Peripheral Artery Disease
Assessment and treatment of reduced blood flow to the limbs caused by narrowed arteries
What is peripheral artery disease?
The same process that narrows the arteries of the heart narrows those of the legs. Plaque builds within the wall over decades, the channel narrows, and the muscle beyond receives less blood than it needs while it is working.
Disease is described by which level is involved: the aorta and its division into the pelvis, the thigh vessels, or the small arteries below the knee. The level matters more than almost anything else, since the vessels below the knee are narrow, long and calcified and behave very differently from the wide vessels in the pelvis.
It is also a marker of arterial disease everywhere else. Someone with narrowed leg arteries carries a substantially raised risk of trouble in the heart arteries and the vessels to the brain, and treating that risk matters as much as anything done to the leg.
What you might notice
- Calf pain that starts when you walk and stops when you rest
- A foot that stays cold or pale
- A foot wound that will not heal
How it is diagnosed
The examination is the starting point: the pulses at the groin, behind the knee and at the ankle and foot, along with the colour, temperature and hair of the leg and the state of the skin between the toes.
The ankle brachial index compares the blood pressure at the ankle with the pressure at the arm and grades severity in a few minutes with a cuff and a hand-held probe. In diabetes the ankle vessels can be too stiff to compress, so a toe pressure is used instead. A duplex ultrasound then maps where the narrowings sit and how fast blood moves through them.
When treatment is being planned, a CT or MR angiogram shows the whole run from the abdomen to the foot, including which vessel actually reaches the area that is failing to heal.
Recovery
Treatment delivered through a catheter is short: a bruised groin or arm puncture, a night in hospital at most, and walking the same day. Antiplatelet medication starts or is intensified immediately afterwards and is what keeps the treated segment open.
A supervised walking programme follows, and it has the strongest evidence of anything on offer here. Walking to the point of discomfort, resting, then walking again, three times a week for three months, builds collateral circulation and improves walking distance more than most interventions do.
Foot care becomes a daily habit. Inspecting the feet, treating fungal infection between the toes, keeping the nails short and never walking barefoot are what prevent the small injury that turns into a wound nothing will close.
If it is left untreated
Untreated, narrowed leg arteries limit walking distance progressively in most people and stabilise in some. The serious turn comes when the blood supply falls below what the tissue needs even at rest: the foot then becomes vulnerable to any small injury, and tissue loss and amputation enter the picture.
The larger threat is elsewhere. Most people with this disease are lost to heart attack and stroke before the leg becomes the problem, so medication, blood pressure control and stopping smoking matter more than the state of any single vessel.
Where walking is limited but the foot is warm and healthy, exercise and medication alone are a proper treatment, and many people need nothing further.
One turn cannot wait. A leg that becomes suddenly painful, cold, pale and numb over minutes to hours has lost its blood supply outright, usually to a clot landing in an already narrowed vessel. Muscle starts dying within about six hours, so this needs an emergency department the same hour.
Questions about peripheral artery disease
Will walking exercise really help if my arteries are narrowed?
Yes, and this surprises people. A supervised programme of walking to the point of discomfort, resting, then walking again, done three times a week for around three months, improves walking distance as much as many procedures do and its benefit lasts. It works by opening up small collateral vessels around the blockage and by making the leg muscle more efficient. It also has none of the risks of an intervention. The main obstacle is that it takes months of effort, and it is the treatment most often abandoned early.
How urgent is a leg that has suddenly become cold and painful?
That is an emergency, and it should be assessed in a hospital immediately, without waiting for the next clinic appointment. A sudden loss of blood supply gives roughly six hours before muscle and nerve start to die, and the window narrows further once sensation or power in the foot is lost. Do not wait to see whether it settles, do not apply heat, and do not take anything by mouth on the way, in case an urgent procedure is needed. Restoring flow early is what saves the limb.
Why am I on a statin when my cholesterol is normal?
Because in this condition the statin is being given for the arteries themselves and not solely for the number in the blood test. Narrowed leg arteries indicate the same process is under way in the heart and the vessels to the brain, and most people with this diagnosis are ultimately at greater risk from a heart attack or a stroke than from the leg. Statins and antiplatelet medication reduce that risk substantially at any starting cholesterol level, and they are continued indefinitely alongside blood pressure control and stopping smoking.
Other vascular surgery treatments
Treatment for enlarged, twisted veins that may cause pain, swelling, heaviness or skin changes
Day CareManagement of small visible surface veins for cosmetic or symptomatic concerns
Day CareTalk to a care coordinator about peripheral artery disease
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one