Hi, I'm Cathy with Level Up RN. In this episode of Ask a Nurse, I'll be answering your questions about peripheral artery disease or PAD, such as, "What is peripheral artery disease? What are the symptoms of peripheral artery disease? And how is peripheral artery disease diagnosed and treated?" Peripheral artery disease or peripheral arterial disease, as it is also called, is a condition where there is impaired blood flow to the legs. This is most commonly caused by atherosclerosis, which is the buildup of plaque on the inner lining of the arteries. This buildup of plaque causes the arteries to become narrowed, which means the legs are getting less blood and less oxygen. Risk factors for peripheral artery disease include smoking, high blood pressure, diabetes, obesity, high cholesterol, older age, and a family history of PAD. In addition, African Americans are at higher risk for PAD and are more likely to experience complications of PAD.
Many people with peripheral artery disease do not have any symptoms. When symptoms are present, the most common symptom is pain or cramping in the legs that occurs with walking or exercise and goes away after a few minutes of rest. So this type of pain that occurs with exercise and that goes away with rest is called intermittent claudication. Other symptoms of PAD include numbness or a feeling of pins and needles in the legs, skin that appears pale or bluish in color and is cool to the touch, decreased leg hair and toenails that are thick and stop growing, and sores or wounds on the toes, feet, or legs that heal slowly or don't heal at all.
In terms of diagnosis, your provider will obtain information about your symptoms, medical history, and family history and perform a physical exam. When peripheral arterial disease is present, blood pressure will be decreased in the affected leg, and pulses will be weaker or absent in the affected leg as well. In addition, when the provider uses a stethoscope to listen to the artery in the leg, an abnormal whooshing sound may be heard, which is called a bruit, which indicates that blood flow is impaired in the leg. Diagnostic tests that may be performed include an ankle-brachial index or ABI test, which compares the blood pressure in the ankles to the blood pressure in the arms. An ABI less than 0.9 is indicative of PAD, and an ABI less than 0.4 is indicative of severe PAD. Other tests that may be ordered include a Doppler ultrasound, which is used to locate areas of decreased blood flow and measure how fast blood is flowing through the arteries. In addition, magnetic resonance angiography or CT angiography may be ordered to determine the location and severity of artery blockages.
Treatment of peripheral artery disease includes lifestyle changes, medications, and surgery. In terms of lifestyle changes, your provider will likely recommend that you stop smoking, eat a heart-healthy diet, lose weight if applicable, and manage your stress levels. In addition, a supervised or home-based exercise program may be recommended with the goal of reducing your symptoms, improving the circulation in your legs, and improving your ability to walk or go about your daily activities. This type of exercise program often involves walking to the point of pain, stopping for a brief rest, and then walking again once the pain subsides. But definitely check with your provider before starting any kind of exercise program. Medications that may be prescribed to treat PAD and prevent complications include antiplatelets and anticoagulants. Cilostazol is one type of antiplatelet that can help reduce symptoms of PAD by dilating or widening the arteries in the legs. Other medications that may be prescribed include statins to lower cholesterol levels, as well as medications to treat high blood pressure and/or diabetes.
If lifestyle changes and medications are not effective, there are procedures and surgeries used to treat PAD. One procedure is an angioplasty where a small balloon is inflated in the artery to flatten the plaque and a stent is placed to hold the artery open. In severe cases, bypass surgery is another option. During this surgery, the surgeon uses a blood vessel from your body or an artificial vessel to divert blood flow around the blocked artery. Peripheral artery disease can lead to a number of complications, including serious infections in the feet and legs that can spread to the bloodstream as well as tissue death, which may require amputation. In order to prevent these complications, it's important to tell your provider if you are having any symptoms of PAD that I shared earlier. And if you are diagnosed with PAD, it's important to adhere to your treatment plan, including medications and lifestyle changes in order to reduce the risk of infection and amputation.
That's it for this episode of Ask a Nurse. I hope it was helpful. If so, be sure to hit that like button. And if you have a health topic or question you'd like me to cover in a future episode, then definitely leave that in the comments. Stay informed and stay well.
