Leg Artery Disease
- Leg artery disease (LAD), also called peripheral artery disease, refers to a partial or complete blockage of the circulation to the legs and feet (through the arteries of the leg). This compromised blood flow can cause problems in the hip, buttock, thigh, knee, shin, or upper foot. Atherosclerosis (hardening of the arteries) is considered the primary cause.
- The risk factors for LAD include diabetes mellitus, smoking, high blood pressure, high blood cholesterol, male gender, advanced age, and a sedentary lifestyle.
- Discomfort in the leg muscles while walking (a phenomenon called intermittent claudication) is a common symptom of LAD.
Many cases of leg artery disease are ‘silent,’ meaning that the person with the disease may not experience any noticeable symptoms (it is asymptomatic). However, asymptomatic peripheral artery disease is a serious issue. Even though the individual feels well, he or she is at significantly increased risk of suffering a heart attack or stroke.
Discomfort in the legs is a common first symptom of leg artery disease. Called intermittent claudication (or, IC), the discomfort usually occurs in large muscles in one or both legs during exercise such as walking. Not every person with LAD experiences leg pain. Some people may feel a tightness, heaviness, cramping, or weakness in the leg.
When people experience IC, the discomfort tends to occur consistently—typically each time a person walks a certain distance—and fades away within a few minutes after the person stops to rest. As LAD progresses, leg pain may occur even with shorter stretches of physical activity. Eventually a person may feel pain in the arch of the foot (even while at rest), when reduced blood flow prevents tissues from getting enough oxygen, a condition called critical limb ischemia. Many people with advanced leg artery disease report pain in the arches of their feet or in their toes while lying down.
In severe cases of leg artery disease, people may develop painful skin ulcers on their toes or feet.
Causes & Risk Factors
As people age, the normal flow of blood through the legs and feet can be affected by the buildup of plaque inside the arteries. Over time, these plaques continue to grow on arterial walls as cholesterol circulates in the blood, and as the plaque collects, the arteries become narrow and stiffened. This process is called atherosclerosis (commonly known as ‘hardening of the arteries’). When this narrowing occurs in leg arteries, the circulation of blood through the leg is compromised. Poor circulation in turn can cause ischemia—a decrease in blood flow that causes insufficient oxygen levels.
Atherosclerosis may also cause coronary heart disease (CHD) when plaque causes blockages in the arteries that bring blood to the heart muscle. Carotid artery disease, or plaque buildup that interferes with the flow of blood to the brain, is also caused by atherosclerosis. These conditions are serious because CHD can cause heart attacks, and carotid artery disease can result in stroke.
Physicians estimate that thirty to forty percent of people with CHD or carotid artery disease also suffer from leg artery disease or another form of PAD. Fifty to sixty percent of patients with PAD will also develop either CHD or carotid artery disease.
A person’s risk of developing leg artery disease increases with age, with people over age 50 being at greatest risk of developing the disease. More men than women tend to develop leg artery disease.
Other factors that contribute to the risk of developing leg artery disease are:
- Hypertension (high blood pressure)
- Diabetes mellitus
- High levels of cholesterol or triglycerides in the blood
- Being more than 30 percent over one’s optimal weight
- Having high levels of an amino acid called homocysteine in the blood
Physicians can diagnose LAD by carefully reviewing a patient’s medical history and performing a physical examination that includes measuring the blood pressure in the legs, testing blood cholesterol levels, and analyzing a person’s self-described symptoms. During testing, a physician will also assess the strength of the pulse in arteries behind the knee and on the foot. Weak or absent pulses in those areas may indicate LAD.
To test the blood pressure in the legs, the physician will measure the ankle/brachial index, or ABI. This painless test combines a traditional blood-pressure device and Doppler ultrasound to compare the blood pressure in a person’s arms to the blood pressure in that person’s legs.
To provide more information about the extent of LAD, doctors may perform other tests, including:
- Duplex Ultrasound
- Pulse Volume Recording
- Magnetic Resonance Imaging
When detected early, LAD can be treated with exercise, weight reduction, control of blood sugar, reduction in blood pressure, cholesterol management, and the adoption of other healthy lifestyle changes.
Medications (including those that help control blood pressure, lower cholesterol levels, and block platelets) are also sometimes used to treat less-advanced cases of LAD. While these drugs do not treat LAD or its symptoms directly, they can help to prevent coronary and carotid disease, and help prevent atherosclerosis from worsening.
In many cases of LAD, these kinds of changes and treatments are not enough. In some people, the leg artery disease is so advanced that it does not respond to lifestyle management changes. In these cases, surgical procedures may be the solution.
Minimally invasive procedures such as angioplasty may be helpful for some advanced cases. For more advanced forms of LAD, direct reconstruction of the circulation, usually with a surgical bypass graft or endarterectomy, may be needed to relieve symptoms. An endarterectomy can be performed to clear plaque from leg arteries.
As a last resort, when all treatments fail and the person’s circulation is so severely compromised that leg tissue has become gangrenous, amputation or removal of the lower leg or foot may be required. In approximately 90 percent of the cases, however, amputation can be avoided or limited to the toes.
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Medical Review Date: November 24, 2009 / Copyright © 2012 NorthPoint Domain, Inc. All rights reserved. This material cannot be reproduced in digital or printed form without the express consent of NorthPoint Domain, Inc. Unauthorized copying or distribution of NorthPoint Domain’s Content is an infringement of the copyright holder’s rights.