Peripheral
Artery Occlusive Disease (PAD) & Claudication
Background
Peripheral Arterial Disease
What is Claudication?
What is Aortoiliac Occlusive
disease?
What is Leg Artery Disease?
Peripheral Arterial Disease
Peripheral arterial disease (PAD), also known as peripheral
vascular disease (PVD), is a very common condition affecting
12-20 percent of Canadians age 65 and older. PAD develops most
commonly as a result of atherosclerosis, or "hardening of
the arteries," which occurs when cholesterol and scar tissue
build up, forming a substance called plaque inside the arteries
that narrows and clogs the arteries. This is a very serious condition.
The clogged arteries cause decreased blood flow to the legs,
which can result in pain when walking, and eventually gangrene
and amputation.
Because atherosclerosis is a systemic disease, people with
PAD are likely to have blocked arteries in other areas of the
body. Thus, people with PAD are at increased risk for heart disease,
aortic aneurysms and stroke. PAD is also a marker for diabetes,
hypertension and other conditions. This is a major public health
issue and the Society of Interventional Radiology recommends
greater screening efforts through the use of the ankle brachial
index (ABI) test. This simple, painless test compares the blood
pressure in the legs to the blood pressure in the arms to determine
how well the blood is flowing and if further tests are needed.
Each September, during Peripheral Vascular Disease Month, Interventional
Radiologists participate in Legs For Life, a nationwide screening
program sponsored by the Society of Interventional Radiology.
Symptoms
The most common symptom of PAD is called claudication, which
is leg pain that occurs when walking or exercising and
disappears when the person stops the activity.
- Other symptoms of PAD include: numbness and tingling
in the lower legs and feet; coldness in the lower legs
and feet; and ulcers or sores on the legs or feet that
don't heal.
- Many people simply live with their pain,
assuming it is a normal part of aging, rather than reporting
it to their doctor.
Prevalence
- Peripheral Arterial Disease (PAD) is a disease of the arteries
that affects 1 million Canadians.
- PAD can happen
to anyone, regardless of age, but it is most common in men
and women over age 50.
- PAD affects 12-20 percent of Canadians
age 65 and older.
What is Claudication?
Claudication is pain or a tired or weak feeling that occurs
in your legs, usually during activity such as walking. The symptoms
typically begin when you start to exercise, and go away a short
time after you rest.
Your arteries carry blood rich with oxygen and nutrients from
your heart to the rest of your body. When the arteries that
carry blood to your legs become narrowed or blocked, your leg
muscles may not receive enough of the blood and oxygen they need
to support physical activity. Physicians call this lack of oxygen
ischemia. Initially, your legs may receive enough blood while
you are at rest so that you do not experience any discomfort
without activity.
However, your muscles need more oxygen when you exercise, so
if the arteries in your legs are narrowed to the point that
too little blood reaches your muscles, you may feel leg pain
when you walk. Claudication, which physicians also call intermittent
claudication because it happens off and on, is a serious
warning symptom because people who have it are also at increased
risk for heart attack and stroke.
Your arteries are normally smooth and unobstructed on the
inside but, as you age, they can become blocked through a
process called atherosclerosis, also called “hardening of
the arteries.” As you age, a sticky substance called plaque
can build up in the walls of your arteries. Plaque is made
up of cholesterol, calcium, and fibrous tissue. As more plaque
builds up, your arteries can narrow and stiffen. Eventually,
enough plaque builds up to reduce blood flow to your leg
arteries. Physicians call this condition peripheral arterial
disease (PAD).
What are the symptoms?
Claudication is discomfort or pain in your legs that happens
when you walk and goes away when you rest. You may not always
feel pain; instead you may feel a tightness, heaviness, cramping,
or weakness in one or both of your legs. Claudication often
occurs more quickly if you walk uphill or up a flight of
stairs. Over time, you may feel claudication at shorter walking
distances, as the degree of artery blockage worsens.
What causes claudication?
Claudication is a symptom of PAD, which is caused by atherosclerosis.
Risk factors for atherosclerosis include:
- Smoking;
- High cholesterol levels in the blood;
- High blood pressure;
- Obesity; and
- Having a family history of heart or vascular
disease.
What is Aortoiliac Occlusive disease?
 Aortoiliac
occlusive disease occurs when your iliac arteries become narrowed
or blocked. The aorta, your body's main artery, splits into branches
at about the level of your belly button. These branches are called
the iliac arteries. The iliac arteries go through your pelvis
into your legs, where they divide into many smaller arteries
that run down to your toes. Aortoiliac disease is considered
a type of peripheral arterial disease (PAD), because it affects
arteries that carry blood away from your heart to your limbs.
Your arteries are normally smooth and unobstructed on the inside,
but as you age, a sticky substance called plaque can build
up in the walls of your arteries. Plaque is made up of cholesterol,
calcium, and fibrous tissue. As more plaque builds up, it causes
your arteries to narrow and stiffen. This process is called
atherosclerosis, or hardening of the arteries. Eventually, enough
plaque builds up to interfere with blood flow in your iliac arteries
or leg arteries. Physicians call this aortoiliac occlusive disease.
When your iliac arteries narrow or become blocked, your legs
may not receive the blood and oxygen they need. This lack
of oxygen is called ischemia and it can cause pain. In severe
cases, sores or gangrene can develop, which can result in
you losing a limb. However, these developments are uncommon unless
the process is not treated and is allowed to progress.
What are the symptoms?
Early in the disease, you may feel pain, cramping, or fatigue
in your lower body when you walk or exercise. The pain
with walking usually occurs in your buttocks, thighs, and legs.
This symptom is called intermittent claudication because
it stops when you rest. As the disease worsens, you may
find that pain occurs when you walk for shorter distances. Ultimately,
as the disease progresses, you may feel pain, usually in
your toes or feet, even when you are resting.
Some men who have aortoiliac occlusive disease also experience
erectile dysfunction, the inability to have or maintain an
erection.
Aortoiliac disease may worsen if it is not treated. Signs
that it has advanced include:
- Severe pain, coldness, and numbness in a limb
- Sores on
your toes, heels, or lower legs
- Dry, scaly, cracked skin
on your foot. Major cracks, or fissures, may become infected
if left untreated
- Weakened muscles in your legs
- Gangrene (tissue death), which
may require amputation
If you experience any of these advanced
symptoms, it usually means that your leg arteries are blocked
in more than one place. Your physician may need to treat more
than one site to prevent gangrene or limb loss.
What causes Aortoiliac Occlusive disease?
Atherosclerosis, or hardening of the arteries, causes
most cases of aortoiliac occlusive disease.
Risk factors for hardening of the arteries include:
- Smoking
- High cholesterol
- High blood pressure
- Obesity
- Having a family history of heart disease
In rare cases, a condition known as Takayasu’s arteritis
may cause blockages in your aorta and
its branches. Takayasu’s arteritis usually affects young
Asian women between the ages of 10 and 30.
What is Leg Artery Disease?
 Your
arteries carry blood rich in oxygen and nutrients from your heart
to the rest of your body. When the arteries in your legs become
blocked, your legs do not receive enough blood or oxygen and
you may have a condition called leg artery disease. Leg artery
disease can cause discomfort or pain when you walk. The pain
can occur in your hips, buttocks, thighs, knees, shins, or upper
feet. Leg artery disease is considered a type of peripheral arterial
disease because it affects arteries that carry blood away from
your heart to your limbs. You are more likely to develop leg
artery disease as you age. One in 3 people age 70 or older has
leg artery disease. Smoking or having diabetes increases your
chances of developing the disease sooner.
The aorta is the largest artery in your body, and it carries
blood away from your heart. Just beneath your belly button
in your abdomen, the aorta splits into the two iliac arteries,
which carry blood into each leg. When the iliac arteries reach
your groin, they split again to become the femoral arteries.
Many smaller arteries branch from your femoral arteries to take
blood down to your toes.
Your arteries are normally smooth and unobstructed on the inside
but, as you age, they can become blocked through a process
called atherosclerosis, which means hardening of the arteries.
As you age, a sticky substance called plaque can build up
in the walls of your arteries. Plaque is made up of cholesterol,
calcium, and fibrous tissue. As more plaque builds up, your
arteries narrow and stiffen. Eventually, enough plaque builds
up to reduce blood flow to your leg arteries. When this happens,
your leg does not receive the oxygen it needs. Physicians
call this leg artery disease. You may feel well and still have
leg artery disease or similar blockages in other arteries to
the heart or brain. It is important to treat this disease not
only because it may place you at a greater risk for limb loss
but also for having a heart attack or stroke.
What are the symptoms?
You may not feel any symptoms from leg artery disease at
first. The most common symptom is intermittent claudication
(IC). IC is discomfort or pain in your legs that happens
when you walk and goes away when you rest. You may not
always feel pain; instead you may feel a tightness, heaviness,
cramping, or weakness in your leg. IC often occurs more quickly
if you walk uphill or up a flight of stairs. Over time, you
may begin to feel IC at shorter walking distances. Only
about 50 percent of the people with leg artery disease have blockages
severe enough to experience IC.
Critical limb ischemia is a symptom that you may experience
if you have advanced leg artery disease. This occurs when
your legs do not get enough oxygen when you are resting.
With critical limb ischemia, you may experience pain in your
feet or in your toes even when you are not walking.
In severe leg artery disease, you may develop painful sores
on your toes or feet. If the circulation in your leg does
not improve, these ulcers can start as dry, gray, or black
sores, and become dead tissue (called gangrene).
What causes leg artery disease?
Atherosclerosis causes leg artery disease. As you get older,
your risk of developing leg artery disease increases. People
older than age 50 have an increased risk of developing the
disease, and men have a greater risk than women. Other factors
that increase your chances of developing the disease include:
- Smoking;
- Diabetes
- High blood pressure
- High cholesterol or triglycerides
- High levels of homocysteine,
an amino acid in your blood
- Weighing over 30 percent more
than your ideal weight
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