PERIPHERAL ARTERIAL DISEASE

When atherosclerosis (hardening of the arteries) affects the arteries supplying the legs, it can give rise to a number of symptoms. When it is not too severe, patients notice pain in the muscles of the leg when they walk. This pain usually settles quickly on stopping, and doesn’t require them to sit down. The pain is most commonly felt in the calf, but other muscles can be affected. This is called claudication. This is not uncommon, and rarely progresses to anything more serious. It is, however, a sign that the patient’s arteries are diseased, and may mean they are at higher than average risk of other arterial diseases, including heart attacks and strokes.

If the arterial disease in the leg progresses, and can lead to pain in the feet at rest, or the skin starting to break down. This is called critical limb ischaemia.

Risk factors.

As with other arterial diseases, the risk factors for peripheral arterial disease are smoking, high cholesterol, high blood pressure and diabetes. It is rare, but not unknown for patients to develop peripheral arterial disease without any of those factors.

Treatment.

For patients with claudication, their best chance of a long term improvement lies with controlling their risk factors and exercise. This has been shown to be at least as good as more invasive treatments, and is safer. It does however require considerable effort and will power, particularly if the patient needs to give up smoking. Patients who have critical limb ischaemia are in a different situation. If nothing is done to improve their situation, they are at risk of losing their leg. These patients require detailed investigations to look at the arteries in their leg to see if anything can be done to improve their circulation. This can sometimes be an angioplasty (stretching up the artery with a small balloon, normally under local anaesthetic) or a bypass operation. These treatments are not without risk.