Peripheral artery disease (PAD) is a chronic condition that commonly affects people with diabetes. PAD causes narrowing in the blood vessels of the legs and arms and can exacerbate problems with diabetic ulcers and neuropathy. Proper prevention and treatment of PAD can reduce your risk of developing serious complications such as infections or amputations.

Peripheral Artery Disease Explained

Peripheral artery disease (PAD) is a chronic disease that causes the blood vessels outside of the brain and heart to narrow, leading to poor blood circulation in these areas of the body. PAD most commonly affects the legs, but it is possible to have blocked arteries in the arms, neck, and belly.

Having diabetes puts you at an increased risk for atherosclerosis—the leading cause of PAD. Atherosclerosis is the term for plaque build-up along blood vessel walls, which can occur in arteries throughout your body. Fatty deposits of cholesterol accumulate along the inner walls of these arteries and gradually begin to block the flow of nutrient-rich blood from your heart to your extremities. Eventually, these blockages become severe and cause problematic symptoms that impact your day-to-day living.

Symptoms of Peripheral Artery Disease

The symptoms of PAD can range from mild to severe, depending on the extent of the blockages.

The most common symptom of PAD is pain while walking, also known as claudication. This muscle pain or cramping will occur during mild or moderate activity and resolve after a few minutes of rest. Calf cramping is the most common complaint from people with claudication, but the location of pain can vary.

Claudication can become severe and significantly impact your quality of life by making walking and other activities nearly impossible.

Other signs of PAD include:

• Numbness or tingling
• Muscle weakness
• One foot or leg that is noticeably colder than the other
• Loss of leg or arm hair
• Changes to the color of your skin
• Sores or ulcers that will not heal
• Shiny skin on your legs
• Weak or absent pulse in your feet
• Erectile dysfunction
• Poor nail growth
  

If allowed to progress, the symptoms of PAD can become severe even when at rest.

Risk Factors and Lifestyle Modification

Diabetes is one of the strongest risk factors for the development of peripheral artery disease. Resistance to insulin, elevated blood sugar, and high cholesterol damage the inner wall of the arteries and cause plaque build-up. If diabetes is left untreated or poorly controlled, the risk of PAD increases.

Additional genetic and lifestyle factors can increase your chances of developing PAD.

• Smoking
• Obesity
• High blood pressure
• High cholesterol
• Family history of atherosclerosis
• 50 years or older

Taking steps to modify your lifestyle will significantly reduce your risk of developing this disease. Quitting smoking, losing weight, engaging in regular physical activity, and eating a balanced diet low in processed sugar and fat are excellent ways to protect yourself from PAD.

Diagnosis

If you have diabetes, you should see your doctor once or twice per year for regular check-ups. However, if you begin to notice the signs and symptoms of PAD, you should see your doctor as soon as possible. They will perform a series of tests to determine if you have PAD.

• Physical Examination

Your doctor will check your limbs for signs of reduced blood flow by assessing your pulses, skin color and temperature, and sensation in your legs.

• Laboratory tests

Blood tests such as cholesterol, triglycerides, and blood sugar can determine if you are at risk for PAD.

• Ankle-Brachial Index (ABI)

Your doctor can detect a blockage by using a mathematical formula that measures the difference between the blood pressure in your arms and legs.

• Ultrasound

Ultrasound imaging is a painless and non-invasive method of visualizing the arteries in your arms and legs. This technology allows your doctor to measure the blood flow through the vessels and identify a blockage.

• Angiography

Angiography is a minimally invasive procedure used to visualize your blood vessels under x-ray imaging. Your doctor injects contrast dye into the blood vessel through a small plastic catheter, which appears highlighted on the x-ray image. Your doctor can follow the flow of the dye through the blood vessel and see any blocked areas.

Treating PAD

The goals for treating PAD are to manage symptoms, improve quality of life and functioning, and limit further disease progression. Which treatments your doctor prescribes will depend on the severity of your PAD and symptoms.

Your doctor may treat mild PAD with preventative medications for cholesterol and blood pressure, improved diabetes management, and lifestyle modifications.

For more severe PAD cases, treatment with blood thinners, pain medication, and surgery may be necessary.

Angioplasty and Surgery

Angioplasty and surgical interventions may be necessary to treat more severe cases of PAD.

Angioplasty involves the same type of procedure as angiography with the addition of wires, balloons, and sometimes stents to help open up the blocked blood vessel. The doctor performs this procedure by inserting a small plastic catheter through an artery in the hip, allowing them to guide their instruments toward the area of blockage in the artery.

Angioplasty is typically performed as an outpatient procedure, meaning you can return home the same day with minimal recovery time.

Surgical treatment for PAD is more extensive than angioplasty but may provide longer-lasting results for certain people. A vascular surgeon performs bypass surgery by rerouting blood flow around the blockage in your leg with a natural or artificial graft. This surgery takes a few hours to complete, and your recovery time may be up to several weeks.

Bypass surgery might be necessary for people with very diffuse blockages or blockages in the arteries around large joints like the hips and knees.

Foot Care

If you have diabetes and peripheral artery disease, you should be taking extra care of your feet to prevent wounds, ulcers, and infections.

• Make sure your feet are clean, dry, and moisturized.
• Wear comfortable, close-toed shoes.
• Check your feet daily for new cuts or abrasions.
• Notify your doctor if you notice any changes to your feet.

Specialized socks from Siren can prevent infections by wirelessly monitoring your feet’s temperature and moisture level. Connect with us to learn more about our wearable technology and find a certified provider near you.

Sources:

American Heart Association. Peripheral Artery Disease and Diabetes. Reviewed May 4, 2021.

Mayo Clinic. Peripheral Artery Disease (PAD). Reviewed January 14, 2021.

Thiruvoipati, Kielhorn, Armstrong. Peripheral artery disease in patients with diabetes: Epidemiology, mechanisms, and outcomes. World Journal of Diabetes. Published July 10, 2015.

USA Vascular Centers. PAD Symptoms.