Peripheral arterial disease (PAD) is a common circulatory problem in which narrowed arteries reduce the blood flow to your extremities; most often the lower extremities. The most common cause of this narrowing is fatty deposits (atherosclerosis) accumulating in the walls of the arteries. As deposits continue to build within the arterial wall, the internal diameter of the vessel decreases, blockage results, and the blood flow to the extremity is jeopardized. Once the artery becomes narrowed, the sluggish flow of blood may result in clots forming completely shutting off the blood flow to an area. This may become an emergency situation. Another concern is that peripheral arterial disease is likely to be a sign of widespread accumulation of fatty deposits in your other arteries. This condition may also be reducing blood flow to your heart and brain. This may then result in heart attacks and strokes.

Atherosclerosis is a degenerative disease of the arteries resulting in plaques consisting of necrotic cells, lipids, and cholesterol crystals. Scientists think the disease starts when the very inner lining of the artery (the endothelium) is damaged. High blood pressure, high levels of cholesterol and triglycerides in the blood, and smoking are believed to lead to the development of plaque.

About half of people with peripheral arterial disease have mild or no symptoms. About one-third to one-half develop more severe symptoms, including intermittent claudication. Intermittent claudication is characterized by muscle pain or cramping in your legs or arms that is triggered by a certain amount of activity, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is the most common area of intermittent claudication. The severity of pain varies widely. Pain from this condition can range from mildly bothersome to debilitating. Severe intermittent claudication can impair your ability to function and engage in any physical activity. It may interfere with the ability to do your job. Risk factors are similar to those for coronary artery disease and include family history, age over 50, smoking, hypertension, hyperlipidemia, diabetes, and smoking.

Other signs and symptoms of peripheral arterial disease include:

• Leg numbness or weakness
• Cold legs or feet
• Sores on your toes, feet or legs that won't heal
• A change in the color of your legs
• Hair loss on your feet and legs
• Changes in your nails

Sometimes, peripheral arterial disease progresses, and pain may begin to occur when you're at rest or when you're lying down. This is called ischemic rest pain. This is a more serious condition and suggests a higher risk of limb loss due to gangrene.  Rest pain may be intense enough to prevent sleep or to wake you from sleep. You may be able to temporarily relieve the pain by hanging your legs over the edge of your bed or by walking around your room. If you are worried about peripheral arterial disease, contact your physician. Rest pain should lead you to seek more urgent medical attention. Early diagnosis and treatment of PAD is important not only to preserve the health of your limbs, but also to decrease your risk of heart disease, stroke, and other medical conditions.

If you are worried that you are suffering from peripheral arterial disease, then seek medical attention. Your practitioner may find signs of PAD during a physical examination. These include:

• A weak or absent pulse below a narrowed area of your artery
• Whooshing sounds (bruits) over your arteries that can be heard with a stethoscope
• Evidence of poor wound healing in the area where your blood flow is restricted
• Decreased blood pressure in your affected limb

The next step in diagnosis usually involves an arterial duplex evaluation. Duplex ultrasonography is performed to provide an overview of the location, extent, and severity of vascular disease. The ultrasound evaluation can begin at the level of the aorta and continue all the way to the vessels of the foot to help facilitate clinical management decisions. The duplex ultrasound can provide two-dimensional structure and motion evaluation as well as velocity spectral analysis to help aid the physician in determining the extent of the disease.

Once peripheral arterial disease is diagnosed, then a more specific test is necessary to accurately identify the location of the diseased blood vessel. This can be done with CT angiography or arteriography. CT angiography has become more successful over the last few years.  This has been made possible with the development of more powerful computers and helical multidetector CT equipment.  CT angiography is now replacing conventional angiography for diagnostic applications throughout the body.  Macon CardioVascular Institute has a powerful helical multidetector CT scan in the office for your convenience. CT angiography allows accurate and beautiful 3D assessment of peripheral vascular disease, with less artifacts than with magnetic resonance angiography, particularly in visualization of distal vessels.

Conventional angiography remains important for therapeutic interventions such as angioplasty, arterial stenting, and thrombolysis.

Treatment for PAD has three major goals. The first is to manage symptoms, such as leg pain, so that you can resume physical activities. The second is to lower the risk of limb loss by amputation if the disease progresses. The third goal is to stop the progression of atherosclerosis throughout the rest of your body to reduce your risk of heart attack and stroke.

You may be able to accomplish these goals with lifestyle changes. If you smoke, quitting is the single most important thing you can do to reduce the progression of the blockage and reduce your risk of complications. Begin a regular program of exercise, after first consulting with your doctor to help relieve leg pain.

If lifestyle changes are not enough, you will need additional medical treatment. Your doctor may prescribe medicine to prevent blood clots, lower blood pressure, lower cholesterol and triglyceride levels, control pain and other symptoms. Antiplatelet therapy may be necessary to lower your risk of heart attack or stroke.

Intervention procedures such as balloon angioplasty with or without stent placement and bypass surgery may be needed to relieve the symptoms of PAD and prevent amputation. Angioplasty usually offers the the advantage of a shorter hospital stay and a faster recovery. It may be repeated if necessary and maintains the option of bypass surgery as a later procedure. Results are best with short segment disease of larger vessels that are narrowed instead of completely occluded. The procedure is limited in those with abnormal renal function since the contrast dye used for the arteriogram may damage the kidneys.

Surgery is the appropriate option for patients with severe cases of PAD. One surgical option is endarterectomy. During this procedure, the surgeon cleans out the plaque buildup inside the artery. The blood vessel is then usually closed with a patch, allowing the vessel diameter to be increased and improve blood flow to the extremity.

Increasingly, combined surgical bypass and percutaneous endovascular intervention procedures are being done to optimize patient outcome while minimizing morbidity.

With angioplasty and stenting, patients are usually given a mild sedative during the procedure. They may be discharged home the same day as the procedure or spend one night and go home the next morning. Most patients are able to resume normal activities when they get home after an endovascular procedure.