Nothing peripheral about this artery disease

Guidelines put the spotlight on the consequences of peripheral artery disease.

If ever a disease deserved a splashy new name, peripheral artery disease is it. "Peripheral" smacks of something on the sidelines. Nothing could be further from the truth. 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 high-visibility 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 a Rodney Dangerfield can't-get-no-respect disease over the years? Its scope is partly to blame. 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 a bevy of medical specialties.

Central impact

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. It's akin to angina of the legs. Severely narrowed or clot-blocked arteries are also responsible for thousands of foot and leg amputations each year, many of which could be prevented. It can have similar effects in the arms.

Kidneys supplied by narrowed or blocked arteries can weaken or fail. Because the kidneys play such a vital role in regulating blood pressure, poor blood flow to the kidneys can also lead to severe hypertension.

Blood flow problems in the intestinal (mesenteric) arteries can cause abdominal pain after eating. In severe cases, they can lead to weight loss, malnutrition, and even permanent damage to the bowel, much like the devastation wrought by a heart attack.

The pipeline to all these arteries, the abdominal aorta, also falls into the territory of peripheral artery disease. This major outlet from the heart doesn't usually narrow. Instead, a small patch of the artery wall may weaken and bulge outward. This is called an abdominal aortic aneurysm. Although these don't usually cause symptoms, large ones can rupture, with deadly consequences.

It's everywhere

Peripheral artery disease can affect many parts of the body, from the arms and legs to the kidneys and digestive system. The problem usually stems from arteries narrowed by cholesterol-filled plaque.

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, the odds are high that you 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 the same malevolent process, arteriosclerosis. Triggered by the insults of modern life — smoking, a diet rich in saturated fats and refined carbohydrates, too much food, inactivity, and others — arteries throughout the body gradually stiffen and narrow. As their flexibility fades, so does their ability to deliver oxygen and nutrients to tissues and to whisk away wastes, especially during exercise or digestion.

Local treatments, such as 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. Here we'll focus on a central theme of the guidelines — early detection.

Find it early

Peripheral artery disease often does irreparable damage before it is diagnosed. That's partly because it starts silently, and partly because many people don't mention their symptoms to their doctors, but instead chalk them up to the inevitable travails of getting old.

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 a physical exam of the blood vessels. This involves measuring blood pressure in both arms and checking pulses in the neck, arms, thighs, behind the knees, at the ankles, and in the feet. It also includes checking the abdomen for signs of an aortic aneurysm.

Another test that can help detect peripheral artery disease, especially in the legs, is the ankle-brachial index. It is a comparison of the blood pressure measured at your ankle against the pressure measured just above the elbow. A normal value is between 0.9 and 1.3. Anything below 0.9 (lower pressure at your ankle than arm) suggests a blockage in the leg. The lower the index, the more severe the blockage.

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.

  • You are between the ages of 50 and 69 and you smoke or have diabetes.

  • You are over 70 years old.

The guidelines also recommend a one-time ultrasound of the abdomen for older individuals who have ever smoked or who have a parent or sibling with an abdominal aneurysm.