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Peripheral Arterial Disease
Also known as Peripheral Artery Disease or PAD
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Peripheral arterial disease or PAD is a relatively common disease of the cardiovascular system. It involves a narrowing of the arteries in the limbs resulting in pain and loss of circulation of the limbs. It is far more common in the legs than it is in the arms. You have problems walking and pain when walking longer distances.
Peripheral arterial disease is a sign of overall body atherosclerosis and can be a harbinger of things like heart attacks and strokes. One of the main symptoms of peripheral arterial disease is called intermittent claudication. It involves having pain in the thigh or calf when walking long distances. The pain can feel like a charley horse or cramp in the leg and goes away at rest. Calf pain is more common than thigh pain.
Other symptoms of peripheral diagnosis include numbness or weakness in the leg, a cold foot or leg, sores that won't heal on the toes or foot, a change in the color of the affected leg, slow growth of the nails in your toes, shiny skin on the legs, a lack of pulses in the feet and a lack of hair growth on the lower legs. Erectile dysfunction can also occur.
Risk factors for PAD include being over the age of seventy years, being older than 50 and being a smoker or diabetic. Being under age fifty and being obese, having high blood pressure, diabetes and smoking as a part of your medical history. If you have known atherosclerosis in other body areas, you are more likely to have PAD.
Habits and aspects of your medical history that lead to peripheral arterial disease include having a history of diabetes, smoking, obesity, high blood pressure, increasing age, high cholesterol, having a family history of PAD, stroke or heart disease and having too much homocysteine in your blood. If you smoke or have diabetes, you have the greatest risk of developing peripheral arterial disease.
Tests for peripheral arterial disease include a physical exam that shows absent pulses in the distal aspect of the leg and a bruit or whishing sound when the artery is examined with a Doppler ultrasound machine. This indicates turbulence within a narrowed artery. The exam can show poor wound healing and sores in the foot. There is a test called the ankle-brachial index or ABI. It compares the blood pressure in the ankle with the blood pressure within the arm. If there is a great difference in the blood pressures of these two areas, there is a likelihood of PAD. An ultrasound can show the flow of blood within the arteries and can identify PAD. An angiogram of the lower legs is considered the gold standard of testing for PAD. It uses dye and x-rays to see the degree of blockage in the legs. Doctors can immediately break up a blockage using balloon angioplasty at the time of the peripheral arterial angiogram.
There are a number of treatments for peripheral arterial disease. The basis of the treatments is to manage the symptoms of the disease and to reduce the amount of atherosclerosis in the body so as to reduce the risk of stroke and heart attack as well as PAD.
You can change the course of peripheral arterial disease by stopping smoking, increasing exercise and losing weight. This lessens the degree of atherosclerosis on the arteries. Medications are also used to affect a change. These include cholesterol-lowering drugs such as a statin drug. The statin drugs reduce the degree of atherosclerosis in the body. Atherosclerosis is a result of an elevated LDL cholesterol in the body.
High blood pressure medications will reduce the systolic blood pressure which will reduce the degree of atherosclerosis. Medications that block blood sugar elevations in diabetes will decrease the degree of PAD you can develop. Blood clot prevention is attained through medications that keep blood from clotting, including a medication called Plavix. There are medications, such as Pletal, that increases the blood flow to the legs by preventing blood clots through dilating the blood vessels.
Angioplasty is sometimes performed to maximize blood flow to the extremities. This involves using a catheter passed through the affected artery and blowing up a balloon at the end of the catheter, cracking open the artery. In bad cases, actual bypass is done of the arteries using a harvested vein from another body area. A synthetic blood vessel can be used instead of a harvested vein.