Peripheral arterial disease

About peripheral arterial disease

Peripheral arterial disease is a type of cardiovascular disease. It usually develops when plaques (fatty deposits) build up on the walls of your arteries. This is called atherosclerosis. The fatty deposits can cause your arteries to narrow and this reduces the supply of blood to your muscles and other tissues. If you have peripheral arterial disease, it’s usually your legs which are affected. 

You’re more likely to get peripheral arterial disease as you get older, especially if you smoke or have diabetes. See our section on causes below for more information about who might get peripheral arterial disease. It’s quite common – it affects around one in five people aged over 60.

If you have peripheral arterial disease, you’ll be at higher risk of heart attack and stroke, both of which can also be caused by narrowed blood vessels.

Symptoms of peripheral arterial disease

Many people who have peripheral arterial disease have no symptoms, so you may not know that you have the condition.

The most common symptom of peripheral arterial disease is cramp-like pain, aching or tiredness in your calf when you walk, climb stairs or exercise. It then goes away when you rest for a few minutes. This is called ‘intermittent claudication'. The pain may be worse in one leg than the other, and might also be in your foot, thigh or buttock.

If you’re a man, peripheral arterial disease can be accompanied by erectile dysfunction (difficulty in getting an erection). Over time, as the condition progresses, you may notice that the distance you can walk without pain or discomfort gets less and less.

If you have severe peripheral arterial disease, you may also have:

• pain in your foot or calf at rest or at night
• weakened muscles in your legs
• pale, cool skin on your legs and feet, especially when your feet are put up
• sores or wounds on your toes, feet or legs that won't heal
• hair loss from your toes, feet or legs

If you have any of these symptoms, contact your doctor. If your symptoms develop or change quickly, you may need immediate medical treatment.

Diagnosis of peripheral arterial disease

Your doctor will ask about your symptoms, lifestyle and medical history, including if you’ve got a long-term condition like diabetes. They’ll also ask about your family’s medical history; for example, if there are any heart problems.

They’ll examine you, particularly your legs and feet. They’ll also measure your blood pressure and check the pulses in your groin, foot, and behind your knee. This will show if the blood is not flowing well in part of your body. Comparing the difference between blood pressure in your arm and in your ankle can also help with diagnosis. This is called the ‘ankle brachial pressure index’ (ABPI).

Your doctor may refer you to see a vascular surgeon, who specialises in diseases of the blood vessels outside the heart, to confirm your diagnosis. They may advise you to have an imaging test to find out where and by how much your arteries are narrowed. The types of imaging test are explained below.

• A special type of ultrasound scan called Doppler ultrasonography or duplex ultrasound. This uses sound waves to produce an image of the inside of your body, including your arteries and how blood flows through them. 
• Angiography. This is a test that uses an injection of a special dye into your blood vessels to make them clearly visible on X-ray images. This may be combined with a CT scan or an RI scan. Or you may be offered a test called digital subtraction angiography where the dye is injected straight into your artery and X-ray images are taken.

Self-help for peripheral arterial disease

There are lots of things you can do yourself to help control the symptoms of peripheral arterial disease and keep your legs healthy. Having a healthier lifestyle will also reduce your chance of having a heart attack or a stroke. 

Healthy changes you can make to your lifestyle include the following.

• If you’re a smoker, stopping smoking is the single most important thing you can do to prevent your peripheral arterial disease getting worse.
• Increase the amount of physical activity you do. Try to build up your exercise gradually until you’re doing activities such as walking for 30 minutes at least five times a week. If it becomes painful, take a short break until the pain stops. Ask your doctor about supervised exercise classes (see our treatment section below for more information).
• If you have diabetes – either type 1 or  – make sure that your blood glucose levels are well controlled by being careful with what you eat.
• Have your blood pressure checked regularly, and make sure you take any blood pressure medicines your doctor prescribes.
• If you’re overweight, try to get down to a healthy weight.
• Eat a healthy, balanced diet.
• Look after your feet. Wear well-fitting shoes that give good support. Try to avoid going barefoot and letting your feet get very hot or cold. Take care when cutting your toenails – consider visiting a chiropodist or podiatrist.

Treatment of peripheral arterial disease

Lifestyle changes and treatments aim to reduce your symptoms and stop peripheral arterial disease from getting worse. See our section on self-help above for more information about healthy changes you can make to your lifestyle.

Your doctor may also recommend treatments to reduce your chance of developing other cardiovascular problems such as heart attack and stroke.

Supervised exercise programme

If they are available in your area, your doctor may recommend you attend supervised exercise classes for people with peripheral arterial disease. These may be held at hospital or in a community or leisure centre. They’ll usually involve two or three sessions of 30 to 45 minutes a week over a three-month period.

Medicines

To help manage your condition, it’s important to treat any other health problems that may make it worse. So, if you have high cholesterol, high blood pressure or diabetes, your doctor will recommend medications to control these.

They may advise you to take medicines called statins and/or a blood-thinning medicine, such as aspirin or clopidogrel to reduce your risk of having a heart attack or stroke.

Surgery

Surgery may be an option if lifestyle changes (including an exercise programme) aren’t helping you or your symptoms are getting worse and seriously affecting you.

There are two different operations to treat peripheral arterial disease:

• angioplasty
• bypass surgery 

These are described in turn below. Your surgeon will talk to you about which operation is best for you and discuss the risks and benefits of each. You’ll recover more quickly after an angioplasty, and may have fewer complications from the procedure. But bypass surgery may give longer-lasting treatment. You should feel free to ask your doctor any questions you have.

Angioplasty

In an angioplasty, a radiologist or surgeon will insert a catheter (fine tube) with a small balloon on the end into your narrowed artery. They’ll inflate the balloon to stretch your artery and squash the fatty tissue inside to allow more blood to flow through. A stent may be put inside the artery. This is a small wire-mesh tube that will hold your artery open, and is left in place after the catheter is removed. You may need to stay in hospital overnight after an angioplasty, or be able to leave the same day.

Bypass surgery

In bypass surgery, your surgeon will create a detour around the blockage in your artery. They’ll use a healthy blood vessel taken from somewhere else in your body, usually an arm or leg. If it’s not possible to use one of your own blood vessels, an artificial tube will be used instead. You’ll only be offered bypass surgery if your leg pain is severely affecting your day-to-day life. You’ll probably need to stay in hospital for at least a week. You should take it easy for a while afterwards but do regular gentle exercise.

Causes of peripheral arterial disease

Peripheral arterial disease is usually caused by fatty deposits forming in your arteries (atherosclerosis). You’re more likely to develop peripheral arterial disease as you get older.

You’re also more at risk if you:

• smoke
• have diabetes, either type 1 or type 2
• have high blood pressure
• have high cholesterol
• are obese
• are physically inactive
• have personal or family history of peripheral arterial disease, coronary heart disease or stroke

Complications of peripheral arterial disease

If you have peripheral arterial disease, you may also have a build-up of fatty deposits in the walls of other arteries in your body. This may lead to:

• coronary heart disease (including angina and heart attack), if the arteries supplying blood to your heart are affected 
• stroke, if an artery in your neck that supplies blood to your brain is affected

Critical limb ischaemia

Around one in five people who have leg pain when walking (intermittent claudication) will develop critical limb ischaemia. This is when the blood flow to your legs becomes so restricted that you get pain even at rest. This may be at night, when you’ll find the only way to relieve the pain is to hang your leg out of bed.

The severe lack of blood flow may also cause damage to the tissues of your leg so you may get ulcers or wounds that don’t heal. This can sometimes lead to gangrene, where some of the tissues die due to a lack of blood supply. It can be painful, and it can get infected and make you very unwell.

See our section on symptoms above for what you may notice if you have severe peripheral arterial disease. If you have critical limb ischaemia, you doctor will discuss your options for treatment. This may involve removing areas of dead tissue.

Special considerations if you're pregnant

The way your heart and circulation works changes when you’re pregnant. From just a few weeks into your pregnancy, your heart has to pump harder and faster. If you have valve disease, your heart might have trouble coping. In fact, some women are first diagnosed with valve disease when they become pregnant because they get symptoms for the first time. If you have heart valve disease, you’re likely to need regular check-ups while you’re pregnant and close monitoring for you and your baby. Depending on your health and the type of valve disease you have, you may need treatment while you’re pregnant. You may also need specialist care when you give birth. Talk to your midwife and obstetrician for more information.