Peripheral Artery Disease

Do you have pain in your legs when you walk?  If you are diabetic, have a history of coronary artery disease, or or have a tobacco use history, you may be at risk for poor circulation. The heart pumps blood through major arteries supplying the arms and legs.

Claudication is the medical term referring to pain in either the arms or legs caused by reduced blood flow. When the arteries of your body get damaged, they can harden and form plaque, known as atherosclerosis. When this involves the arteries of your arms and legs, it is labeled as peripheral artery disease, or PAD. Exercise causes the muscles of your limbs to require more blood flow and more oxygen. If you have claudication, you may initially have pain when you exercise vigorously. With progression of the disease, the pain may come on more suddenly and with walking shorter distances. When the disease is most severe, you may even develop pain at rest. Individuals with the worst disease may be at risk of developing non-healing ulcers and gangrene, sometimes even requiring amputation.

If you feel cramps in your legs when you walk that get better quickly when you stop walking and return as soon as you start walking again, you should bring this to your doctor’s attention. You may have symptoms of decreased blood flow to your legs. Your doctor will determine your risk factors for developing peripheral artery disease. These include having diabetes, a smoking history, high blood pressure, high cholesterol, age over 70, being overweight, or having a family history of artery heart disease or peripheral artery disease. If you have any of these risk factors, you are also at increased risk of heart disease.

Your doctor may recommend undergoing testing and seeing a specialist to assess your circulation. A simple test that compares the blood pressure in your arms and legs is a good first start. Known as the ankle brachial index (ABI), this test compares the blood pressure in your legs to your arms. The blood pressure should be roughly the same in each of your limbs. If your blood pressure is lower in your legs, you may have blockages causing this. Your doctor may recommend additional non-invasive tests such as Doppler testing, ultrasound testing, CT scans, or MRI scans to determine where the blockages are located. Not all pain in the legs and arms is caused by poor circulation. Your doctor will help determine if you have problems with your joints or with your back that may be causing your pain instead.

If you have a blockage, physicians specializing in cardiovascular and vascular medicine can be of help. Your doctor will first recommend controlling your risk factors. This involves quitting smoking if you still smoke. Also, it involves controlling your risk factors such as diabetes, high blood pressure, and high cholesterol. Your doctor may recommend beginning a regular walking program. This helps your muscles use oxygen more efficiently, requiring less blood flow. It also improves your circulation by opening up small vessels known as collateral arteries reroute blood around your blockages. Medications may also help promote good circulation.

Sometimes, however, the blockages may be severe enough to require intervention. Some blockages can be fixed by angioplasty. This involves placing small tubes in your arteries and using small balloons to widen your arteries in the location of the blockage. In some cases, cutting tools and lasers can also be used in your arteries to open blockages. In other cases, small pieces of metal mesh known as stents may be used to prop open the arteries. In more severe cases, you may even require bypass surgery. This involves removing a blood vessel from another location in your body and using it to reroute blood around your blockage.

But the best treatment is prevention. If you smoke, try your best to quit. If you have difficulty quitting, speak with your doctor about treatment options and strategies. Make sure to control your diabetes, high blood pressure, cholesterol. Eat a well-balanced, low-fat, low-cholesterol diet. And, get plenty of exercise.

Shalin B. Mehta, MD, FACC
Dr. Shalin Mehta is a board certified cardiovascular disease specialist and interventional cardiology specialist with Florida Heart Associates with cardiovascular training from Brown University. He specializes in the treatment of heart and vascular disease, including angioplasty of the arteries of the heart, legs, and arms.

For more information or to schedule an appointment, please call his office at 239-938-2000 or visit his website at www.flaheart.com.