PAD or worsening of the disease in people who already have it.
There is no evidence that neuropathy is a risk factor for PAD.
4. TRUE. The symptoms of PAD generally start only after significant narrowing of the arteries has developed. In the initial stages, there are usually no symptoms at all. However, there are screening tests that can reveal slowed blood flow or blockages in major arteries. Your doctor should check the pulses in your feet and legs regularly; if they are weak or absent, it’s a good indication of circulatory problems. There are also several tests that measure the blood flow to the legs and can detect an obstruction in the blood vessels there. A measure of the ankle–brachial index (ABI), or the ratio between the blood pressure of your ankle and your arm, can indicate PAD. If your ABI is abnormal, your doctor can follow up with ultrasound (which can display images of blocked or diminished blood flow), computed tomography (CT) scanning, or magnetic resonance imaging (MRI). The American Diabetes Association (ADA) recommends that people who have diabetes and are over 50 (or younger, if the person has other risk factors) be screened regularly for PAD, even if they don’t have symptoms.
5. B, C, and D. The main treatment for the narrowing of the arteries that is characteristic of PAD is surgery. Vascular surgeons can perform a bypass, allowing blood to flow around the closed vessel. Another option is to open the vessel with a catheter and a balloon (a procedure called an angioplasty), after which a stent can be inserted to keep it from closing again in the future. Lifestyle changes (including quitting smoking, exercising, and losing excess weight) can help significantly, keeping surgically treated vessels open and keeping minimal PAD from getting worse. While there are no oral medicines that have been shown to be effective at opening blood vessels, several drugs can treat PAD in other ways. After surgery, stenting, or angioplasty, the use of aspirin and other blood thinners can stop the treated vessels from reclosing. Moreover, oral medicines for the treatment of PAD risk factors such as high blood pressure and high cholesterol are useful in preventing and slowing the progression of the disease itself.
No herbal remedies have been shown to treat PAD.
6. A, B, and C. PAD is a manifestation of atherosclerosis; the same process that can cause blockages in the blood vessels in the legs can cause them in the arteries leading to the brain, causing stroke, or the heart, causing heart attack. These conditions have similar risk factors as PAD. PAD can also result in amputation, when the disease has progressed to complete blockage of the vessels in the legs and feet.
Colon cancer is not related to PAD.