What is peripheral arterial disease?
arterial disease (PAD) is poor blood flow in your arteries. Your arteries carry
blood to your organs and muscles. If arteries become narrowed or blocked
because of disease, they cannot carry enough blood to allow your muscles and
organs to work properly.
The most common cause of peripheral
arterial disease is
atherosclerosis, which is the buildup of
plaque on the inside of arteries. The plaque deposits
decrease the space through which oxygen-rich and nutrient-rich blood can flow.
Poor blood flow "starves" the muscles and other tissues in the lower body.
Reduced blood flow may result in intermittent claudication, which
is tightness or squeezing pain in the calf, thigh, or buttock during exertion,
such as walking up a steep hill or a flight of stairs.
high blood pressure, and smoking contribute to
atherosclerosis and peripheral arterial disease.
How is peripheral arterial disease treated?
Lifestyle changes and medicine often can stop or even reverse the buildup
of plaque in your arteries and improve the quality and length of your life. In
many people, leg pain decreases after they have used these treatments for
Quitting smoking is by far the most important factor in
treating peripheral arterial disease. And studies show that nicotine
replacement therapy; use of the medicine
varenicline (Chantix); and supportive therapy
significantly increase long-term success in quitting.1
This success can be critical, because continued smoking is associated not only
with PAD symptoms getting worse but also with a poor outcome, including a
higher chance of having an amputation.2 If you use a
nicotine replacement product or take the medicine bupropion or nortriptyline,
you can double your chances of quitting tobacco for at least 6 months.1, 3
Your doctor also will
strongly advise that you follow a
heart-healthy diet and an
exercise program. You will probably need to take
cholesterol-lowering medicines. People with
diabetes should try to keep their blood sugar levels
as close to normal as possible.
People with PAD who have
intermittent claudication have a higher risk for death, mainly from
heart attack, compared to other people the same age.
Aspirin and strict blood pressure control is often recommended to reduce this
If these measures do not reduce your symptoms, angioplasty
or bypass surgery may be considered to treat severe or limb-threatening
peripheral arterial disease.
What kinds of procedures are done for peripheral arterial disease?
Your doctor will recommend either angioplasty or
bypass surgery if you decide to have a surgical procedure for peripheral
arterial disease. Surgical procedures to treat peripheral arterial disease
Angioplasty. This is a procedure in
which the surgeon inserts a small, thin tube called a catheter through a blood
vessel in the groin and guides it to the affected artery. When the tube reaches
the narrowed part of the artery, the surgeon inflates a balloon to press the
built-up plaque against the wall of the artery and improve blood flow. A small,
expandable wire-mesh tube called a
stent often is placed in the artery to hold it
- Bypass surgery. The types of surgery used to treat PAD are
categorized according to the location of the affected leg artery or arteries.
Common surgeries include:
The bypass surgeries can be done with a vein or with a
man-made (prosthetic) graft. But vein grafts can keep the blood vessel open
longer than the man-made grafts.4
choice of angioplasty or bypass surgery depends on all of the following
- Risks of the procedure.
- Size of the
- Number and length of the narrowing or blockages in the
In general, angioplasty works best in larger arteries.
Angioplasty has the best rates of success in the aorta and in the iliac
arteries, which branch from the lower aorta. In the femoral arteries,
angioplasty works better if the area of narrowing is short. In the past,
doctors have preferred bypass surgery over angioplasty when the narrowing or
blockages are in the popliteal and tibial arteries (which are small arteries).
But angioplasty in these arteries is becoming more successful with advances in
What are the risks of surgical procedures?
surgeries pose a certain amount of risk. In general, the risks of surgery for
peripheral arterial disease (PAD) of the legs are similar to those of other
types of surgery. These risks include:
- Infection from the
- Heart attack or
- Leg swelling.
- Failed or blocked grafts.
Angioplasty has fewer life-threatening risks than
surgery. Risks include:
- Rupture of the artery.
at the site of the catheter insertion.
- Sudden closure of the
- Blood clots.
- Kidney damage.
For more information, see the topic
Peripheral Arterial Disease of the Legs.