Peripheral arterial disease

Published by Bupa's Health Information Team, May 2010.

This factsheet is for people who have peripheral arterial disease, or who would like information about it.

Peripheral arterial disease is a disease of the arteries, the blood vessels that carry blood from the heart to the rest of the body. The arteries become narrowed, restricting blood flow to the muscles in the limbs. Peripheral arterial disease usually affects the legs and can cause pain which comes on when walking.

About peripheral arterial disease

Peripheral arterial disease is most common in the arteries that supply blood to your legs. Around one in 10 people aged between 60 and 70 have peripheral arterial disease and this rises to two in 10 people over the age of 70. It's more common in men than in women.

Peripheral arterial disease is also sometimes called peripheral vascular disease.

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

Peripheral arterial disease can affect other arteries including those in your neck or near your pelvis. If you have peripheral arterial disease, it can increase your risk of heart attack or stroke.

Symptoms of peripheral arterial disease

Three out of four people who have peripheral arterial disease have no symptoms at all and may not know that they have it. However, some people do have symptoms.

The most common symptom is pain in your calf (lower leg). This is called intermittent claudication. The pain comes on after walking or other exercise and usually goes away within about five minutes of stopping the exercise. Usually just one leg is affected.

If your condition gets worse and there isn't enough blood getting to your legs, you may also develop the following symptoms:

• cold, pale and numb feet and toes
• thin, shiny skin on your legs and feet
• pain in your legs
• losing hair from your feet, toes or legs
• wounds on your legs or feet that won't heal.

Complications of peripheral arterial disease

Cardiovascular disease

People with peripheral arterial disease are likely to have narrowed arteries in other parts of the body.

If you have peripheral arterial disease, the arteries that supply your heart muscle can also become narrowed. This is called coronary heart disease and may lead to angina. The blood vessels that supply your heart can eventually become blocked, which can cause a heart attack.

When an artery leading to your brain, or inside it, becomes narrowed, this can lead to a stroke.

Aortic aneurysm

Aortic aneurysm is a swelling in the aorta, which is the main artery that leaves your heart. Anything that causes your artery walls to weaken, including atherosclerosis and high blood pressure, can lead to an aneurysm. Most of these swellings are small but sometimes they can get bigger and may burst. This can be very serious and would need immediate medical treatment. If you have peripheral arterial disease, your doctor will examine you to check for signs of an aneurysm.

Amputation

Most people with peripheral arterial disease find that symptoms such as leg pain don't get any worse, but just stay about the same. However, a few people find that their condition gets worse. This can become serious if it's not treated quickly and for a small number of people it may mean losing an infected toe or even a limb. This is called amputation.

If you have diabetes, or if you smoke, you are at greater risk of developing a serious infection and having amputation.

Causes of peripheral arterial disease

Peripheral arterial disease is usually caused by atherosclerosis. This is when fatty deposits build up in your arteries. You are more likely to develop atherosclerosis if you:

• are a smoker
• are older than 50
• are male
• have diabetes
• have high blood pressure
• eat a lot of high-fat foods - which means you develop a high cholesterol level
• are overweight or obese
• are physically inactive

Diagnosis of peripheral arterial disease

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may examine your feet and feel them to test for a pulse. You may have a blood test and an ECG - which measures the electrical activity of the heart.

You may have a test to compare the blood pressure in your arm and in your ankle. This is called an ankle brachial pressure index. The difference between the measurements can help your GP to diagnose peripheral arterial disease and also see how severe it is.

If your peripheral arterial disease is severe or if the pain in your leg is affecting your day to day life, your GP may refer you to see a vascular surgeon. He or she may ask you to have further tests. These may include an angiogram, which is a procedure that involves putting a long, thin, flexible tube called a catheter into a blood vessel in your groin or wrist. The catheter is then guided to your arteries. A special dye is injected through the catheter so that X-ray pictures show your arteries more clearly. You may also have an ultrasound or CT scan.

These tests are usually done only if your doctor is considering surgery, or if your GP isn't sure whether your symptoms are caused by peripheral arterial disease or something else.

Treatment of peripheral arterial disease

Treatment for peripheral arterial disease aims to reduce your risk of heart attack and stroke in the future, as well as help to ease any symptoms of leg pain you may have.

Self-help

There are a number of lifestyle changes that you can make to help yourself. Some of the main ones are listed below.

• If you smoke, stop. Smoking greatly increases the chances of your peripheral arterial disease getting worse.
• Increase the amount of activity you do, by walking more and by walking regularly. Try to build up gradually until you are walking for 30 minutes at least five times a week. This can be a very effective way of reducing pain and helping you to walk further. There are also exercise classes available for people with peripheral arterial disease. Your GP may be able to refer you to one in your local area.

These measures will also reduce your risk of cardiovascular disease.

You should also check your feet every day for changes to your skin. You should wear well-fitting shoes at all times and treat any injuries as soon as you can. Good foot care is particularly important if you have diabetes as small injuries can quickly become infected.

Medicines

There are a number of medicines that can help to either slow or stop the progression of peripheral arterial disease. They can also help to reduce your risk of a heart attack or stroke in the future.

Most people with peripheral arterial disease will be asked to take a medicine called a statin, which helps to control cholesterol levels. If you have high blood pressure, then you may also be given medicines to lower your blood pressure.

If you have diabetes, then it's important to make sure that your blood glucose levels are well controlled, as this will help to prevent peripheral arterial disease from getting worse.

You may also be given an anti-platelet drug. These drugs prevent blood clots from forming; blood clots can lead to loss of blood supply to your leg, heart attack and stroke. Anti-platelet drugs include clopidogrel and aspirin.

There are some medicines that can help improve blood flow to your legs. These are usually used if changes to your lifestyle haven't worked and if your day-to-day life is severely affected by peripheral arterial disease.

Surgery

Most people who have peripheral arterial disease won't need surgery. Surgery is usually only needed if your condition is very severe, is getting worse, or if other treatment hasn't worked.

Your GP will refer you to a vascular surgeon (a doctor specialising in conditions affecting the blood vessels) if he or she thinks you need surgery. There are several procedures used. These are explained below.

• Angioplasty. This involves inserting a catheter (fine tube) with a tiny balloon on the end of it into the affected artery. The balloon is inflated and then removed. This stretches the artery allowing more blood to flow through. A stent is often used to hold the artery open after the balloon has been removed. Angioplasty is normally done under local anaesthesia. This means you won't feel any pain but you will stay awake during the procedure.
• Bypass surgery. This involves creating a detour around your affected artery, using an artificial blood vessel or a healthy blood vessel taken from somewhere else in your body. Bypass surgery is usually done under general anaesthesia. This means you will be asleep during the procedure.
• Endarterectomy. This involves opening your artery and removing the plaque.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.