Everything You Need to Know About Peripheral Artery Disease (PAD)

Peripheral Artery Disease (PAD) is a common yet often overlooked circulatory condition that affects millions of people worldwide. It occurs when the arteries that supply blood to your limbs, particularly the legs and feet, become narrowed or blocked due to atherosclerosis—the buildup of fatty deposits (plaques) in the artery walls. When blood flow to the feet is restricted, it can lead to a variety of symptoms, primarily because the tissues in the feet are not receiving adequate oxygen and nutrients.

Some of the most common symptoms include:

• Leg pain/cramping: Many people with PAD experience pain or cramping in their legs or feet, particularly during activities like walking or climbing stairs. This symptom, known as intermittent claudication, usually eases with rest.
• Coldness in the feet: One of the noticeable symptoms is the sensation of coldness in the feet. This occurs due to reduced blood flow, which limits the delivery of warm, oxygen-rich blood to the extremities.
• Skin changes: You may notice a pale or bluish discoloration of the skin, particularly on the toes and feet. This condition, known as cyanosis, occurs when blood flow is insufficient to supply adequate oxygen, leading to a lack of colour in the skin. Additionally, the skin may take on a shiny appearance, indicating that the underlying tissues are not receiving the necessary nutrients and oxygen to maintain their normal condition.
• Slow healing wounds: One of the most concerning complications of Peripheral Artery Disease (PAD) is the slow healing of cuts, sores, or wounds on the feet. When blood supply is inadequate due to narrowed or blocked arteries, the body struggles to deliver the essential nutrients and oxygen required for effective wound healing. This impaired healing process can result in minor injuries taking much longer to recover, or, in some cases, not healing at all. This is a significant concern, as untreated wounds can lead to infections or even gangrene.
• Weak or absent pulses: During a medical examination, a healthcare provider may assess the pulses in the feet and legs to evaluate blood flow. In individuals with Peripheral Artery Disease (PAD), the provider may detect weak or even absent pulses, which serve as critical indicators of compromised circulation.

If you have noticed any of the above symptoms, we highly advise that you book an appointment with Thames Foot Clinic as soon as possible for a thorough assessment.

Risks and complications

If left untreated, PAD can lead to severe complications, including:

• Critical Limb Ischemia (CLI): This severe form of PAD occurs when blood flow to the legs and feet is severely reduced, leading to constant pain, non-healing wounds, or gangrene. If untreated, CLI may require surgical interventions such as bypass surgery, angioplasty, or even amputation to prevent life-threatening infections.
• Increased risk of heart disease and stroke: PAD is often a sign of widespread atherosclerosis, meaning plaque buildup not only affects the legs but also the arteries leading to the heart and brain. This significantly raises the risk of heart attacks and strokes. Individuals with PAD are two to four times more likely to experience these cardiovascular events.

Other risks include poor wound healing, chronic ulcers, infections, and blood clots, all of which require early intervention to prevent serious outcomes. Effective management through lifestyle changes, medications, and, in some cases, surgery can greatly reduce these risks.

Diagnosis and treatment of Peripheral Artery Disease (PAD)

Diagnosis

The diagnosis of PAD typically begins with a comprehensive physical examination and a review of your medical history. Your healthcare provider will check for weak pulses, listen for abnormal sounds in your arteries (bruits), and inspect your legs and feet for any signs of poor circulation, such as skin discoloration or non-healing wounds.

• Ankle-Brachial Index (ABI): One of the most common diagnostic tests for PAD is the Ankle-Brachial Index (ABI). This simple, non-invasive test measures blood pressure in the ankles and compares it to the blood pressure in the arms. A significant difference between the two can indicate reduced blood flow to the legs, confirming the presence of PAD.
• Additional Testing: In more advanced cases, your doctor may order imaging tests such as Doppler ultrasound, angiography, or magnetic resonance angiography (MRA) to get a detailed view of your blood vessels and pinpoint areas of blockage or narrowing.

Treatment options

Depending on the severity of your condition, treatment options may include:

Lifestyle changes

• Quit smoking: Smoking significantly worsens PAD by constricting blood vessels and promoting plaque buildup, therefore, it is the best step you can take to slow the progression of PAD.
• Heart-healthy diet: Adopting a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can help reduce cholesterol levels and improve overall vascular health.
• Exercise: Engaging in regular physical activity can help increase circulation to the legs, reduce pain, and improve mobility, as well as strengthening the cardiovascular system.

Medications

Medications such as cilostazol and pentoxifylline may be prescribed to improve blood flow to the legs and reduce claudication (leg pain during activity). Statins and antihypertensive drugs on the other hand, can help lower cholesterol levels and control blood pressure, reducing the risk of further artery narrowing. Aspirin may be prescribed to reduce the risk of blood clots, which can block already narrowed arteries and lead to more serious complications.

Surgical procedures

In more severe cases of PAD, when lifestyle changes and medications are not enough, surgical procedures may be necessary to restore blood flow. Common surgical treatments include:

• Angioplasty: A minimally invasive procedure where a small balloon is inserted into the narrowed artery and inflated to open the artery and improve blood flow. A stent (a small mesh tube) may also be placed to keep the artery open.
• Bypass surgery: In this procedure, the surgeon creates a new pathway for blood flow around the blocked artery using a graft (a blood vessel from another part of your body or a synthetic tube). This can help restore circulation to the affected areas of the legs and feet.