December 24, 2010
Dear Mayo Clinic:
Can poor circulation in feet due to peripheral arterial disease be treated?
Peripheral arterial disease (PAD) occurs when plaque builds up in the arteries (atherosclerosis), reducing blood flow to the limbs. Common risk factors of PAD include smoking, exposure to secondhand smoke, high blood pressure, high lipids (cholesterol and/or triglycerides), diabetes, obesity, inactivity, age greater than 50, male gender, family history, genetic conditions and ethnicity.
Common symptoms of PAD include pain, fatigue, heaviness, cramping or discomfort in the leg muscles (calf, thigh or buttocks) that occur during activity such as walking or climbing stairs. The location of intermittent claudication depends on where the artery is blocked or narrowed. The pain or discomfort goes away once the activity is stopped and during rest.
Treatment for peripheral arterial disease depends on a person's overall health, the symptoms, and the results of tests a doctor may perform to diagnose the condition. Treatment may be a combination of lifestyle changes, medications, catheter-based procedures or, in some cases, surgery.
For mild disease, we may recommend that a person remain under observation while adopting lifestyle changes. Smokers should quit. Stopping tobacco use is the first step in treating peripheral arterial disease. Regular walking will help condition muscles and improve blood flow in the legs. Exercise will also help control other risk factors such as high blood pressure, high cholesterol, obesity and diabetes. Eating healthy foods can help lower high cholesterol levels and control diabetes. And those who are overweight should lose weight.
Medications cannot cure peripheral arterial disease, but they can help treat conditions that contribute to the disease, such as high cholesterol and triglycerides, high blood pressure or diabetes.
Several procedures can treat narrowed or blocked arteries. In angioplasty, a thin tube (catheter) with a tiny balloon at its tip is inserted into a blood vessel and threaded to the blocked area of the artery. The balloon is then inflated, pushing plaque to the side and opening the artery. Sometimes a wire mesh tube (stent) is wrapped around the balloon so that when the balloon is inserted and inflated, the stent is opened and positioned within the artery. The balloon is then deflated and removed, leaving the stent in place.
Bypass surgery can improve circulation in the legs, depending on the extent and location of the blockage. Bypass uses a graft (man-made or a vein from the patient's body) to reroute circulation. The graft is attached above and below the blocked area of the artery, allowing blood to go around the blockage.
A diagnosis of peripheral arterial disease means a person is at risk for other blockages in other arteries — blockages that can cause heart disease and stroke. Patients with peripheral arterial disease are often screened for blockages in the arteries serving the heart and brain.
Because you have peripheral arterial disease — whether or not you receive medical treatment — it is very important that you take care of your health and modify any risk factors to stop the progression of the disease and prevent occurrence elsewhere. Treatment options are available. But you should first meet with your physician to discuss all of your symptoms.
— Henna Kalsi, M.D., Gonda Vascular Center, Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.