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Peripheral arterial disease

Peripheral arterial disease is a type of cardiovascular disease. It affects the arteries (blood vessels that carry blood from your heart) that supply blood to your legs.

Peripheral arterial disease is also known as peripheral vascular disease. It affects the blood flow from your heart to your muscles. Around two in 10 people aged over 60 have peripheral arterial disease. It's more common in men than in women.

Peripheral arterial disease usually develops when plaques (fatty deposits) build up on the walls of your arteries. This is called atheroma. The fatty deposits cause your arteries to narrow and this reduces the supply of blood to your muscles and tissues. You may get pain when you start to exercise, because the muscles in your leg can’t get enough blood.

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An image showing how peripheral arterial disease affects the arteries

Details

  • Symptoms Symptoms of peripheral arterial disease

    Some people who have peripheral arterial disease have no symptoms, so you may not know that you have the condition. If you have symptoms, the most common is pain (like cramp) in your leg or buttock while walking. This is called intermittent claudication and most often happens in your calf. The pain will come when walking or doing other exercise. It will usually go away quickly when you stop exercising.

    You may also have:

    • numb or cold feet or toes
    • hair loss from your toes, feet or legs
    • sores or wounds on your toes, feet or legs that won't heal

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  • Diagnosis Diagnosis of peripheral arterial disease

    Your GP will ask about your symptoms and your medical history. They’ll also carefully examine your legs and feet to check your blood vessels for signs of the condition.

    They may check your blood pressure and measure the pulse in your groin, knee and foot. You may be advised to have a blood test or an electrocardiogram (ECG). This measures the electrical activity of your heart to see how well it’s working.

    Your GP may compare the blood pressure in your arm and in your ankle. The difference between the measurements can help your GP diagnose peripheral arterial disease.

    Your GP may refer you to see a specialist doctor to confirm your diagnosis. They may advise you to have an imaging test to find out where and how much your arteries are narrowed. Types of imaging tests are given below.

    • An ultrasound scan. This uses sound waves to produce an image of the inside of your body.
    • Angiography. This is a test that uses an injection of a special dye into your blood vessels to make them clearly visible on X-ray images. This may be combined with a CT scan or an MRI scan. A CT scan uses X-rays to make a three-dimensional image of the body or part of your body. An MRI scan uses magnets and radio waves to produce images of the inside of your body.

    You may also be asked to do some exercise, such as walking on a treadmill. This shows your doctor how far you can walk. They may measure the blood pressure in your ankle and arm before and after you exercise.

  • Treatment Treatment of peripheral arterial disease

    Lifestyle changes and treatments aim to stop peripheral arterial disease from getting worse. They can also help to reduce your symptoms.

    Peripheral arterial disease is a type of cardiovascular disease. Having it puts you at higher risk of getting other problems that affect your heart and blood vessels such as heart attack and stroke. Because of this, your GP may also recommend treatments to reduce your chance of developing cardiovascular disease in other areas of your body. Taking steps to reduce your chance of another cardiovascular problem, once you’ve already had one, is called secondary prevention.

    If your condition is getting worse, your doctor may refer you to a vascular surgeon for treatment.

    Self-help

    Healthy changes to your lifestyle can help treat peripheral arterial disease and reduce your chance of getting cardiovascular disease in other areas of your body. Your GP will explain the changes you can make and can give you advice and help with achieving these.

    Changes you can make to your lifestyle are listed below.

    • If you smoke, stop.
    • Increase the amount of physical activity you do.
    • If you have diabetes, make sure that your blood glucose levels are well controlled.
    • If you’re overweight, try to lose weight.

    Try to build up your exercise gradually until you’re doing activities, such as walking, for 30 minutes at least five times a week. There are exercise classes available for people with peripheral arterial disease. Ask your GP about whether these classes are available in your local area.

    Medicines

    To help manage your condition, it’s important to treat any other health problems that may make it worse. So, if you have high cholesterol, high blood pressure, or diabetes, your GP will recommend medications to control these. For example, you may be advised to take medicines called statins to lower your cholesterol. You may also be prescribed an anti-platelet medicine such as clopidogrel to reduce your risk of having a blood clot.

    If you’re getting a lot of pain, your doctor may recommend paracetamol and either weak or strong opioids to help control this. If you take strong opioids, these may make you feel sick or constipated. You may be offered other medicines which can help relieve these symptoms.

    Surgery

    You‘ll usually only be offered surgery if exercise isn't helping your symptoms. Before your surgery, you’ll have an MRI scan. Alternatively, you may have a CT scan.

    There are two different operations to treat peripheral arterial disease. Your surgeon will advise you which type of operation is best for you. This will depend on many factors such as how severe your condition is, if you have any other health conditions and your personal preferences.

    • In an angioplasty, a radiologist or surgeon will insert a catheter (fine tube) with a small balloon on the end into your narrowed artery. He or she will inflate the balloon and then remove it. This will stretch your artery to allow more blood to flow through it. Your radiologist or surgeon may put a stent in the artery. This is a small mesh tube which will hold your artery open.
    • In bypass surgery, your surgeon will create a detour around your affected artery. They will use a healthy blood vessel taken from somewhere else in your body. If it’s not possible to use one of your own blood vessels, a man-made tube will be used instead. This surgery is more risky. You’ll only be offered bypass surgery if your leg pain is severely affecting your day-to-day life.
  • Causes Causes of peripheral arterial disease

    Peripheral arterial disease is usually caused by fatty deposits forming in your arteries (atheroma). You’re more likely to develop peripheral arterial disease as you get older. You’re more at risk if you:

    • smoke
    • have diabetes
    • have high blood pressure
    • eat a lot of high-fat foods (which means you may develop high cholesterol)
    • are obese
    • are physically inactive
  • Complications Complications of peripheral arterial disease

    If you have peripheral arterial disease, you’re at greater risk of developing some other medical conditions. These are described below.

    • There’s a chance you might develop coronary heart disease. This is when the arteries that supply your heart muscle narrow. It may lead to a condition called angina or a heart attack. This happens if the blood vessels that supply your heart are blocked.
    • You may have an increased risk of having a stroke or transient ischaemic attack. This is when an artery to or inside your brain becomes narrowed.

    Critical limb ischaemia

    If you have leg pain when walking (intermittent claudication), there’s up to a one in five chance that your condition will get worse.

    This can lead to serious problems caused by your leg not getting enough blood. This is called critical limb ischaemia and happens for about one or two in every 20 people with intermittent claudication. The main symptom of critical limb ischemia is that your leg becomes painful when you’re resting. If this happens, contact your doctor straight away as you’ll need to have urgent treatment.

    You might get gangrene if you have critical limb ischaemia. Gangrene happens when your leg doesn’t get enough blood supply. This causes pain and the tissue in your leg can die. If you have critical limb ischaemia, you may need to have your leg amputated. This is always a last resort and surgery to try to improve the blood flow will always be considered first.

    If you have any questions, or would like more information about this, speak to your doctor.

  • FAQs FAQs

    Does peripheral arterial disease run in families?

    Answer

    If one of your family members has heart disease, such as coronary heart disease, you may be more likely to develop peripheral arterial disease.

    Explanation

    If you have a family history of heart disease, you may have a greater chance of getting peripheral arterial disease. This might be a parent, brother, or sister for example.

    But your chance of developing peripheral arterial disease is affected by more than just your family history. Your lifestyle is very important and affects your risk of getting the condition. If you have a family history of cardiovascular disease, it’s important that you lower your risk by thinking about your lifestyle. For example, smoking is one of the greatest risk factors for peripheral arterial disease. Giving up smoking is one of the most important things you can do to reduce your risk of getting peripheral arterial disease.

    Is surgery only for people with severe peripheral arterial disease?

    Answer

    Surgery for peripheral arterial disease is usually only considered for people who have found that exercise isn’t helping them. This is because surgery might not work in the long term and comes with some risks.

    Explanation

    You might be recommended to have an angioplasty if your condition isn't improving with exercise. This involves stretching your narrowed artery with a balloon so that more blood can get through it. Angioplasty can help you in the short term, but there’s no proof that it will help you be more active in the long term. Exercise programmes can work just as well as angioplasty, which is why it is only usually used if you have already tried exercise.

    Another operation is an arterial bypass. In this operation, a blood vessel from elsewhere in your body, or a man-made tube, is used to make a detour around your narrowed artery. An arterial bypass will only be recommended for you if angioplasty hasn't worked and you have severe symptoms affecting your daily life. It comes with some risks – for example up to three in every 100 people having an arterial bypass may die in the operation. This is why your doctor will recommend that you try other approaches such as exercise instead of surgery if possible.

    I have peripheral arterial disease. Will it get worse?

    Answer

    Peripheral arterial disease can get worse if you don’t get treatment. Getting treatment and making lifestyle changes can’t always cure your condition. It can help prevent peripheral arterial disease from getting worse and improve your symptoms though.

    Explanation

    Your doctor may find it hard to predict how peripheral arterial disease may affect you in the future. This is because it worsens very slowly for some people, but for others it gets suddenly worse. If you have pain in your leg when walking (intermittent claudication), there’s a chance that this will get worse. It may lead to serious problems with blood flow to your leg. This is called critical limb ischaemia and happens for about one or two in every 20 people with intermittent claudication.

    Changes to your lifestyle and other treatments for peripheral arterial disease can help to stop it from getting worse and improve your symptoms.

    There’s proof that if you can increase the amount of exercise you do, this can help your peripheral arterial disease. Exercise can help your blood vessels to widen and increase the number of small vessels (capillaries) in your muscles. It can also allow more blood to flow through your small vessels. These changes can help to get more oxygen to your leg muscles and may help to prevent pain.

    Smoking prevents these small arteries from developing. So if you smoke, it’s important to stop. Ask your doctor for advice on the support and help that is available to help quit smoking.

  • Resources Resources

    Further information

    Sources

    • Diagnosis and management of peripheral arterial disease. Scottish Intercollegiate Network. www.sign.ac.uk, 2006
    • Lower limb peripheral arterial disease: diagnosis and management. Information for the public. National Institute for Health and Care Excellence (NICE), 2012. www.nice.org.uk
    • Lower limb peripheral arterial disease: diagnosis and management. National Institute for Health and Care Excellence (NICE), 2012. www.nice.org.uk
    • Peripheral arterial disease (peripheral vascular disease). The Merck Manuals. www.merckmanuals.com, published May 2014
    • Map of Medicine. Peripheral arterial disease. International View. London: Map of Medicine; 2013 (Issue 2)
    • Peripheral arterial disease. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published April 2014
    • Gangrene. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 12 March 2014
    • Peripheral arterial disease. British Heart Foundation. www.bhf.org.uk, published 2012
    • Haas TL, Lloyd PG, Yang HT, et al. Exercise training and peripheral arterial disease. Compr Physiol 2012; 2(4): 2933–3017. doi :10.1002/cphy.c110065
    • Cardiovascular disease. Oxford handbook of nutrition and dietetics (online). Oxford Medicine Online. www.oxfordmedicine.com, published January 2012
    • Peripheral arterial disease. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 30 December 2012
    • Peripheral arterial occlusive disease. Medscape. www.emedicine.medscape.com, published 20 October 2014
    • Peripheral vascular disease. BMJ Best Practice. www.bestpractice.bmj.com, published 6 August 2014
    • Small steps to prevention. The World Heart Federation. www.world-heart-federation.org, accessed 13 March 2015
    • Start active, stay active. A report on physical activity for health from the four home countries’ Chief Medical Officers. Department of Health. www.gov.uk, 2011.
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 23 February 2015
    • Overview of coronary heart disease. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Myocardial infarction. Medscape. www.emedicine.medscape.com, published 1 December 2014
    • Transient ischaemic attack. PatientPlus. www.patient.co.uk/patientplus.asp, published 14 March 2014
    • Ischaemic stroke. BMJ Best Practice. www.bestpractice.bmj.com, published 24 October 2014
    • Levy BI, Schiffrin EL, Mourad J, et al. Impaired tissue perfusion: a pathology common to hypertension, obesity and diabetes mellitus. Circulation 2008; 118: 968−79. doi:10.1161/circulationaha.107.763730
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