Trouble Walking May Be Sign of Peripheral Arterial Disease

What is PAD?

Peripheral arterial disease (PAD) is narrowing of the arteries in the arms, legs or abdomen. The narrowing is caused by the build up of plaque on the inside walls of the arteries. (Plaque is made up of excess cholesterol and other substances in your blood.) This results in reduced blood flow to your muscles and organs.

PAD can be a sign that there is plaque buildup in arteries throughout your body (atherosclerosis). Atherosclerosis can cause reduced blood flow to your heart (coronary artery disease). Plaque buildup to the arteries flowing to your brain can cause a stroke.

At first, people with PAD may not have symptoms. Over time, you can get pain in your calves and legs when walking ("intermittent claudication"). This can be treated with medication or surgery. More blockages can form, further cutting off blood supply. Poor circulation can cause foot sores. At this point, there is a risk of gangrene (dead tissue), which may require amputation.

Plaque can also block flow to the kidneys and cause severe high blood pressure that won't respond to medication. Below the kidneys, gritty calcium deposits can form in the wall of the aorta. The damaged wall may balloon out. This can cause an aneurysm, which may bleed suddenly.

Risks factors for PAD

Many people with PAD in their legs don't even know it. This is because the blockages aren't large enough to cause symptoms. Risk factors are:

• Diabetes
• High cholesterol
• Smoking
• Age 50 years or older
• History of heart disease, stroke or atherosclerosis

Clues that kidney arteries are blocked

This type of PAD often goes undetected. It is silent and leads to gradual kidney failure. Risk factors include:

• High blood pressure before age 30 or severe high blood pressure after age 55
• Severe high blood pressure that doesn't respond to medication

Prevention and treatment

If you smoke, ask your doctor for information on quitting. If you have high cholesterol, you may be placed on a low-fat diet and cholesterol-lowering medication. If you have diabetes, work on lowering your hemoglobin A1c to less than 7 percent. Your blood pressure should be lower than 120/80.

Treating claudication

Your doctor may prescribe medication to help you walk farther. Also, several procedures can help improve the blood flow to your legs:

• Angioplasty: A tiny balloon is passed into the artery, widened to expand the blockage, and then removed.
• Stent: A wire mesh is put in place to keep the plaque area open.
• Bypass surgery: A graft is used to re-route your blood flow, restoring circulation to your limb. Grafts are made from synthetic material or can come from your own vein.

What you can do about PAD:

• Tell your doctor. If you have pain in your calf when you walk, a major leg artery may be blocked.
• Stop Smoking. Smokers are more likely to develop PAD than non-smokers. PAD advances quickly in smokers and is more difficult to treat if they continue smoking.
• Control your cholesterol. The same healthy diet that protects you against heart disease and stroke can also prevent PAD.
• Exercise. Walking 30 to 50 minutes per day, three to five days a week helps reduce claudication. It also reduces your risk for heart disease.
• Keep your blood sugar under control if you have diabetes. Diabetes can cause plaques to form more quickly in your arteries. Keep your blood sugar as close to normal as possible.
• Keep your blood pressure under control.

Related Articles Are You a Candidate for AAA Screening?

External Sources Hirsch, A. T., Haskal, Z. J., Hertzer, N. R., et. al. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity renal, mesenteric and abdominal aortic). Journal of the American College of Cardiology. 2006. Stewart, K. D., Hiatt, W. R., Regensteiner, J. G., Hirsch, A. T. Exercise training for claudication. New England Journal of Medicine. 2002; 347:1941-1951. Vascular Disease Foundation National Heart, Lung, and Blood Institute National Workshop on PAD

This article was reviewed and updated June 2007.

Search