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Peripheral Artery Disease of the Legs

Maybe you walk less than you used to because of "muscle aches" in your legs. Or you've had a sore on your foot that seemed to take forever to heal. Perhaps you've also heard you have "poor circulation."

These are the sneaky symptoms of peripheral artery disease, or PAD, which affect 8 million Americans. Peripheral artery disease narrows arteries in the legs, limiting blood flow to your muscles. It can take you by surprise, causing no symptoms at all -- or symptoms you may think are something else.

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PAD is usually caused by atherosclerosis, the same disease process that causes heart attacks and strokes. And even mild peripheral artery disease is an important signal that atherosclerosis might be affecting vital arteries elsewhere.

Symptoms of Peripheral Artery Disease of the Legs

Atherosclerosis is a disease process that occurs throughout the arteries of the body. Common causes include high blood pressure, high cholesterol, cigarette smoking, and lack of exercise.

Over years, plaques made of cholesterol and debris gradually obstruct the arteries.

When atherosclerosis narrows the long arteries of the legs, blood flow to the leg muscles becomes inadequate when the muscles are working. Muscle pain, called intermittent claudication, can result. Claudication typically comes on with exercise, and is relieved with rest.

Depending on the arteries that are affected and where the blockage is, different muscle groups can be affected:

  • Buttock and hip
  • Thigh
  • Calf (most common)
  • Foot (less common)

But pain can be atypical and occasionally attributed to something else. Some patients describe burning or numbness. There also can be severe blockages with no pain at all. Often this is because the body grows blood vessels that "bypass" the blockages, called collateral circulation.

Other signs and symptoms of peripheral artery disease include:

  • Wounds that heal poorly
  • Legs are cooler than the arms
  • Shiny skin over the legs
  • Loss of hair on the legs
  • Decreased pulses in the feet

Atherosclerosis causes peripheral artery disease, coronary artery disease, and strokes through the same general process. For this reason, the risk factors for peripheral artery disease are the same as for heart attacks and strokes:

  • Diabetes
  • Abnormal cholesterol
  • Cigarette smoking
  • High blood pressure

Diabetes seems to be particularly important in the development of peripheral artery disease. People with diabetes have worse peripheral artery disease, and tend to improve less with treatment.

Diagnosing Peripheral Artery Disease of the Legs

Diagnosing peripheral artery disease is simple and painless. Most commonly, doctors use the ankle-brachial index (ABI). Using a handheld ultrasound probe, the blood pressure at the ankle and upper arm is calculated; it should be roughly equal. If the pressure in the ankle is significantly less, peripheral artery disease is present.

For severe peripheral artery disease, an angiogram can allow a doctor to see the exact location of the blockage. This can be important if your doctor is recommending bypass surgery

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