Arteriosclerosis of the extremities

Definition:

Arteriosclerosis of the extremities is a disease of the blood vessels characterized by narrowing and hardening of the arteries that supply the legs and feet. This causes a decrease in blood flow that can injure nerves and other tissues.

Alternative Names:

Peripheral vascular disease; PVD; Peripheral arterial disease; PAD; Arteriosclerosis obliterans

Causes, incidence, and risk factors:

Arteriosclerosis, or "hardening of the arteries," commonly shows its effects first in the legs and feet. The narrowing of the arteries may progress to total closure (occlusion) of the vessel. The vessel walls become less elastic and cannot dilate to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness. The effects of these deposits may be seen on ordinary X-rays.

This is a common disorder, usually affecting men over 50 years old. People are at higher risk if they have a personal or family history of coronary artery disease (heart disease) or cerebrovascular disease (stroke), diabetes, smoking, hypertension, or kidney disease involving hemodialysis.

Symptoms:

Often, symptoms affect one limb. If arteriosclerosis exists in both limbs, the intensity is usually different in each.

Leg pain (intermittent claudication)
- Occurs with exercise (such as walking)
- Relieved with rest
Numbness of the legs or feet at rest
Cold legs or feet
Muscle pain in the thighs, calves, or feet
Loss of hair on the legs and/or feet
Change of color of the legs
Paleness or blueness (cyanosis)
Pulse, weak or absent in the limb
Walking/gait abnormalities

Signs and tests:

An examination may show arterial bruits (whooshing sound heard with the stethoscope over the artery), decreased or absent pulse in the extremities, or decreased blood pressure in the affected limb.

Blood tests may show high cholesterol.

Peripheral artery disease may be revealed by:

An abnormal ratio between the blood pressure of the ankle and arm (ankle/brachial index, or ABI)
A Doppler ultrasound exam of an extremity
Angiography of the arteries in the legs (arteriography)
Intravascular ultrasound (IVUS) of the extremity
An MRI scan

Treatment:

Treatment focuses on the relief of symptoms and self-care to improve circulation.

Medications may be required to control the disorder, including pain relievers, blood thinners, and medications to enlarge or dilate the affected artery(ies)

Surgery is usually performed only on severe cases where the ability to work or pursue essential activities is affected. Surgery may consist of removing the lining of the artery (endarterectomy), or repairing or replacing the vessel (grafting); most commonly, bypass surgery is performed, using a vein or synthetic graft.

Alternatives to surgery may include treatments such as balloon angioplasty (a similar technique to that used to open the coronary arteries, but performed on the blood vessels of the affected extremity), sometimes followed by stent implantation, laser treatment, or other treatments.

Self-care:
Exercise must be balanced with rest. Walking or other activity, performed to the point of pain and alternated with rest periods, is often recommended. Over time, circulation improves because of the development of collateral (new, small) blood vessels.

Stop smoking! Smoking constricts arteries, decreases the blood's ability to carry oxygen and increases the risk of forming clots (thrombi and emboli).

Foot care is particularly important if diabetes is also present. Wear shoes that fit properly. Pay attention to any cuts, scrapes or injury -- the tissues heal slowly when there is decreased circulation and are prone to infection.

If cholesterol is high, change the diet to a low-cholesterol and low-fat diet.

Expectations (prognosis):

Arteriosclerosis of the extremities is usually controllable with treatment. Surgery provides good relief of symptoms. Complications may require amputation of the extremity.

Complications:

Injury or infection of the feet and legs
Presence of open sores (ischemic ulcers) on the lower extremities
Ulcers on the feet and toes
Gangrene (tissue death) -- see gas gangrene
Arterial emboli
Impotence

Calling your health care provider:

Call your health care provider if symptoms indicate arteriosclerosis of the extremities.

Call your health care provider if new symptoms develop, especially formation of new sores/ulcers or signs of infection (fever, redness, general ill feeling, or joint pain).

Prevention:

Control risk factors such as obesity, high blood pressure, and smoking.

Review Date: 5/25/2002
Reviewed By: Seth Keller, M.D., Division of Cardiology, Yale New Haven Medical Center, New Haven, CT. Review provided by VeriMed Healthcare Network.

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