Peripheral Artery Stenosis

Peripheral artery stenosis, commonly known as peripheral artery disease (PAD), affects millions of people worldwide when arteries in the limbs become narrowed or blocked, restricting blood flow and potentially causing pain, difficulty walking, and serious complications if left untreated.

Table of contents

• What Is Peripheral Artery Stenosis?
• Other Names for This Condition
• What Causes This Condition?
• Risk Factors
• Signs and Symptoms
• How Is It Diagnosed?
• Treatment Options
• Living With Peripheral Artery Stenosis
• Potential Complications

What Is Peripheral Artery Stenosis?

Peripheral artery stenosis is a condition where the arteries that carry blood to your arms or legs become narrowed or blocked^[1]. This narrowing limits how much blood can flow through these vessels, which means your muscles and tissues don’t get enough oxygen and nutrients, especially when you’re active^[2].

The condition usually affects the legs more than the arms. When arteries in your legs narrow, you might feel pain or cramping in your calves, thighs, or buttocks when you walk or exercise^[1]. This pain typically goes away when you rest.

This condition is quite common. It affects more than 200 million people around the world and around 12 million adults age 40 or older in the United States^[2]. The disease becomes more common as people get older, affecting up to 20% of people over age 70^[4].

Peripheral artery disease, PAD, peripheral arterial disease, peripheral vascular disease, PVD, peripheral vascular occlusive disease, PVOD, peripheral arterial occlusive disease, PAOD, lower extremity peripheral artery disease, lower-extremity PAD, LEAD

Other Names for This Condition

This condition is known by several different names in medical practice. Most commonly, it is called peripheral artery disease or PAD. Other terms you might hear include peripheral arterial disease, peripheral vascular disease (PVD), or peripheral vascular occlusive disease (PVOD)^[6]. Some people refer to it as “hardening of the arteries” or peripheral atherosclerosis^[6]. When the condition specifically affects the legs, doctors may call it lower-extremity PAD or LEAD^[2].

What Causes This Condition?

The main cause of peripheral artery stenosis is atherosclerosis, which is the gradual buildup of fatty deposits called plaque inside your artery walls^[1]. Plaque is a sticky substance made up of cholesterol, fats, and other materials^[6].

Your arteries are shaped like hollow tubes with smooth inner linings that allow blood to flow freely. When you have this condition, plaque slowly forms inside your artery walls, making the space where blood can flow narrower^[2]. Over time, this buildup can make your arteries stiff and unable to widen when your muscles need more blood during physical activity^[7].

Many plaque deposits are hard on the outside but soft on the inside. The hard surface can crack or tear, allowing small particles in your blood called platelets to gather at that spot. Blood clots can form around the plaque, making your artery even narrower^[2]. If the blockage becomes severe enough, it can damage the tissues below the blockage or cause them to die.

Risk Factors

Several factors can increase your chances of developing peripheral artery stenosis. Smoking is the single most important risk factor for this condition^[4]. People who smoke are four times more likely to develop the disease^[4].

Other major risk factors include^[3][4]:

• High blood pressure (hypertension)
• High cholesterol levels, especially when “bad” LDL cholesterol is elevated or “good” HDL cholesterol is low
• Diabetes, both type 1 and type 2
• Chronic kidney disease
• Being over 60 years old
• Family history of peripheral artery disease, heart disease, or stroke
• Obesity (having a body mass index over 30)
• High levels of homocysteine, a protein component in the body

The risk increases significantly when you have multiple risk factors. Having three or more risk factors gives you a 10-fold increase in your chances of developing this disease^[4].

Black people face a higher risk compared to non-Hispanic white people, especially after age 50 in men and age 60 in women^[2]. Hispanic people may have similar or slightly higher rates compared with non-Hispanic white people^[3].

Signs and Symptoms

Many people with peripheral artery stenosis have no symptoms at all, especially in the early stages of the disease^[2]. Up to 4 in 10 people with this condition have no leg pain^[3]. However, when symptoms do occur, they can range from mild to severe.

The classic symptom is leg discomfort during physical activity, called intermittent claudication, which means “to limp”^[4]. This happens because your leg muscles aren’t getting enough oxygen-rich blood when they’re working harder. You might feel pain, cramping, numbness, or fatigue in your calves, thighs, or buttocks^[2]. The discomfort starts during activities like walking or climbing stairs and stops when you rest, usually within 10 minutes^[2].

The location of your pain depends on which artery is narrowed. If you feel discomfort in your buttocks, hip, or thigh, there’s likely narrowing in your lower aorta or iliac arteries in your pelvic area. If the pain is in your calf, the narrowing is probably in your femoral or popliteal arteries in your thigh and knee area^[2].

Other symptoms can include^[1][6]:

• Coldness in your lower leg or foot, especially when one leg feels colder than the other
• Changes in skin color, such as pale, bluish, or shiny skin
• Hair loss on your legs and feet
• Slow-growing or brittle toenails
• Weak or absent pulses in your feet
• Numbness or weakness in your legs
• Sores or ulcers on your feet, legs, or toes that heal slowly or don’t heal at all
• Muscle wasting or shrinking in your legs

As the disease progresses, you may develop pain in your legs, feet, or toes even when you’re resting^[2]. This often happens when you’re lying flat and may improve when you dangle your legs over the edge of your bed. Men might also experience erectile dysfunction, particularly when there’s narrowing in the lower aorta or iliac arteries^[2].

If you experience a sudden blockage, your skin might turn purple, green, black, or very pale, and it may feel cool to the touch or like “pins and needles.” These are signs of severe disease and require immediate medical attention^[2].

How Is It Diagnosed?

If your doctor suspects you have peripheral artery stenosis, they will start with a physical examination. During the exam, they will check the pulses in your legs and feet and listen for unusual sounds in your arteries using a stethoscope^[1][10]. They may notice that your legs have cooler skin, less hair growth, shiny or tight skin, or pale or bluish coloring.

The main test used to diagnose this condition is called an ankle-brachial index, or ABI^[3][10]. This is a simple, noninvasive test that compares the blood pressure in your ankle with the blood pressure in your arm. A difference between the two measurements may indicate blocked or narrowed arteries. Your doctor might also measure your blood pressure before and after you walk on a treadmill to see how exercise affects blood flow^[10].

If you have symptoms of the disease but a normal resting ABI, your doctor may perform an exercise ABI test. This involves taking measurements after you’ve been physically active to see if problems show up during exertion^[14].

Other tests that might be used include^[3][10]:

• Ultrasound, especially Doppler ultrasound, which uses sound waves to create pictures of how blood moves through your blood vessels
• Angiography, which uses a dye injected into your blood vessels and imaging tests to look for blockages
• Magnetic resonance angiography (MRA) or computed tomographic (CT) angiography, which create detailed images of your blood vessels
• Blood tests to check cholesterol levels, blood sugar, and other factors that increase your risk

Current guidelines recommend ABI testing for patients with symptoms or examination findings that suggest this disease. However, routine screening for people who aren’t at increased risk is not recommended^[14].

Treatment Options

Treatment for peripheral artery stenosis aims to reduce symptoms, improve your ability to walk and perform daily activities, and prevent serious complications like heart attack, stroke, or limb loss^[11]. There is no cure for this condition, but various treatments can help manage it effectively.

Lifestyle Changes

Making changes to your daily habits is one of the most important parts of treatment. The two most critical lifestyle changes are stopping smoking and exercising regularly^[12].

If you smoke, quitting is essential. Smoking is the most significant risk factor, and stopping can reduce your symptoms and lower your risk of complications^[11]. It’s also important to avoid secondhand smoke.

Regular exercise, particularly supervised exercise programs, can significantly improve your symptoms. Walking is often the best exercise you can do^[7]. The recommended approach is to walk until you feel pain, rest until the pain goes away, then start walking again. Using this “stop-start” method, try to walk for a total of at least 30 minutes several times a week^[12]. Supervised exercise therapy programs typically involve 2 hours of supervised exercise per week for 3 months^[12].

Other important lifestyle changes include eating a healthy, balanced diet, maintaining a healthy weight if you’re overweight, and limiting alcohol consumption^[12].

Medications

Several types of medications are used to treat peripheral artery stenosis and reduce the risk of complications^[12]:

Statins are prescribed if you have high cholesterol. These medications help reduce the production of “bad” LDL cholesterol by your liver^[12].

Antihypertensives, particularly angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), are used to control high blood pressure and have been shown to reduce illness and death in people with this condition^[14].

Antiplatelet medications, such as aspirin or similar drugs, help prevent blood clots and reduce the risk of serious complications from atherosclerosis^[3][14].

Your doctor may also prescribe medications specifically to help reduce leg pain and improve your ability to walk longer distances.

Surgical and Minimally Invasive Procedures

If lifestyle changes and medications don’t adequately improve your symptoms, or if you have severe blockages, your doctor might recommend a procedure to improve blood flow^[10].

Angioplasty is a minimally invasive procedure where a doctor threads a small balloon attached to a thin tube through your blocked blood vessel. The balloon is inflated to open the vessel and restore normal blood flow^[17].

Stenting involves placing a small metal mesh tube inside your artery to keep it open. Stents come in different sizes to fit specific arteries and are often used when angioplasty alone isn’t enough^[17].

Atherectomy is a procedure that removes the hardened plaque that narrows your arteries using a rotating blade or burr attached to a catheter^[17].

Bypass surgery may be recommended for severe cases or when you have blockages in several arteries. During this procedure, surgeons create a route around your blocked artery using one of your veins or a synthetic tube^[7][17].

It’s important to note that surgical interventions should not be used as a first line of treatment for most patients with intermittent claudication. These procedures are typically reserved for those with lifestyle-limiting symptoms who haven’t improved with other treatments^[14].

Living With Peripheral Artery Stenosis

Living with peripheral artery stenosis requires ongoing attention to your health, but many people manage the condition successfully and maintain active, fulfilling lives.

Daily Self-Care

Taking care of your feet and legs is especially important. Check them daily for sores, cracks, blisters, or any changes in color or temperature^[19]. Even minor problems need attention because wounds may not heal well when blood flow is reduced. Wear shoes that fit properly and are comfortable for walking.

Stay warm, as cold can make symptoms worse. However, avoid using compression socks unless your doctor specifically recommends them, as they can sometimes cause more harm in people with this condition^[19].

Exercise and Activity

Although it may be tempting to limit physical activity because of leg pain, exercise is actually one of the most helpful things you can do. The key is to listen to your body. When your legs start to hurt during walking or exercise, take a break until the pain subsides, then continue^[19]. Don’t push through the pain, as this can make things worse.

Try to exercise for 30 minutes most days of the week. Choose activities you enjoy, such as walking, swimming, or cycling. Having a friend exercise with you can make it more enjoyable and help you stay committed^[19].

Nutrition

Eating a healthy diet can help improve circulation and reduce plaque buildup. Focus on whole foods like fruits, vegetables, whole grains, and lean proteins^[20]. Limit saturated and trans fats, which can raise cholesterol levels. The Mediterranean diet, which emphasizes fruits, vegetables, whole grains, nuts, beans, and olive oil while limiting red meat and processed foods, may be particularly beneficial^[20]. Stay well hydrated by drinking plenty of water throughout the day.

Mental Well-Being

Living with a chronic condition can affect your mental health. The pain and limitations caused by peripheral artery stenosis can be frustrating. If you’re experiencing depression or anxiety, it’s important to seek support^[12]. Consider joining a support group where you can connect with others who understand what you’re going through. Stay in regular contact with your healthcare providers and keep yourself informed about your condition.

Regular Medical Care

Keep up with regular check-ups with your doctor. These visits help monitor your condition and allow your doctor to adjust your treatment plan as needed. Take all prescribed medications as directed, even if you’re feeling better. If you have diabetes, it’s especially important to keep your blood sugar levels well controlled, as poorly controlled diabetes can make symptoms worse^[12].

Potential Complications

While peripheral artery stenosis itself is not immediately life-threatening, it can lead to serious complications if not properly managed^[9].

One of the most serious complications is critical limb ischemia, which occurs when blood flow to your legs becomes severely restricted^[9]. Signs include severe burning pain in your legs and feet that continues even at rest, wounds and ulcers that don’t heal, and changes in skin color including turning black (gangrene). If you develop symptoms of critical limb ischemia, contact your doctor immediately or call emergency services. This condition can be very challenging to treat and may require emergency procedures^[9].

Having peripheral artery stenosis also significantly increases your risk of developing other forms of cardiovascular disease. The atherosclerosis that causes blocked arteries in your legs can also affect arteries supplying your heart and brain^[9]. This means people with this condition have a higher risk of heart attack, stroke, and coronary heart disease. In fact, patients with peripheral artery stenosis have cardiovascular risk equivalent to those who have already had a heart attack^[4].

This is why treatment focuses not only on improving leg symptoms but also on aggressive management of risk factors to improve long-term survival and reduce the risk of heart attack and stroke.