What Is Peripheral Arterial Disease?

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What Is Peripheral Arterial Disease?

Do you ever experience cramping leg pain while walking that goes away after a few minutes of resting? It could be a sign of peripheral arterial disease, which can cause a host of problems. The sooner it is diagnosed and treated, the better. Here’s what you need to know.

Causes of peripheral arterial disease

The main cause of peripheral arterial disease (abbreviated PAD and also known as peripheral vascular disease) is atherosclerosis in the arteries in the leg. Atherosclerosis itself is caused by the build-up of a substance called plaque on the inner lining of the arteries. Plaque, a witch’s brew of fat, cholesterol, fibrous tissue, and calcium, can hinder the flow of blood in arteries throughout the body. People with diabetes have an increased risk of developing PAD due to insulin resistance, high blood pressure, and blood lipid abnormalities such as high cholesterol levels. Other risk factors include age (being 65 years old or older), a family history of cardiovascular disease, chronic kidney disease, smoking, not getting enough exercise, high blood pressure, excess weight or obesity, stress, and poor diet (such as one that is high in saturated fat). Certain ethnic groups, such as African Americans and Hispanics, have a higher risk of PAD.

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Signs and symptoms of peripheral arterial disease

The most common symptom of PAD is intermittent claudication, which is cramping pain that occurs when walking or climbing stairs and goes away after a period of rest. The pain is caused by an insufficient supply of oxygen and nutrients from the blood to meet the extra demands of exercise. The pain subsides after rest because the leg’s tissues no longer need as much blood. Although the pain is usually in the calf, it may also occur in the buttocks, thigh, or foot. People may also notice that the foot is pale, discolored, or blue. In severe cases of PAD, the pain occurs even when the leg is at rest.

Sores may develop in the toes, feet, or legs that heal slowly, if at all, and they may become infected. People with diabetes are at increased risk for these infections. They may have diabetic neuropathy, or nerve disease, which may keep them from noticing small injuries to the foot, such as cuts and blisters. Reduced blood flow to the foot also slows healing and the ability to fight infection.

If PAD progresses, it can lead to other serious complications. It may severely reduce mobility, making it difficult to continue normal daily activities. In some cases, a person can develop chronic poor blood flow in the leg, leading to pain even during rest and causing sores and infections to develop. The tissue can develop gangrene (or tissue death), a very serious complication that sometimes requires amputation. If the foot sores become infected, the infection can spread to tissues, muscles, and bone or even get into the bloodstream. The infections can be treated with antibiotics but may require a stay in the hospital to get them under control.
One of the most serious complications of PAD is acute limb ischemia, a sudden decrease in the blood flow to the leg. If you develop any of the symptoms of acute limb ischemia, such as sudden loss of feeling in the foot, a blue or pale foot, or one foot that is colder than the other, call 911 or seek medical attention immediately.

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The Medical Jargon at a Glance

Peripheral arterial disease (PAD)

Caused by atherosclerosis, a condition in which the flow of blood in the peripheral arteries (those that carry blood throughout the body) in the legs or lower extremities is reduced.

Atherosclerosis

The build-up of a waxy substance called plaque, composed of fat, cholesterol, fibrous tissue, and calcium, on the inner lining of arteries. In addition to contributing to peripheral arterial disease, atherosclerosis can lead to heart attack and stroke.

Intermittent claudication

Pain and fatigue of leg muscles, caused by inadequate blood supply, which is brought on by walking and relieved by rest.

Diabetic neuropathy

Nerve damage due to high blood glucose levels caused by diabetes.

Acute limb ischemia

A sudden drop in blood flow to the leg, which requires immediate medical attention.
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Diagnosing peripheral arterial disease

If you have symptoms of peripheral arterial disease, see your doctor. The doctor can rule out other causes for this pain, such as arthritis or a pinched nerve. They can check for weak pulses in your legs and use a stethoscope to listen to the blood flow in your legs. Blood tests may be used to check for abnormal cholesterol, triglycerides (a type of blood fat), and blood glucose levels that might set the stage for atherosclerosis. Another diagnostic test your doctor may use is the ankle-brachial index (ABI). To determine your ABI, the doctor uses a blood pressure cuff to measure blood pressure in both your arm and your ankle and compares the two readings. A low ABI (low blood pressure in the ankle as compared with the arm) suggests that you have poor blood flow to the leg and possible PAD.

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The doctor may use a variety of imaging methods to visualize blood flow in the leg:

  • Doppler ultrasound, which uses sound waves to create visual images, can help locate areas of reduced blood flow or blockages, and measure how fast the blood is flowing.
  • Computer tomography angiography (CTA) involves injecting a special dye and taking X-rays to show the location of any blockages.
  • Doctors use magnetic resonance angiography (MRA) to visualize the structure of the arteries of the leg. Catheter-based angiography involves inserting a thin tube called a catheter into an artery in the groin, guiding it to the area in question, injecting a special dye through the catheter, and taking X-rays.

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Foot Care in People With Diabetes

For people with diabetes and peripheral arterial disease, proper foot care is essential. Poor circulation and loss of feeling in the feet can set the stage for serious complications such as foot ulcers and infection, some of which may eventually require amputation. Here are some steps you can take to protect your feet:

  • Always wear comfortable shoes and socks. Don’t go barefoot!
  • Check your feet every day for injuries or sores that you might not be able to feel.
  • Don’t treat foot problems, even minor ones, yourself. It’s too easy to injure your foot. If you have corns, calluses, or long or ingrown toenails, see your doctor.

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Treatment for peripheral arterial disease

Treatment may begin with lifestyle changes, such as quitting smoking, eating a healthier diet, maintaining a healthy body weight, getting regular physical activity, and learning to manage stress. The doctor may prescribe any number of different types of medications to treat PAD and its complications:

  • Antiplatelet medicines, such as aspirin, clopidogrel, and cilostazol, may help to prevent blood clots and, in some cases, make walking easier.
  • Statins, drugs that lower cholesterol levels, may be used to slow the progression of plaque build-up in the arteries.
  • Certain blood pressure medications may be used to prevent blood vessels from narrowing. Some of the most commonly used of these medications are ACE inhibitors and angiotensin II receptor blockers (ARBs).

If all these measures fail to control PAD adequately, certain medical procedures may be used. Angioplasty is sometimes used to open narrowed or blocked arteries. The doctor inflates a small balloon in an artery to flatten the plaque, and sometimes a tube called a stent is inserted into the artery to prop it open and decrease the chances that it will become narrow again. Another option is bypass surgery, in which the doctor uses another vessel in the leg to create a path (or “bypass”) around the blocked artery.

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Heading off trouble before it begins

You can’t control risk factors like age and ethnicity, but there are measures you can take to lower your risk:

Leg pain from peripheral arterial disease can be a wake-up call to improve your lifestyle. These changes can slow the development of not only PAD but also of many other diabetes complications.

Want to learn more about keeping your feet healthy with diabetes? Read “Tips for Healthy Feet With Diabetes,” “How to Choose Footwear” and “Improving Blood Flow to the Feet.”

Robert S. Dinsmoor

Robert S. Dinsmoor

Robert S. Dinsmoor on social media

A contributing editor at Diabetes Self-Management, Dinsmoor is an award-winning medical journalist who has written hundreds of articles on health and medicine, including dozens related to diabetes.

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