heart and blood vessel disorders
Occlusive Peripheral Arterial Disease
Symptoms of Occlusive Peripheral Arterial Disease
Symptoms of occlusive peripheral arterial disease vary depending on Which artery is affected How completely the artery is blocked Whether the artery is gradually narrowed or suddenly blocked Usually, about 70% of the artery’s interior has to be blocked before symptoms occur. Gradual narrowing of an artery may result in less severe symptoms than sudden blockage—even if the artery eventually becomes completely blocked. Symptoms may be less severe because gradual narrowing allows time for nearby blood vessels to expand or new blood vessels (called collateral vessels) to grow. Thus, the affected tissue can still be supplied with blood. If an artery is suddenly blocked, there is no time for collateral vessels to develop, so symptoms are usually severe. Sudden, complete blockage of an artery in a leg or an arm may cause severe pain, coldness, and numbness in the affected limb. The person’s leg or arm is either pale or bluish (cyanotic) or with a distinct color change. No pulse can be felt below the blockage. The sudden, drastic decrease in blood flow to the limb is a medical emergency. The absence of blood flow can quickly result in loss of sensation in or paralysis of a limb. If blood flow is absent for too long, tissue may die, and the limb may need to be amputated. Intermittent claudication,the most common symptom of peripheral arterial disease, results from gradual narrowing of a leg artery. It is a painful, aching, cramping, or tired feeling in the muscles of the leg—not in the joints. Intermittent claudication occurs regularly and predictably during physical activity but is always relieved promptly by rest. The muscles ache when a person walks, and the pain begins more quickly and is more severe when the person walks quickly or uphill. Usually, after 1 to 5 minutes of rest (sitting is not necessary), the person can walk the same distance already covered, although continued walking will again provoke the pain at a comparable distance. Most commonly, the pain occurs in the calf, but it can also occur in the thigh, hip, or buttock, depending on the location of the blockage. Very rarely, pain occurs in the foot. As a leg artery is narrowed further, the distance a person can walk without pain decreases. Eventually, as the disease becomes very severe, leg muscles may ache even at rest, especially when the person is lying down. Such pain usually begins in the lower leg or front of the foot, is severe and unrelenting, and worsens when the leg is elevated. The pain often interferes with sleep. For relief, the person may hang the feet over the side of the bed or rest sitting up with the legs hanging down. Large blockages of the arm arteries, which are rare, may cause fatigue, cramping, or pain felt in the arm muscles when the arm is used repeatedly. When the blood supply is only mildly or moderately reduced, the leg or arm may look almost normal. When the blood supply to a foot is severely reduced, the foot may be cold, and doctors may need special equipment to detect pulses in the foot. The skin of the foot or leg may be dry, scaly, shiny, or cracked. Nails may not grow normally, and the hair on the leg may not grow. As the artery is narrowed further, a person may develop sores that do not easily heal, typically on the toes or heel and occasionally on the lower leg, especially after an injury. Infections occur easily and become serious quickly. In people with severe occlusive peripheral arterial disease, wounds in the skin may take weeks or months to heal or may not heal. Foot ulcers may develop. Leg muscles usually shrink (atrophy). A large blockage may cause gangrene (death of tissue due to lack of blood supply). In some people who have had predictable, stable claudication, claudication can suddenly worsen. For example, calf pain that occurs after walking 10 blocks may suddenly occur after walking one block. This change may indicate that a new clot has formed in a leg artery. Such people should seek medical care immediately. When people suddenly develop a painful, cool, and pale arm or leg, they should seek medical care immediately. 