That sudden cramp in your legs when you walk, that sneaky pain that disappears when you stop, or your feet never getting warm… Often, we dismiss these symptoms as “old age” or "tiredness", but they can be signs of a disease that is critically important in medicine, called Peripheral Artery Disease (PAD). If left untreated, the disease directly threatens not only your ability to walk but also your heart health.
What is Artery Disease?
Our blood vessels are highways that transport oxygen and nutrients to all parts of our body. This process is called atherosclerosis (hardening of the arteries). Fat and cholesterol build up on the walls of these highways and form plaques. Over time these plaques constrict or entirely block the arteries, limiting blood flow to the legs. It’s not just in the legs. Many people with arterial disease also have similar problems in the vessels of the heart and brain.
What are the basic differences between arterial and venous disease?
Diseases of arteries (arterial) and veins (venous) are two major groups that influence different characteristics and mechanisms of blood circulation in the legs. Arterial diseases are serious nutritional problems related to the inability of blood to “reach” the leg. Venous diseases are problems of pressure and congestion related to the inability of blood to "return". Both conditions should be referred to a specialist vascular surgeon.
- • Arterial Disease (PAD): This condition is characterised by the narrowing or blockage of arteries that carry oxygenated and clean blood from the heart to the tissues (legs), typically due to atherosclerosis (plaque buildup).
- • Venous Disease (CVI/Varicose Veins): The failure of the valves in the veins that return blood from the legs to the heart to prevent the backflow (reflux) of blood and pooling in the legs.
What Are the Symptoms of Artery Disease?
Peripheral artery disease (PAD) is usually caused by narrowed or blocked arteries in the legs. The symptoms may vary greatly depending on how far the disease has progressed. Some people are asymptomatic initially, but functional limits can be found in these patients when testing is performed.
Early-Stage Symptoms
The most classic and common sign of the condition. It is identified by the following characteristics: • Pain when walking: This is generally described as a feeling of weariness, tightness or pain in the calf, hip or thigh muscles.
- • Exercise-induced – pain begins when walking or climbing stairs.
- • Relief with relaxation: The discomfort fades totally when you stop and relax for a few minutes.
- • Reproducibility: The discomfort generally recurs while walking the same distance or exercising at the same incline.
Symptoms Abnormal
Note that in around half the patients “atypical” complaints are seen instead of conventional claudication. This can make it difficult to diagnose: • Feeling tired or weak in the legs.
- • Leg discomfort that begins with exercise but does not immediately resolve with rest, or that is intermittent.
Advanced Stage: Critical Limb Ischaemia (CLI)
With increasing arterial blockage, the blood flow becomes inadequate for the nourishment of the resting tissue. This condition necessitates emergency medical intervention:
- • Rest discomfort: A persistent discomfort, usually in the front of the foot or toes, especially at night, that wakes a person from sleep. You can also dangle your feet over the edge of the bed to increase blood flow and provide some pain relief.
- • Non-healing wounds: Ulcers on the ankle, heel or toes that do not heal in weeks.
- • Gangrene: The death of tissue caused by a lack of blood flow.
Physical Exam Results
The following symptoms suggest the presence of PAD during the doctor’s examination:
- • Loss of Pulse: Decreased or no pulse in the arteries of the top of the foot or inner wrist.
- • Skin changes: Brightness, thinness or paleness of the skin on the leg; loss of hair on the legs and thickening of the nails.
- • Temperature Difference: The affected limb or foot is cooler than the other.
- • Colour Change: The leg becomes over-white when lifted and a deep crimson or purple colour (dependent rubor) when dependent.
- • Muscle Wastage: Weakness and loss of leg muscle strength owing to decreased blood flow over a lengthy period.
If you suffer from frequent cramping in the legs when walking or cuts on the feet that do not heal, visit our cardiovascular surgery specialist in Istanbul. It is very important to consult Prof. Dr Cenk Eray Yıldız. The best way to prevent loss of limbs and systemic problems such as heart attacks/strokes is early detection.
Risk Factors:
- • Smoking: It is the most important and substantial risk factor for PAD. The risk for active smokers is 16 times higher than for non-smokers and 7 times higher in former smokers. Cigaret smoke also destroys the vessel walls, which speeds plaque formation.
- • Sedentary lifestyle: Lack of regular physical activity has a detrimental effect on vascular health.
Nutrition and Obesity: High-fat diets and excess weight (obesity) initiate and promote the process of arteriosclerosis (atherosclerosis) and increase the risk.
- • Diabetes (Sugar Disease): This is a very important risk factor; every 1% increase in glycosylated haemoglobin (HbA1c) increases the risk of PAD by 25%. In diabetics, vascular occlusion is more aggressive, and the danger of limb loss is substantially higher.
- • Hypertension (High Blood Pressure): It almost doubles the risk of PAD.
- • Hyperlipidaemia (High Cholesterol): This condition is characterised by high levels of total cholesterol and LDL (bad cholesterol) in the blood and low levels of HDL (good cholesterol). This leads to plaque build-up in the blood vessels.
- • Renal Failure: People with chronic renal disease are in a high-risk group.
Polyvascular Disease: People with blockages in the vessels of the heart (coronary) or brain vessels have a 30% to 50% incidence of disease in the leg vessels.
- • Age – An important risk factor for PAD. The risk usually begins to increase after the age of 50 years. The disease is seen in about 10-20% of those over the age of 60 years.
- • Gender: It is more common in men than in women, but the disparity lessens with age.
- • Ethnic Origin: The risk of getting PAD in people of African origin (Blacks) is 2 times higher than in whites.
- • Family History: There is a hereditary risk for those with a family history of peripheral arterial disease or vascular stiffness in general.
- • Socioeconomic Status: Low-income and low-education communities experience a higher incidence of PAD and accompanying limb loss.
Diagnosis and Therapy
If arterial occlusion is suspected, the initial step is usually a simple and painless test termed the Ankle Brachial Index (ABI). In this test, a comparison is made between the pressure in your ankle and that in your arm. If a more extensive examination is needed, a vascular map is generated using Doppler ultrasonography, MR angiography (MRA) or computed tomography (CT).
Lifestyle and Exercise
The First Step and Most Important Step Treatment is based on protection of the blood vessels.
- • Stop Smoking: This is the most critical thing you can do for your vascular health and greatly minimises the chance of limb loss and death.
- • Walking Therapy: The cure for this ailment is a matter of “walking through the pain". Supervised walking programmes (30-45 minutes, at least 3 days a week) assist the blood vessels build collateral paths, extending your walking distance.
Drug Therapy
Your doctor may give medicines such as aspirin or clopidogrel to thin the blood, statins to reduce cholesterol and cilostazol to increase the walking distance.
Surgical Procedures
If medication and exercise are not enough, the following are utilised to unblock the blocked artery: • Angioplasty and Stent: A thin catheter is put through the groin area, and a balloon is inflated to open the blockage in the artery. If necessary, a metal cage (stent) is put there.
- • Bypass Surgery: A new path (bridge) is made for blood to flow around the blockage. For this, usually the patient’s own veins or synthetic grafts are employed.
- • Thrombectomy/Thrombolysis: Medications to break up a clot are used, or a surgical operation is performed to remove a clot that abruptly blocks a blood vessel.
Are there any risks with surgical methods?
Sources said there are significant hazards with surgical treatments employed in the treatment of both venous (varicose veins) and arterial illnesses.
Dangers of Venous (Varicose Vein)
Open surgical techniques (stripping, ligation) performed for varicose veins are typically safe but may have the following complications: • Risks in the operation: sometimes bleeding (0.01-0.1%), injury to nerves (0.01-6.6%) and damage to major vessels.
- • Complications after the operation: The most prevalent are haematoma (blood collection under the skin), wound infection and healing issues. Haematoma development is more frequent with surgical than with non-surgical procedures.
- • Serious complications: Very low rates can lead to deep vein thrombosis (DVT), pulmonary embolism and lymphoedema due to damage to the lymphatic channels.
- • Recurrence: Between 20% and 28% of people who had this procedure will develop varicose veins again.
Risks of Artery Disease Surgery
Because of the severity of the condition, bypass or other surgical techniques for blocked arteries involve more serious risks:
- • Infection and Thrombosis: Surgical procedures carry a greater risk of wound infection than closed (endovascular) procedures. Also, the risk of thrombosis (clot formation) in the first 30 days after surgery has been found to be increased in surgical procedures.
Systemic Risks: Serious complications such as heart attack, stroke and death may occur after major surgery, especially if conducted for critical limb ischaemia.
- • Risks of Anaesthesia. Surgery usually needs general anaesthesia, which is an added risk factor for people with heart or lung problems.
- • Recovery Time: Hospital stay and return to regular life time are often longer in surgical methods than minimally invasive methods.
Early Diagnosis Saves Life
Don’t let your leg discomfort be a “normal” part of ageing. Prof. Dr Cenk Eray Yıldız, Turkey's most experienced cardiovascular surgeon with more than 25 years of expertise in the field, offers services to safeguard your vascular health with the most contemporary and minimally invasive (closed) techniques. Early diagnosis not only saves you from losing your leg but also minimises your risk of heart attack and stroke.
F.A.Q.
Will I lose my limb because of Peripheral Artery Disease (PAD)?
If untreated and progressive, particularly in association with diabetes and smoking, PAD can result in gangrene and loss of the limb (amputation).
Is it exclusively observed in the elderly?
The risk rises after age 50 but can occur at a much younger age among diabetics and heavy smokers.
How are varicose veins different from arterial disease?
Varicose veins are a problem with veins, making it difficult for blood to get back to the heart. PAD is a problem with arteries, preventing clean blood from getting to the legs.
Is the ABI test painful?
No, the ABI test is a simple technique that measures blood pressure in your arms and ankles and is absolutely painless.
If I stop smoking, would my blood vessels get cleared of blockages?
It won’t entirely remove the current obstruction, but it will stop the disease from progressing and considerably decrease the chances of consequences.
When I walk, my leg hurts. Should I keep walking?
Yes, PAD patients are encouraged for restricted exercise regimens designed as 'walking to pain and resting'.
Does the stent obstruct again?
Yes, it's possible that narrowing (restenosis) could come back again in the location of the stent over time; taking the medication as prescribed helps to lower the chance of this happening.
Can a blood vessel be opened without surgery?
Yes. Angioplasty, stenting, etc., are interventional procedures done without cutting. They go in through a needle hole.
Do I have to be on blood thinners?
Most PAD patients should be on blood thinners for life to decrease the chances of blood clots and heart attack/stroke owing to obstruction of the vessels.
When is bypass needed?
Surgical bypass is chosen in case of very long, diffuse occlusions or if the other methods of angioplasty/stent have failed.
Are my wounds on my feet due to vascular occlusion?
Yes, when the leg does not have enough blood circulation, even the slightest scratches will not heal and can develop into severe venous/arterial ulcers.
Does chilly weather aggravate my pain?
Yes, cold can cause blood vessels to contract (vasoconstriction), which reduces blood flow that is already reduced and can lead to pain.
Does diet change assist PAD?
The Mediterranean diet (olive oil, vegetables, fruits, and fish) is good for vascular health and minimises the incidence of PAD.
Can herbal products clear vascular obstructions?
Some supplements like Ginkgo biloba might marginally improve walking distance. But they cannot open a physical blockage in the vessel without medical treatment.
Are PADs spread?
No, PAD is not contagious; it is only a lifestyle, hereditary and systemic health problem.
