If you or someone you know has been told you have Peripheral Artery Disease (PAD), you probably have some questions, including what causes it. While there are several less-common causes of PAD, there is a main cause of this condition that is a leading trigger of heart attacks and strokes in people over the age of 60. Clinics like the Commonwealth Vein Center in Richmond, and Colonial Heights, VA can successfully treat PAD before it causes more severe issues.
What Is the Main Cause of Peripheral Artery Disease (PAD)?
The main cause of PAD is fatty deposits, or plaques, that accumulate along the walls of your arteries, causing them to narrow and restrict blood flow. You’ve probably heard of atherosclerosis in relation to the heart, which is where it often occurs and is responsible for many heart attacks. However, atherosclerosis can affect all other arteries in your body, and when it impacts the arteries in your limbs, you develop PAD. This is also a sign of more widespread atherosclerosis.
The legs are the most common body parts affected by PAD, since your heart already has to work harder to pump blood that far away. When you add in narrowed arteries due to plaque buildup, your legs don’t stand a chance. The restriction of blood flow in your legs also means that your leg muscles aren’t getting the oxygen they need, especially when they’re working hard. This is the reason your legs may cramp when you walk or even stand.
Less-Common Causes of PAD
While the vast majority of PAD cases are the result of atherosclerosis, there are some less-common causes as well. These include injury to the limb, inflammation of the blood vessels, radiation exposure, and abnormal anatomy. Scientists believe that damage to the inner wall of the vessels in some form or another leads to cholesterol and cell waste getting trapped at the damaged point, creating the atherosclerosis. If not cleared, the plaque continues to accumulate until it fully blocks the artery.
Complications of PAD
If left untreated, PAD could lead to several life-threatening conditions. Atherosclerosis does not just appear in limbs, so if you have it in your legs or arms, you are likely to have it in other arteries, such as those that lead to your heart and brain. If an artery that leads to your heart becomes fully blocked, you will have a heart attack. If an artery that leads to your brain becomes completely blocked, you will have a stroke.
The other main complication of PAD is critical limb ischemia, which can occur if you get an open wound on, an injury to, or an infection in your limb that is affected by PAD. PAD makes it difficult for the wounds or injuries to heal, and eventually, as they progress, the surrounding tissues die. This is called gangrene and can sometimes lead to the amputation of all or part of the limb that PAD has impacted.
If you have PAD in your legs, the pain you experience may make it difficult to manage your daily activities. Additionally, if there is a sudden drop in blood flow to your affected limb, you can develop acute limb ischemia and you need to seek emergency care right away. You may suddenly lose feeling in your limb, see it turn blue, or have it become suddenly cold. Quick action and medical intervention could save your limb.
Symptoms of PAD
There are quite a few symptoms that can indicate the presence of PAD, and some of them can be symptoms of other conditions, so it’s important that you see a doctor to confirm your diagnosis and seek treatment. The most common symptoms of PAD in the legs are the following:
- Pain in your hips, thighs, or calves when walking or climbing stairs
- Cramping in your hips, thighs or calves when walking or climbing stairs
- Numbness in your legs (neuropathy)
- Weakness in your legs
- Coldness in one lower leg or foot as compared to the other leg or foot
- Wounds on your legs or feet that do not heal
- Discoloration of the legs
- Slower-growing hair on your legs or hair loss on your legs
- Slower-growing toenails
- Shiny skin on your legs
- A weak pulse or no pulse in your legs
While these are symptoms of PAD in your legs, you can also experience any of them in your arms and hands as well, although it is less common. Men who have PAD in their legs may also experience erectile dysfunction as well as the above-listed symptoms. Additionally, the symptoms may come and go, and usually worsen with activity and improve with rest.
Risk Factors of PAD
While PAD can develop at any age, the risk of getting PAD increases as you age. In the United States, PAD is common among people aged 65 years old and older, but on a worldwide basis, especially in countries with less access to medical care, the age is lower, between 45 and 49 years old.
Men are slightly more likely than women to develop PAD, and men and women experience PAD symptoms differently. Women will often have PAD and have no symptoms, but are also more likely than men to have complications such as reduced mobility. Men usually have more symptoms of PAD than women.
Race and Ethnicity
PAD is more likely to develop in African Americans than in other races, and they are also more likely to develop complications of PAD. American Indian women are at a higher risk of developing PAD than Asian American and white women, but Hispanic and Latino adults who live sedentary lifestyles are at higher risk than others of having PAD in their lower limbs. This is true even if they have no other risk factors.
If your family has a history of PAD, stroke, vasculitis or other blood vessel diseases, or heart disease, your risk of developing PAD is significantly increased. There also appear to be gene variations that could raise the risk of developing PAD or that make the condition worse; however, this is still being studied. Speak to your doctor about any family history concerning PAD or the other conditions mentioned to assess your risk.
Various unhealthy lifestyle habits can increase your risk of developing peripheral artery disease. These include smoking, not getting enough exercise, unhealthy dietary habits, and stress. Smoking not only damages blood vessels, raises blood pressure, and raises cholesterol levels, the nicotine in smoking tobacco also narrows blood vessels and causes a reduction to the blood flow in the limbs. Quitting smoking is necessary for reducing your risk of PAD, because if you have any other factors, smoking is exacerbating them.
Stress constricts blood vessels, making it harder to circulate blood to your limbs, and not exercising enough makes your other risk factors worse. Following an unhealthy diet that is high in saturated fats increases the amount of plaque in your body, which is what leads to atherosclerosis, the main cause of peripheral artery disease. Instead, following a heart-healthy diet that is low in fat and cholesterol is important when reducing your risk of PAD.
Other Medical Conditions
The presence of other medical conditions can increase your risk of developing peripheral artery disease. These include the following conditions.
- High blood pressure
- Chronic kidney disease
- Antiphospholipid antibody syndrome
- Fibromuscular dysplasia
- High blood triglycerides
- Gestational diabetes
If you have one or more of these conditions, you will want to talk to your doctor about how they can affect your risk of PAD and how you may be able to mitigate that risk.
Screening, Diagnosis, and Treatment
Screening and Diagnosis
To determine if you have PAD, your doctor will first conduct a medical exam that will include questions about your family history of PAD or PAD-related conditions, your personal risk factors, and any symptoms you have. Your doctor will then examine your limbs, checking your pulse, your pain response, and your skin for wounds. They will also check your blood pressure in your legs compared to your arms and run a variety of diagnostic laboratory tests.
Other screening tools your doctor will use include an ultrasound to assess the flow of blood through the vessels in your legs or arms and to identify any narrowed or blocked vessels and angiography to allow your doctor to see your blood flow through your body in real-time. An MRI or a CTA can be used to trace the flow of a dye that has been injected into your bloodstream to determine how well your blood is circulating.
There are two main goals for treating peripheral artery disease. The first is focused on managing your symptoms, including pain, so that you can return to your daily activities. The second is to halt the progression of atherosclerosis in your blood vessels so that your risks of stroke and heart attack decrease. Much of this can be accomplished through lifestyle changes, especially by quitting smoking, which is the single best thing you can do to lower your risks.
There are many medications that may be considered for your treatment of PAD, including those that lower cholesterol and high blood pressure, those that control blood sugar, and those that prevent blood clots. There are also medications available that will help you improve your symptoms, such as cilostazol, which widens blood vessels and thins the blood, thereby increasing blood flow and alleviating pain, discoloration, heaviness, numbness, and weakness, among others.
There are three types of surgical procedures that are used to treat PAD. Angioplasty uses a small balloon that’s inserted into your artery with a catheter to reopen the artery and reduce the blockage. A stent may also be inserted to keep the artery open after the balloon and catheter are removed. Bypass surgery uses either a man-made vessel or a vessel from somewhere else in your body to create a path for blood to flow around the blocked artery.
This treatment will only be used if there is a blood clot blocking your artery. A clot-dissolving medication will be injected into your artery where the clot is located to dissolve the clot and reopen your artery. It is important to administer this treatment as quickly as possible to prevent permanent damage. Thrombolytic therapy can take up to 48 hours to completely dissolve the clot, especially in the case or a clot in a leg.
If you are experiencing any of the symptoms of peripheral artery disease that have been discussed here, the next step is to make an appointment with a doctor who can assess your condition and risk of PAD. Contact our experts at Commonwealth Vein Center in Richmond, or Colonial Heights, VA to schedule an exam today.