Vascular Disease

Causes

PAD is most often caused by a narrowing of blood vessels. The narrowing is often caused by a buildup of plaque called atherosclerosis. The buildup occurs over long periods of time and is increased with:

• High blood pressure
• High cholesterol
• Diabetes
• Smoking

This buildup happens in blood vessels all over the body. It may mean there is an increased risk of heart disease or stroke. PAD may be first sign of atherosclerosis.

Blood clots and swelling can also narrow blood vessels. These may be caused by medical issues or treatment.

Atherosclerosis

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Risk Factors

PAD is more common in men and in people over 50 years of age. Other things that may raise the risk of PAD are:

• A family history of PAD
• Diabetes
• Smoking
• A personal or family history of heart or blood vessel problems, such as:
• High blood pressure
• Stroke
• High cholesterol
• Coronary artery disease (CAD)
• Obesity
• High levels of homocysteine
• HIV infection

Symptoms

Symptoms of PAD will depend on the area most affected. Common symptoms are:

• Pain, fatigue, aching, tightness, weakness, cramping or tingling in the leg(s) that is:
  • Brought on by exercise
  • Goes away when resting
• Numbness and pain of the legs or feet at rest
• Cold hands, legs, or feet
• Loss of hair on the legs and/or feet
• Paleness or blueness of the legs
• Weak or absent pulse in the leg
• Sores, ulcer, or infection of the feet and legs that heal slowly
• Erectile dysfunction

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done.

During the exam, the doctor may:

• Check the strength of the pulse in the legs
• Use a stethoscope to listen for abnormal sounds in leg arteries or the abdomen
• Check blood pressure in the leg

If the doctor suspects a change in blood flow, other tests may be done to confirm the change or look for causes. Pictures of blood vessels can be taken with:

• Doppler ultrasound
• Angiography
• MRI scan

A person's heart activity may need to be tested. This can be done with an ECG.

Treatment

Early treatment can slow or stop the disease. Treatment options include:

Lifestyle Changes

Certain lifestyle changes can improve the health of the heart and blood vessels. Steps that may help slow or even reverse PAD include:

• Carefully manage related medical conditions such as:
  • High blood pressure
  • High cholesterol
  • Diabetes
• Increase physical activity—such as a walking program
• Quit smoking
• Eat a heart healthy diet—one that is low in saturated and trans fats and high in vegetables an fruits

Medicine

Medicines that may help blood flow include:

• Blood thinners to reduce blood clots
• Statins to lower cholesterol
• Vasodilators to widen arteries

Pain medicine may also be needed to help ease discomfort.

Procedures

If blood flow is very poor, a procedure may be needed to quickly increase blood flow. Options include:

• Balloon angioplasty—a balloon is passed into the artery to flatten the plaque and improve blood flow
• Stent implant—a wire mesh tube is placed in the artery to help keep it open
• Laser treatment
• Atherectomy—a tube called a catheter is used to remove plaque inside a blood vessel

Surgery

Surgery may be needed to open arteries that are severely blocked. Options include:

• Endarterectomy—the lining of the artery is removed, along with plaque build up
• Bypass surgery—a vein from another part of the body or a graft is used to send blood flow around the blockage

Prevention

A heart healthy lifestyle can decrease the risk of PAD. General steps include:

• Regular physical activity—aim for 30 to 45 minutes most days
• Eating a healthful diet
• Reaching and keeping a healthy weight
• Following diabetes care plan for those who have it
• Quitting or not starting smoking or vaping
• Working with the care team to manage any related conditions