Peripheral artery disease

Understanding peripheral artery disease

Peripheral artery disease (PAD) is narrowing of the arteries that carry blood to the limbs, almost always the legs. It happens for the same reason coronary artery disease affects the heart: a build-up of fatty deposits (atherosclerosis) inside the artery wall gradually reduces blood flow. Because it is caused by the same disease process that narrows the heart's own arteries, PAD is as much a signal about the whole circulatory system as it is a leg problem — which is why finding it often prompts a wider look at heart health, not just the legs.

Muscles need more blood flow when they are working than when resting. In a healthy leg, blood flow can increase several times over during walking. When an artery is narrowed, that extra flow cannot get through, and the muscle beyond the narrowing runs short of oxygen — producing the classic cramping pain of PAD. At rest, when demand is low, a mildly narrowed artery may supply just enough blood that there is no pain at all, which is why PAD is so often missed until walking distance is already limited.

What PAD can feel like

These are common descriptions patients use, offered to help you put your own experience into words for a clinician — not a checklist for diagnosing yourself.

• ●Cramping, aching or tiredness in the calf, thigh or buttock brought on by walking a predictable distance, and relieved by rest (intermittent claudication)
• ●A foot or leg that feels colder than the other, or looks pale, bluish or shiny
• ●Numbness, tingling or weakness in a foot or leg
• ●Hair loss on the lower leg, or toenails that grow slowly or thicken
• ●A cut, blister or sore on the toes or foot that heals very slowly or not at all
• ●In more advanced disease, pain in the foot at rest, especially at night, that may ease when the leg is hung over the side of the bed

What causes peripheral artery disease

PAD develops gradually, and several factors together usually drive it.

Atherosclerosis

The underlying process in almost all PAD: cholesterol-rich fatty deposits build up inside artery walls over years, gradually narrowing the space blood can flow through, most often in the arteries of the legs.

Diabetes

High blood sugar over time damages both large and small blood vessels and nerves, making diabetes one of the strongest drivers of PAD — and the reason diabetic foot problems and PAD are so closely linked.

Smoking

Tobacco use directly injures the artery lining and accelerates atherosclerosis; it is the single most modifiable risk factor for PAD and for how quickly it progresses.

Rarer causes

Inflammation of the blood vessels (vasculitis) and blood-clotting disorders can occasionally narrow or block limb arteries, particularly in younger patients without the usual risk factors.

Who is more likely to get PAD

• ●Smoking or tobacco use — the strongest single risk factor
• ●Diabetes
• ●High blood pressure — very common in Nigeria and often undiagnosed
• ●High cholesterol
• ●Increasing age
• ●A family history of PAD or other atherosclerotic disease
• ●Known coronary artery disease or a previous stroke
• ●Chronic kidney disease

What happens if PAD goes untreated

PAD tends to progress slowly, but untreated disease carries real risks beyond leg discomfort.

Reduced mobility and quality of life. Walking distance shrinks over time, which can limit independence and daily activity.

Non-healing wounds and infection. Poor blood flow means even small cuts or blisters can fail to heal and become infected, especially with diabetes involved.

Critical limb-threatening ischaemia. In advanced disease, blood flow can become so limited that tissue dies; this can require amputation if not treated in time — the most serious potential outcome of untreated PAD.

Heart attack and stroke. Because PAD reflects atherosclerosis throughout the body, people with PAD have a higher risk of heart attack and stroke — treating PAD is also protecting the heart and brain.

How Cardiocare finds the cause

The right pathway depends on your symptoms, examination and overall health. It typically draws on some or all of the following:

• 01
  History and examination. Walking distance before symptoms start, wound history, and examination of pulses, skin and temperature in both legs.
• 02
  Ankle-brachial pressure index (ABPI). A simple, painless comparison of blood pressure at the ankle and the arm that screens for reduced blood flow.
• 03
  Vascular ultrasound (duplex scan). A painless scan showing where and how severely an artery is narrowed.
• 04
  CT or MR angiography. Detailed imaging of the leg arteries, used when intervention is being planned.
• 05
  Peripheral angiography. A catheter-based test performed in Cardiocare's on-site cath lab that images the arteries directly and can lead straight into treatment if a blockage is found.
• 06
  Blood tests. Blood sugar, cholesterol and kidney function, to address contributing conditions and guide safe treatment.

How PAD is treated

Treatment aims to relieve symptoms, protect the limb and reduce the wider cardiovascular risk that comes with PAD.

Lifestyle and supervised exercise

Structured, supervised walking programmes are one of the most effective treatments for claudication, encouraging the body to develop small natural bypass vessels around narrowed arteries over time. Stopping smoking is equally important and slows disease progression.

Medicines, by class

Where medicine is needed, it is chosen by what it does, and your clinician will discuss the right option and dose for you:

• ●Antiplatelet medicines — reduce the risk of clots forming in narrowed arteries
• ●Statins — lower cholesterol and stabilise artery deposits
• ●Blood-pressure medicines — protect arteries throughout the body
• ●Medicines to improve walking distance — may be considered for troublesome claudication

Procedures

For more severe or limb-threatening disease, available through Cardiocare's on-site cath lab and vascular service:

• ●Angioplasty and stenting — a catheter opens a narrowed artery and a small mesh tube (stent) can hold it open
• ●Bypass surgery — grafts a new route for blood around a severely blocked segment, for selected patients
• ●Wound care and, where the limb cannot be saved, amputation — a last-resort option used only once every effort to restore blood flow has been made

Living with PAD: everyday self-care

• ✓Inspect your feet daily, including between the toes, for cuts, blisters or colour change
• ✓Wear well-fitting, protective footwear, even indoors
• ✓Never walk barefoot, and treat any wound promptly rather than waiting
• ✓Keep diabetes, blood pressure and cholesterol well controlled
• ✓Walk regularly, as far as comfortably possible, and build up distance over time
• ✓Stop smoking — the single most powerful step you can take

Foot care matters as much as the artery itself

Because PAD slows healing, small foot problems can become serious quickly. Wash and dry feet carefully, moisturise dry skin (but not between the toes), and have a clinician check any wound that has not visibly improved within a few days.

Preparing for your appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Any previous scans, blood test results or hospital letters
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

How far you can walk before symptoms start, whether they ease with rest, your smoking history, and whether you have diabetes, high blood pressure or high cholesterol.

Questions worth asking us

• ●How severe is my PAD, and is my limb at risk?
• ●Do I need any tests, and what will each involve?
• ●Would a supervised walking programme help me?
• ●What should I watch for with my feet at home?