Arteriosclerosis of the extremities Health Article

Definition

Arteriosclerosis of the extremities is a disease of the blood vessels that leads to narrowing and hardening of the arteries that supply the legs and feet. This decreases blood flow, which can injure nerves and other tissues.

Alternative Names

Peripheral vascular disease; PVD; Peripheral arterial disease; PAD; Arteriosclerosis obliterans

Causes, incidence, and risk factors

Arteriosclerosis, or "hardening of the arteries," commonly first affects the legs and feet. The narrowing of the arteries may lead to a total closing (occlusion) of the vessel.

The vessel walls become less elastic and cannot open (dilate) to allow greater blood flow when needed (such as during exercise). Calcium deposits in the walls of the arteries contribute to the narrowing and stiffness.

This is a common disorder, usually affecting men over age 50. People are at higher risk if they have a personal or family history of:

• Diabetes
• Heart disease (coronary artery disease)
• High blood pressure (hypertension)
• Kidney disease involving hemodialysis
• Smoking
• Stroke (cerebrovascular disease)

Symptoms

Often, symptoms affect one limb. If arteriosclerosis is in both limbs, the intensity is usually different in each.

• Change of color of the legs
• Cold legs or feet
• Leg pain (intermittent claudication)
  • Occurs with exercise (such as walking)
  • Relieved with rest
• Loss of hair on the legs and/or feet
• Muscle pain in the thighs, calves, or feet
• Numbness of the legs or feet at rest
• Paleness or blueness (cyanosis)
• Walking/gait abnormalities
• Weak or absent pulse in the limb

Signs and tests

During an examination, the health care provider may find:

• A whooshing sound with the stethoscope over the artery (arterial bruits)
• Decreased blood pressure in the affected limb
• Decreased or no pulse in the legs or feet

Blood tests may show high cholesterol.

Tests for peripheral artery disease:

• An abnormal ratio between the blood pressure of the ankle and arm (ankle/brachial index, or ABI)
• Angiography of the arteries in the legs (arteriography)
• Doppler ultrasound exam of an extremity
• Intravascular ultrasound (IVUS) of the legs or feet
• MRI scan