Peripheral arterial disease: Symptoms, causes, and treatment options

Peripheral arterial disease is a circulatory problem that occurs when the arteries that supply blood to the limbs - especially the legs - become narrowed or blocked due to the build-up of fatty deposits called plaques. This results in decreased blood flow, which can lead to various symptoms and complications. 

Professor Alok Tiwari, leading consultant vascular and endovascular surgeon, provides an expert insight into peripheral arterial disease, including its causes, symptoms, diagnosis, and treatment.

What causes peripheral arterial disease?

The primary cause of peripheral arterial disease is atherosclerosis. This condition occurs when plaque (made up of fat, cholesterol, calcium, and other substances) builds up inside the arteries. Over time, this build-up narrows the arteries, limiting blood flow to the limbs. Reduced circulation can lead to tissue damage and other complications.

Several risk factors can also contribute to the development of peripheral arterial disease. The most significant includes smoking, which damages the blood vessels and accelerates plaque build-up. Diabetes, hypertension, and high cholesterol also increase the risk by damaging the inner lining of arteries and promoting plaque formation. 

Age is another important factor, as the risk increases after the age of 50. Moreover, people with a family history of cardiovascular disease are at a higher risk of developing the condition. Rarely, peripheral arterial disease can be caused by blood vessel inflammation or injury to the limbs. 

What are the common symptoms of peripheral arterial disease?

Many people with peripheral arterial disease experience no symptoms, especially in the early stages. 

However, as the condition progresses, the most common symptom is intermittent claudication. This term refers to pain, cramping, or aching in the leg muscles that occurs during physical activity (such as walking) and goes away with rest. Claudication occurs because the muscles don’t receive enough oxygen-rich blood during activity.

Other symptoms include coldness or numbness in the lower leg or foot, sores or wounds on the feet or legs, and weak or absent pulses in the legs or feet. In advanced cases, peripheral arterial disease can cause changes in skin colour (such as paleness or a bluish tint). 

Severe peripheral arterial disease can lead to critical limb ischemia, where blood flow is so restricted that it leads to severe pain even at rest, along with non-healing ulcers or gangrene, which require urgent medical attention.

How is peripheral arterial disease diagnosed?

Diagnosis of peripheral arterial disease begins with a medical history and physical examination. The doctor will ask about symptoms, risk factors, and lifestyle habits like smoking. During the examination, the doctor will check for weak or absent pulses in the legs and feet, and for signs of poor circulation.

A key tool for diagnosing peripheral arterial disease is the ankle-brachial index (ABI). This quick, non-invasive test measures blood pressure in the ankle and compares it to the blood pressure in the arm. A lower blood pressure reading in the ankle suggests blocked arteries in the legs. 

If ABI results are abnormal or if further information is needed, additional imaging tests may be recommended. These include ultrasound scans, magnetic resonance angiography (MRA), or computed tomography angiography (CTA) to provide detailed images of the arteries.

In some cases where surgical intervention is planned, a catheter angiography may be performed. This procedure involves inserting a thin tube into an artery and injecting a dye to visualise blood vessels on X-ray images. 

What treatments are available for peripheral arterial disease? 

Lifestyle changes are a crucial part of treatment. Quitting smoking is essential, as is regular exercise (under medical guidance) to help improve symptoms by encouraging the development of new blood vessels in the legs. Eating a healthy diet low in saturated fat, cholesterol, and salt is also recommended. 

Managing underlying conditions like diabetes, hypertension, and high cholesterol through medication and lifestyle adjustments is vital.

Furthermore, medications may be prescribed to manage symptoms and reduce cardiovascular risk. These include antiplatelet drugs like aspirin to prevent blood clots, cholesterol-lowering medications (statins), and medications to control blood pressure. Cilostazol is a drug that can help improve walking distance by increasing blood flow.

In more severe cases of when critical limb ischaemia is present, more invasive treatments may be necessary. Angioplasty is a minimally invasive procedure in which a small balloon is inserted into the narrowed artery and inflated to widen it. Sometimes, a stent (a tiny mesh tube) is also placed to keep the artery open.

Other surgical options include bypass surgery, which involves creating an alternate route for blood flow around the blocked artery using vessels from another part of the body or synthetic grafts. Regular follow-ups are important to monitor peripheral arterial disease and adjust treatment as needed. 

Book an appointment with Professor Alok Tiwari via his Top Doctors profile today.