Arterial Insufficiency

Overview

Arterial insufficiency means that not enough blood is flowing through the arteries to meet the needs of the tissues they supply. Arteries carry oxygen-rich blood from the heart to the rest of the body, so when they become narrowed or blocked, the affected area, most often the legs and feet, does not receive enough oxygen and nutrients.

The most common cause is atherosclerosis, a buildup of fatty plaque that narrows the arteries over time, the same process behind peripheral artery disease. Arterial insufficiency can range from mild, with pain only during activity, to severe, with rest pain and poorly healing wounds. It is also a marker of widespread artery disease that can affect the heart and brain.

Symptoms

Symptoms reflect reduced blood flow, usually in the legs:

• Cramping or aching pain in the calves, thighs, or buttocks when walking that eases with rest (claudication)
• Coldness, numbness, or weakness in the affected limb
• Pale or bluish skin and shiny, thin skin with hair loss
• Slow-healing sores or wounds, often on the feet or toes
• In severe cases, pain at rest, especially at night, and dark or blackened tissue

Sudden, severe pain with a cold, pale, pulseless limb suggests an acute blockage and is an emergency.

Causes

Arterial insufficiency develops when arteries narrow or become blocked:

• Atherosclerosis: The most common cause, a gradual buildup of fatty plaque in the artery walls.
• Blood clots: A clot can suddenly block an artery (acute arterial occlusion).
• Inflammation of the arteries (vasculitis) or other vessel diseases.
• Injury to an artery.

Risk factors that drive atherosclerosis, such as smoking and diabetes, strongly contribute.

Risk Factors

• Smoking, the single strongest modifiable risk factor
• Diabetes
• High blood pressure
• High cholesterol
• Older age
• Obesity and physical inactivity
• Family history of artery disease

Diagnosis

Diagnosis combines an exam of pulses and skin with vascular testing:

• Ankle-brachial index (ABI): Compares blood pressure at the ankle and arm to gauge blood flow to the legs.
• Doppler ultrasound: Shows blood flow and locates narrowed segments.
• CT or MR angiography: Detailed imaging of the arteries to plan treatment.
• Angiography: An X-ray with contrast dye to map blockages, sometimes done during treatment.

Treatment

Treatment aims to relieve symptoms, improve blood flow, and reduce the risk of heart attack and stroke from the same underlying disease.

• Lifestyle changes: Quitting smoking is the most important step, along with a supervised walking program, healthy diet, and weight management.
• Medications: To manage cholesterol, blood pressure, and blood sugar, and to reduce clotting; some medicines specifically improve walking distance.
• Procedures: Angioplasty with or without a stent can open narrowed arteries, and bypass surgery may be needed for severe blockages.
• Wound care: Careful treatment of foot ulcers to prevent infection and tissue loss.

Prevention

• Do not smoke, and avoid tobacco in all forms
• Keep blood pressure, cholesterol, and blood sugar well controlled
• Stay physically active and maintain a healthy weight
• Eat a balanced diet low in saturated fat
• Care for your feet daily, especially if you have diabetes, and report any sores early

When to See a Doctor

See a doctor if you have leg pain with walking that eases when you rest, slow-healing foot wounds, or cold, numb, or discolored limbs. Seek emergency care for sudden, severe limb pain with a cold, pale, or pulseless leg or foot, which can mean a sudden artery blockage that threatens the limb. People with diabetes should have any foot wound checked promptly, as poor circulation can lead to serious infections.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Peripheral artery disease.
2. National Heart, Lung, and Blood Institute (NHLBI). Peripheral Artery Disease.
3. Mayo Clinic. Peripheral artery disease (PAD).
4. Society for Vascular Surgery. Peripheral arterial disease.