Peripheral arterial disease, also known as peripheral vascular disease, leads to a build-up of fatty deposits in the arteries, making it more difficult for blood to circulate. This condition typically triggers symptoms in the legs first.
The British Heart Foundation states that around one in five people over the age of 60 have some degree of peripheral arterial disease (PAD). The most common symptom of this heart condition is intermittent claudication, which is a cramp-like pain in the leg muscles during walking or exercising that subsides when resting. Intermittent claudication can increase your risk of a heart attack three to five times higher than normal. Up to 10% of people with intermittent claudication will develop critical limb ischaemia, the most severe form of PAD.
Treatment at this stage often has a grim prognosis, with half of patients likely to die within five years. This is usually due to other artery blockages they have elsewhere in the body, such as in the heart.
If PAD goes untreated, the cardiovascular system can’t deliver enough blood and nutrients to certain parts of the body, which can cause persistent pain, ulcers and even gangrene. These usually start in the feet as its the furthest from the heart.
In extreme cases, PAD can even be life-threatening or necessitate amputations, warns Patrick Coughlin, Consultant Vascular and Endovascular Surgeon at Addenbrooke’s Hospital. If you’re experiencing these symptoms, it’s advised to inform your GP who can refer you to a vascular specialist to examine the blood flow in your legs.
Between 1% and 2% of individuals with intermittent claudication will require an amputation within five years. Consequently, PAD is one of the leading causes of lower-limb amputation in the UK.
By the time ulcers or gangrene symptoms manifest, it’s “often too late for us to improve circulation,” says Coughlin. This leaves patients with only amputation, ulcer management or palliative care as treatment options in more severe cases.
PAD is managed by addressing the symptoms, such as surgeries to enhance blood supply to the legs, lifestyle modifications to reduce your risk of a heart attack and walking programmes to improve claudication.
However, the expert pointed out: “If you have claudication, national guidelines recommend enrolling in a three to six-month walking programme. This is unfortunately not widely available on the NHS due to funding.
“If you can’t access one, you can still follow a structured walking programme on your own, or ask if there’s a cardiac rehabilitation-type programme you can go on.”