Peripheral Artery Disease

Have you heard the term “poor circulation?” It’s what happens when you have peripheral artery disease. This condition typically causes poor blood flow through the arteries reaching your legs. But it can also affect your arms and other areas, like your digestive system. It’s rare, but it can happen.

All peripheral artery disease starts because sticky fat and cholesterol collect into clumps of plaque (atheroma). It blocks your blood vessels (atherosclerosis) so there’s less room for blood to move through them. This puts you at higher risk for:

• Coronary artery disease (CAD).
• Heart attack.
• Mini stroke (transient ischemic attack).
• Stroke.
• Amputation.

PAD can build up over your lifetime, so you may not notice any PAD symptoms until your arteries are already 70% clogged. Common red flags include leg pain when you’re active that goes away when you rest (claudication), cool skin on your feet, redness or other color changes on your skin, frequent skin and soft tissue infections in your feet or legs, and sores on your toes and feet that don’t go away.

But don’t wait for symptoms to talk with your healthcare provider about PAD, especially if you smoke, have high blood pressure, high cholesterol or diabetes. These things can put you at higher risk for PAD. Many people with PAD have no leg pain symptoms at all.

It’s important to know that even though plaque usually builds up slowly, a blockage can sometimes happen quickly. This is known as acute arterial occlusion. It’s a medical emergency that needs to be treated right away.

What to expect at your first visit

It’s natural to feel a little overwhelmed when you come see us for the first time. So don’t worry if you do. Our team’s here to help you get more comfortable with what’s going on and what lies ahead with treatment.

Your provider will talk with you about how you’ve been feeling. They’ll ask you about your symptoms and if you’ve had any pain. And they’ll go over your medical history. Feel free to ask questions and share any concerns you may have about PAD and treatment.

While you’re here, your provider will also take your blood pressure and pulse. And you’ll have a physical exam. It’s important to have your shoes and socks off for a high-quality vascular examination. Our team will want to do testing to rule out other conditions and confirm that you have peripheral artery disease. You may have vascular testing or procedures like:

• Ankle-brachial index (ABI).
• Pulse volume recording (PVR).
• Vascular ultrasound.

Meet Our Peripheral Artery Disease Team

You’ll have a team of expert heart and vascular providers on your side at Cleveland Clinic. They work together to plan the best, most effective treatments for your needs. Your team may include:

• Cardiologists.
• Interventional cardiologists.
• Vascular medicine specialists.
• Vascular surgeons.
• Anesthesiologists.
• Radiologic technologists.
• Occupational therapists.
• Physical therapists.
• Podiatrists (foot and ankle specialists).
• Vascular lab technologists.
• Nurse practitioners.

Left untreated, peripheral artery disease can progress to life-threatening blockages (critical limb ischemia). And you may even need to have a foot or leg removed (amputated). That’s why getting treatment as quickly as possible is so important.

Your personalized treatment plan focuses on the best ways to reduce your risk of complications. We can often do this with lifestyle changes and medications. But you may need other treatments that focus on blockages in your arteries.

Lifestyle changes

If you smoke, we can help you find the best way to stop smoking. You’ll also talk with a dietitian about heart-healthy eating. It’s important to manage other health conditions (and PAD risk factors) like high blood pressure, diabetes and high cholesterol, too. All can affect PAD. So can stress. We’ll help you find ways to manage it — like yoga, meditation and exercise.

Medications

Your provider may prescribe antihypertensive medications to treat high blood pressure or statin medications to treat high cholesterol. You may also need to take aspirin, or Plavix^®, to prevent blood clots. Or you may take drugs to help with leg pain so you can move more with less pain.

Supervised exercise therapy

This structured program is similar to cardiac rehabilitation, but it’s designed for people with PAD. In 36 sessions, you’ll work with our team to begin new exercise habits. You’ll focus on building up walking time and finding ways to manage your leg pain.

The program typically includes walking on a treadmill in a supervised setting at least three times a week. If you have PAD, you should also walk at home for at least 30-60 minutes each day. There are home walking programs available where you walk until your leg starts hurting, then stop, wait until the pain goes away completely, and start walking again.

Minimally invasive treatments

If you have severe PAD, your leg (or arm) pain may not get better with lifestyle changes or medications. We may need to do other treatments to improve your blood flow. Minimally invasive heart disease treatments commonly used for heart disease, like stents, angioplasty or atherectomy can also help PAD.

Your provider might also recommend a new procedure called lithotripsy that uses shock waves to break up calcified lesions.

If you have one of these minimally invasive procedures, you can usually go home the same day, but you may have to stay in the hospital overnight.

Surgery

If your provider determines that you have severe artery blockages (critical limb ischemia), they may recommend either peripheral bypass surgery or an endarterectomy. Both procedures are types of open vascular surgery and can help avoid amputation.

Peripheral artery bypass surgery

Peripheral artery bypass surgery uses grafts to create new routes for blood to flow through your body avoiding the blockage. A graft can be a vein from your own body or a synthetic one.

There are three types of bypass surgery, based on what arteries are affected:

• Aortofemoral bypass treats blockages between the aorta and femoral artery in your legs.
• Femoral-popliteal bypass starts in your femoral artery and connects to the popliteal artery around your knee.
• Femoral-tibial bypass starts in your femoral artery and connects to the tibial arteries below your knee.

Bypass surgery usually takes between two and six hours. And you’ll stay in the hospital for a few days. Once you leave, you may need physical or occupational therapy. And you’ll be able to gradually get back to daily activities. It usually takes about six to eight weeks to recover completely from this surgery.

Endarterectomy

During an endarterectomy, your provider makes an incision (cut) over the blocked artery. Then they’ll clean the plaque out of your artery and stitch it closed. Most often, they’ll use a patch made from a graft of your own vein, bovine pericardium or Dacron® to keep the area from getting narrow again.

There are three types of endarterectomies depending on where your blocked artery is located:

• Carotid endarterectomy removes plaque from the arteries going through your neck to your brain.
• Femoral endarterectomy removes plaque from the arteries running from your groin to your legs.
• Aortic and iliac endarterectomy removes plaque from the arteries in your abdomen (belly) and pelvis.

About four weeks after an open surgery, you’ll have a follow-up visit with your provider. They’ll take a look at your incision and may do an ultrasound and CT scan (computed tomography scan). If all looks good, you can usually go back to work after this visit. If your job requires strenuous physical activity, you may have to wait a month or two. The same goes for exercise. It can help you recover, but it’s important not to overdo it right away.

Life After Peripheral Artery Disease Treatment

Peripheral artery disease doesn’t go away. It’s a condition you’ll need to manage for the rest of your life. Otherwise, it may progress. It’s important to keep up with exercise (walking is great!), healthy eating and no smoking.

Taking good care of your feet is also important. PAD can cause sores on your feet that don’t go away. Wear comfortable, well-fitting shoes. Keep your feet clean and moisturized. And don’t delay treating minor skin and foot problems.

You’ll also see your care team for regular checkups and to make sure your medications are working. Keeping these appointments is key to managing your PAD.

Taking the Next Step

No one wants to learn they have a lifelong condition affecting their major arteries. But you have the power to keep peripheral artery disease from getting worse. And you don’t have to do it alone. Our team of vascular experts is here with the care you need. From lifestyle changes and medications to surgery, we have you covered. You can also reduce your risk for PAD and other cardiovascular disease by not smoking, maintaining a weight that’s healthy for you and getting regular exercise. It’s also important to get checked for high blood pressure, high cholesterol and diabetes.