Peripheral artery disease (PAD) also known as peripheral arterial disease is a condition in which the narrowing of the peripheral arteries reduce blood flow to the legs. It also restricts blood flow to the arms, kidney and stomach.

The term peripheral in this case means away from the heart. PAD is mostly caused by atherosclerosis which is the narrowing and blockage of arteries in critical areas of the body.

PAD is a major risk factor for stroke and heart attack.

Causes of Peripheral Artery Disease

Atherosclerosis is the major cause of PAD. It is a gradual process in which fatty materials (plaque) build up inside the arteries. Less common causes of PAD include injury to the limbs, blood clots in the arteries and unusual anatomy of the ligaments and muscles.

Factors that increase the risk of developing PAD include smoking, diabetes, high blood pressure, obesity, aging, high cholesterol, excess levels of C-reactive protein or homocysteine and family history of heart disease.

Symptoms of Peripheral Artery Disease

Most individuals with PAD have mild to no symptoms with some of them experiencing claudication which is having leg pain when walking.

Symptoms of claudication include cramping in the limbs which is caused by activities such as walking but it tends to disappear after resting for a few minutes. The location of the pain usually depends on where the narrowed or clogged artery is located.

Possible symptoms of PAD include:

• Leg weakness
• Hair loss on the feet and legs
• Leg numbness
• The lower leg or foot might feel cold
• Slow growth of toenails
• Brittle toenails
• The skin on the legs becomes shinny or turns bluish or pale
• Ulcers or sores on the feet or legs that take a long time to heal or never heal
• Difficulty in finding a pulse in the foot or leg
• Erectile dysfunction

Diagnosis of Peripheral Artery Disease

If the doctor suspects PAD, he/she will first perform a physical examination on the legs and then order tests which include:

• Ankle-brachial index: This test compares blood pressure in the ankle with that of the arms blood.
• Doppler and ultrasound (Duplex) imaging: This is a non-invasive test that can visualize the artery using sound waves and measure the blood flow in an artery so as to indicate the presence of blockage
• Angiography, ultrasound scan and blood tests: These may be recommended to check the levels of homocysteine, cholesterol and C-reactive protein
• Computed tomographic angiography (CT): This is also a non-invasive test that images the arteries in the abdomen, pelvis and legs. This test is mostly used on patients with stents or pacemakers
• Magnetic Resonance Angiography (MRA): Gives the same information as that of the CT scan, but without using x-rays
• Angiography: This involves injecting a contrast agent into the artery and taking x-rays to show the blood flow and pinpoint any blockages that might be present

Treatment of Peripheral Artery Disease

Treatment for PAD focuses on managing the symptoms and stop the progression of atherosclerosis throughout the body.

Treatment for PAD includes medications for:

• Lowering cholesterol
• High blood pressure
• Controlling blood sugar
• Preventing blood clots
• Relieving symptoms

Surgery

In some cases, surgery or angioplasty may be necessary to treat PAD that is causing claudication.

Angioplasty involves threading a catheter through a blood vessel to the location of the affected artery. A small balloon which is on the tip of the catheter is then inflated to reopen the artery and flatten the blockage in the artery wall while stretching the artery open so as to increase blood flow.

Bypass surgery: This involves your surgeon creating a graft bypass using either a blood vessel made from synthetic fabric or from another part of your body. This allows the blood to flow around or bypass the narrowed or blocked artery.

Next Step

At King’s College Hospital Dubai, we focus on offering an exemplary service. From initial consultation through to final diagnosis, treatment and beyond. Our multidisciplinary team of expert doctors, nurses, cardiologists and technologists are here to offer tailored management and treatment of your condition, and to answer any questions that you may have throughout your time with us. Whatever you need us for, we’re only a phone-call away.