Information for patients, their families and carers
What is Peripheral Arterial Disease?
Peripheral Arterial Disease (PAD) is also sometimes called Peripheral Vascular Disease (PVD) which is the narrowing of one or more of the large blood vessels called arteries which carry blood to your legs.
Arteries become narrow when clumps of fat called plaques build up inside the artery wall. It's a bit like scale that forms on the inside of water pipes. If you have Peripheral Arterial Disease this indicates that you are at risk of developing other cardiovascular problems such as angina or having a heart attack or a stroke. As you have narrowed arteries in your legs and feet blood vessels in other parts of your body are likely to be affected also.
Your health care professional will discuss with you how severely the blood flow to your legs is restricted.
What are the symptoms?
Typical symptoms will be cramp-like pain that develops in one or both of your calves, thighs or buttocks when you walk or exercise. This is called 'intermittent claudication'. When you walk, your calf muscles need extra blood and oxygen supplies. The narrowed arteries cannot deliver sufficient supplies therefore you get pain because your muscles are starved of oxygen. The pain soon goes when you stop because you do not require the extra blood and oxygen supply. The pain comes on more rapidly when you walk up a hill or stairs when you are demanding a greater blood supply.
Other signs that you have the problem may include:
- Poor hair growth below your knee
- Poor toenail growth or thickened toe nails
- Sores on your toes, feet or legs that won't heal
- Cold or change in colour of your feet
Some people with Peripheral Arterial Disease develop Chronic Limb Threatening Ischaemia which is a serious condition that can be life threatening. If the blood supply is severely restricted, this results with pain being experienced at rest. In severe cases foot ulcers or gangrene may develop and sometimes amputation is needed.
What can be done?
Self-help is a major part of treating Peripheral Arterial Disease. Treatments for Peripheral Arterial Disease are aimed at relieving the symptoms and reducing the risk of further Cardiovascular Disease.
Taking your Medication
It is recommended that you take certain medication if you are diagnosed with Peripheral Arterial Disease. These include antiplatelet agents such as Clopidogrel or Aspirin which help to reduce the risk of clot formation on the walls of the arteries by making the blood less sticky, and a statin which helps to lower your cholesterol levels. If your blood pressure is high, medication to reduce this will also be advised.
This medication will help to reduce your risk of suffering from further cardiovascular events such as heart attacks and strokes, and it is important that you take it if prescribed.
Pain relief
As well as following an exercise programme please continue to take any medicines for pain relief as they have been prescribed and seek support from your GP or health care professional if your pain is not under control.
It is therefore essential that you see your doctor or practice nurse for regular blood pressure checks and if you are prescribed medication you take it regularly. It is also important to reduce your risk factors for high blood pressure.
Important lifestyle changes you can make
Smoking
If you smoke, stopping smoking is the most important thing you can do for two reasons:
1. Smoking speeds up the process of hardening of the arteries. Smoking may prevent the development of new blood vessels which allows blood to by-pass blockages and narrowed arteries.
2. Stopping smoking also greatly reduces your risk of having a heart attack or stroke.
There is a lot of support available to help stop smoking. Please ask your health care professional for further help and advice or log onto: www.smokefreelancashire.org.uk
Exercise
Regular exercise will make your heart and blood circulatory system more efficient because it will: lower your cholesterol level, help keep your blood pressure at a healthy level and help you to reduce weight.
Regular exercise will also help people suffering from claudication pain. When the arteries become hardened in the leg and claudication pain occurs, the body tries to compensate. It does this by getting blood to bypass any blockage - we call these collaterals. When you exercise the number and size of the collaterals increase.
Walk until the pain develops, then rest for a few minutes. Carry on walking when the pain has eased. The pain is not damaging to the muscles. By improving the collateral circulation, you will be able to walk further before the pain stops you. It is important to exercise daily for about 30 minutes a day to get maximum effects and to create new collaterals.
Regular exercise will improve your fitness and well-being. Lots of community exercise programmes are available and where appropriate you can be referred to the healthy lifestyles team by your healthcare professional.
Managing Diabetes
If you are diabetic, it is important to ensure that your blood glucose levels are kept stable and within range. When you have consistently high blood glucose this can cause damage to your arteries and increase the risk of developing Peripheral Arterial Disease. Help and support can be obtained from your GP or specialist diabetes service.
For more information visit Diabetes - NHS (www.nhs.uk)
Healthy eating
A high fat diet is a major risk for developing narrowing arteries. High fat foods can cause a build-up of fatty plaques in the arteries and being overweight can lead to high blood pressure.
To prevent a build-up of plaques in the arteries a low fat, high fibre diet is recommended which includes plenty of fresh fruit and vegetables. The recommendation is five portions a day. It is also important to limit your daily salt intake as too much can increase your blood pressure.
Weight management
If you are overweight or obese, aim to lose weight and maintain a healthy weight by using a combination of regular exercise and a calorie-controlled diet. Your GP or health care professional will be able to advise you on support services to lose weight and eat healthily or further advice can be obtained from:
Lose weight - Better Health - NHS (www.nhs.uk)
Lowering your blood cholesterol
High fat levels which raise the blood cholesterol level play an important part in the build-up of plaques in the arteries.
A low-fat diet could help to reduce your cholesterol level. Try eating lean meat, low fat spreads, skimmed milk and reduce your saturated fat intake.
It is important to have regular checks of your cholesterol level. Your GP will decide how often this will be done. If you have been diagnosed with Peripheral Arterial Disease it is recommended that you take a medication called a statin. It is important to take your medication regularly.
Looking after yourself with a pre-existing condition
Managing High Blood Pressure (Hypertension)
High blood pressure will damage your arteries in the same way that smoking does. Your arteries are designed to pump blood at a certain pressure. If that pressure is exceeded, the walls of the arteries will be damaged. High blood pressure can be caused by:
- Being overweight
- Drinking excessive amounts of alcohol
- Stress
- Smoking
- Lack of exercise
Other treatment options
In some patients where exercise programmes have not relieved your symptoms sufficiently another option is surgery called Revascularisation (procedures on the arteries that increase the amount of blood that can get to your legs). Your health care team or GP will be able to give you specific information on whether this will be appropriate or advisable and the risks involved.
Depending on your condition health care professionals managing your Peripheral Arterial Disease may signpost you to other health services to manage your condition.
Support for patients with Peripheral Arterial Disease
Being diagnosed with Peripheral Arterial Disease can make some people feel anxious or depressed. Please contact your GP or healthcare professional if you need further support or information about your condition or treatment.
Local counselling links can be accessed via the Circulation Foundation website: http://www.circulationfoundation.org.uk/helpadvice/
You can also access the Lower Limb Vascular Service web page for more information, support and advice.
References and Useful Sources of Information
Circulation Foundation: www.circulationfoundation.org.uk
NICE (2012) Lower Limb peripheral arterial disease: diagnosis and management NICE clinical guideline
Peripheral arterial Disease: www.nhs.uk
Peripheral arterial disease in legs go to www.patient.co.uk then type Peripheral Arterial Disease in the search bar.