Peripheral arterial disease is a type of cardiovascular disease. It usually develops when plaques (fatty deposits) build up on the walls of your arteries. This is called atherosclerosis. The fatty deposits can cause your arteries to narrow and this reduces the supply of blood to your muscles and other tissues. If you have peripheral arterial disease, it’s usually your legs which are affected.
You’re more likely to get peripheral arterial disease as you get older, especially if you smoke or have diabetes. See our section on causes below for more information about who might get peripheral arterial disease. It’s quite common – it affects around one in five people aged over 60.
If you have peripheral arterial disease, you’ll be at higher risk of heart attack and stroke, both of which can also be caused by narrowed blood vessels.
Many people who have peripheral arterial disease have no symptoms, so you may not know that you have the condition.
The most common symptom of peripheral arterial disease is cramp-like pain, aching or tiredness in your calf when you walk, climb stairs or exercise. It then goes away when you rest for a few minutes. This is called ‘intermittent claudication'. The pain may be worse in one leg than the other, and might also be in your foot, thigh or buttock.
If you’re a man, peripheral arterial disease can be accompanied by erectile dysfunction (difficulty in getting an erection). Over time, as the condition progresses, you may notice that the distance you can walk without pain or discomfort gets less and less.
If you have severe peripheral arterial disease, you may also have:
If you have any of these symptoms, contact your doctor. If your symptoms develop or change quickly, you may need immediate medical treatment.
Your doctor will ask about your symptoms, lifestyle and medical history, including if you’ve got a long-term condition like diabetes. They’ll also ask about your family’s medical history; for example, if there are any heart problems.
They’ll examine you, particularly your legs and feet. They’ll also measure your blood pressure and check the pulses in your groin, foot, and behind your knee. This will show if the blood is not flowing well in part of your body. Comparing the difference between blood pressure in your arm and in your ankle can also help with diagnosis. This is called the ‘ankle brachial pressure index’ (ABPI).
Your doctor may refer you to see a vascular surgeon, who specialises in diseases of the blood vessels outside the heart, to confirm your diagnosis. They may advise you to have an imaging test to find out where and by how much your arteries are narrowed. The types of imaging test are explained below.
There are lots of things you can do yourself to help control the symptoms of peripheral arterial disease and keep your legs healthy. Having a healthier lifestyle will also reduce your chance of having a heart attack or a stroke.
Healthy changes you can make to your lifestyle include the following.
Lifestyle changes and treatments aim to reduce your symptoms and stop peripheral arterial disease from getting worse. See our section on self-help above for more information about healthy changes you can make to your lifestyle.
Your doctor may also recommend treatments to reduce your chance of developing other cardiovascular problems such as heart attack and stroke.
If they are available in your area, your doctor may recommend you attend supervised exercise classes for people with peripheral arterial disease. These may be held at hospital or in a community or leisure centre. They’ll usually involve two or three sessions of 30 to 45 minutes a week over a three-month period.
To help manage your condition, it’s important to treat any other health problems that may make it worse. So, if you have high cholesterol, high blood pressure or diabetes, your doctor will recommend medications to control these.
They may advise you to take medicines called statins and/or a blood-thinning medicine, such as aspirin or clopidogrel to reduce your risk of having a heart attack or stroke.
Surgery may be an option if lifestyle changes (including an exercise programme) aren’t helping you or your symptoms are getting worse and seriously affecting you.
There are two different operations to treat peripheral arterial disease:
These are described in turn below. Your surgeon will talk to you about which operation is best for you and discuss the risks and benefits of each. You’ll recover more quickly after an angioplasty, and may have fewer complications from the procedure. But bypass surgery may give longer-lasting treatment. You should feel free to ask your doctor any questions you have.
In an angioplasty, a radiologist or surgeon will insert a catheter (fine tube) with a small balloon on the end into your narrowed artery. They’ll inflate the balloon to stretch your artery and squash the fatty tissue inside to allow more blood to flow through. A stent may be put inside the artery. This is a small wire-mesh tube that will hold your artery open, and is left in place after the catheter is removed. You may need to stay in hospital overnight after an angioplasty, or be able to leave the same day.
In bypass surgery, your surgeon will create a detour around the blockage in your artery. They’ll use a healthy blood vessel taken from somewhere else in your body, usually an arm or leg. If it’s not possible to use one of your own blood vessels, an artificial tube will be used instead. You’ll only be offered bypass surgery if your leg pain is severely affecting your day-to-day life. You’ll probably need to stay in hospital for at least a week. You should take it easy for a while afterwards but do regular gentle exercise.
Peripheral arterial disease is usually caused by fatty deposits forming in your arteries (atherosclerosis). You’re more likely to develop peripheral arterial disease as you get older.
You’re also more at risk if you:
If you have peripheral arterial disease, you may also have a build-up of fatty deposits in the walls of other arteries in your body. This may lead to:
Around one in five people who have leg pain when walking (intermittent claudication) will develop critical limb ischaemia. This is when the blood flow to your legs becomes so restricted that you get pain even at rest. This may be at night, when you’ll find the only way to relieve the pain is to hang your leg out of bed.
The severe lack of blood flow may also cause damage to the tissues of your leg so you may get ulcers or wounds that don’t heal. This can sometimes lead to gangrene, where some of the tissues die due to a lack of blood supply. It can be painful, and it can get infected and make you very unwell.
See our section on symptoms above for what you may notice if you have severe peripheral arterial disease. If you have critical limb ischaemia, you doctor will discuss your options for treatment. This may involve removing areas of dead tissue.
The way your heart and circulation works changes when you’re pregnant. From just a few weeks into your pregnancy, your heart has to pump harder and faster. If you have valve disease, your heart might have trouble coping. In fact, some women are first diagnosed with valve disease when they become pregnant because they get symptoms for the first time. If you have heart valve disease, you’re likely to need regular check-ups while you’re pregnant and close monitoring for you and your baby. Depending on your health and the type of valve disease you have, you may need treatment while you’re pregnant. You may also need specialist care when you give birth. Talk to your midwife and obstetrician for more information.
If one of your family members has cardiovascular disease such as coronary heart disease or has had a stroke, you may be more likely to develop peripheral arterial disease. But your chance of developing peripheral arterial disease is affected more by other factors including your lifestyle. That’s why it’s so important to stop smoking if you smoke, take up more exercise, eat well and maintain a healthy weight. These are all things that are within your control and can help reduce symptoms of or prevent peripheral arterial disease.
Being physically active is good for your heart as well as your overall health. It's important to stay physically active if you have any type of heart disease. Exercise won’t improve how well your valve works but it will help with day-to-day fitness.
Everyone with heart valve disease will be affected differently, so it’s important to talk to your doctor before increasing activity. They can tell you how much exercise is safe for you. They may want you to do tests to see how your body responds to exercise and whether it causes new symptoms. This is called exercise stress testing.
It’s best to choose low impact exercise, such as walking, cycling or swimming. With any type of activity, you should stop immediately and contact your doctor if you have any chest pain, breathlessness or extreme tiredness.
If you have significant aortic stenosis or regurgitation, you shouldn’t do vigorous exercise. If you don’t have symptoms, your doctor may want you to test how much exercise it’s safe for you to do. They do this with exercise stress testing every six months if you have severe aortic stenosis and yearly if you have mild or moderate aortic stenosis.
Mitral valve prolapse means one or both of the flaps of your mitral valve don’t close properly. This is usually harmless and doesn’t need treatment.
Most people who have mitral valve prolapse don’t have any symptoms. In fact, many people find out they have it during an examination for something else. If you do develop symptoms, it usually means the condition is getting worse. Symptoms include tiredness and shortness of breath.
If you’re getting symptoms, your doctor may suggest lifestyle changes, such as cutting out caffeine, cigarettes and alcohol, in addition to treatment with beta-blockers. Occasionally the valve can start to leak badly (regurgitation) and if this happens, you may need surgery.
Mitral valve prolapse means one or both of the flaps of your mitral valve don’t close properly. This is usually harmless and doesn’t need treatment.
Most people who have mitral valve prolapse don’t have any symptoms. In fact, many people find out they have it during an examination for something else. If you do develop symptoms, it usually means the condition is getting worse. Symptoms include tiredness and shortness of breath.
If you’re getting symptoms, your doctor may suggest lifestyle changes, such as cutting out caffeine, cigarettes and alcohol, in addition to treatment with beta-blockers. Occasionally the valve can start to leak badly (regurgitation) and if this happens, you may need surgery.
Many people with heart problems can travel by air safely without risking their health.
However, you should always check with your doctor or heart specialist that you’re fit to travel by air, particularly if you’ve recently had surgery or been in hospital due to your heart condition. If you have severe heart valve disease with symptoms, you may not be allowed to fly. Your doctor will have to assess your condition and give you the OK.
If you’re very breathless or usually have oxygen, then you need to talk to the airline well in advance of wanting to travel. If they allow you to fly, they will arrange for help at the airport and on your flight.
If you’re travelling overseas, make sure your travel insurance covers you for treatment abroad, and that your insurer knows about your condition.
www.bhf.org.uk
The information and/or article is solely the contribution of Bupa, (hereinafter referred to as “Bupa UK”) a United Kingdom (UK) based healthcare services expert and is based on their experiences and medical practices prevalent in UK. All the efforts to ensure accuracy and relevance of the content is undertaken by Bupa UK. The content of the article should not be construed as a statement of law or used for any legal purpsoe or otherwise. Niva Bupa Health Insurance Company Limited (formerly known as Max Bupa Health Insurance Company Limited) (hereinafter referred to as “the Company”) hereby expressly disown and repudiated any claims (including but not limited to any third party claims or liability, of any nature, whatsoever) in relation to the accuracy, completeness, usefulness and real-time of any information and contents available in this article, and against any intended purposes (of any kind whatsoever) by use thereof, by the user/s (whether used by user/s directly or indirectly). Users are advised to obtain appropriate professional advice and/or medical opinion, before acting on the information provided, from time to time, in the article(s).
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