Peripheral artery disease affects at least 12 million Americans, more than heart disease and stroke combined. It kills some, maims others, and makes life disagreeable or unbearable for countless more.
Comprehensive diagnosis and treatment guidelines from a coalition of 38 major medical organizations, to be followed in mid-2006 by a public education campaign, aim to put peripheral artery disease on everyone's radar. It's a worthwhile goal, since it likely affects most American families.
How did such a common malady remain an 'unknown' disease over the years? Peripheral artery disease spans so much of the body — all of the arteries below the heart — that its diagnosis and treatment have been split among several medical specialties.
Peripheral artery disease is a catchall term for problems with the arteries that supply the feet, legs, kidneys, intestines, and other body parts south of the heart.
- Narrowed leg arteries can cause claudication, a potentially disabling leg pain that occurs with walking or exercise. Severely narrowed or clot-blocked arteries are also responsible for thousands of foot and leg amputations each year.
- Kidneys supplied by narrowed or blocked arteries can weaken or fail. Poor blood flow to the kidneys can also lead to severe hypertension.
- Blood flow problems in the intestinal arteries can cause abdominal pain after eating. In severe cases, they can lead to weight loss, malnutrition, and even permanent damage to the bowel..
- The abdominal aorta, also falls into the territory of peripheral artery disease. A small patch of the artery wall may weaken and bulge outward. This is called an abdominal aortic aneurysm. Large ones can rupture, with deadly consequences.
Throughout the body
One of the most important things to know about peripheral artery disease is that it isn't usually confined to the peripheral arteries. It's a systemic disease. If you have peripheral artery disease, you may also have problems in the arteries that nourish the heart (coronary artery disease) or those that supply the head and brain (carotid artery disease). Likewise, trouble in the coronary or carotid arteries usually means restricted blood flow to the legs, kidneys, or intestines.
What's the connection? All three are signs of arteriosclerosis. Triggered by smoking, a diet rich in saturated fats and refined carbohydrates, and inactivity, arteries stiffen and narrow. Procedures to bypass or open diseased arteries may ease symptoms. But they don't fix the problem. Peripheral artery disease must be attacked on all fronts with every possible strategy for halting or reversing arteriosclerosis.
Find it early
The guidelines urge doctors to be more aggressive about asking their patients about leg pain or numbness, foot or leg wounds that aren't healing properly, and abdominal pain after eating. Another crucial question is whether they have parents or siblings with peripheral artery disease or an abdominal aortic aneurysm.
The guidelines promote wider use of two physical exams. The first exam tests the blood vessels - measuring blood pressure in both arms and checking pulses at various points in the body. It also includes checking the abdomen for signs of an aortic aneurysm. The second exam is called the ankle-brachial index. It is a comparison of the blood pressure measured at your ankle against the pressure measured just above the elbow.
Does everyone need such an extensive workup for peripheral artery disease? No. But testing is a good idea if any of the following applies to you:
- You have leg pain while walking that goes away when you rest.
- You have heart disease, carotid artery disease, or kidney trouble.
- You have a family history of peripheral artery disease.
- You are under age 50 and have diabetes and one other risk factor for arteriosclerosis, such as high blood pressure or cholesterol.
May 2006 update