Peripheral Artery Disease

When narrowed arteries reduce the blood flow to the limbs, usually legs, doctors talk about a condition called peripheral artery disease. PAD symptoms include pain, numbness, hair loss on the legs. Peripheral artery disease treatment has two main goals – to relieve symptoms and stop progression of the disease. Below we are doing to review this condition, its symptoms, diagnostics services and peripheral artery disease treatment options in more detail.

A disease where plaque builds up in the arteries that carry blood to your head, organs, and limbs. Fat, cholesterol, calcium, fibrous tissue and other substances in the blood make up plaque. Peripheral artery disease (also called peripheral arterial disease) is a common circulatory problem that occurs that causes narrowed arteries reduce blood flow to your limbs.

When you develop this disease, your extremities, normally your legs don’t receive enough blood flow to keep up with demand which will cause symptoms, most notably leg pain when walking. This disease may also signify a more widespread accumulation of fatty deposits in your arteries. It may be reducing blood flow to your heart and brain, as well as your legs.

Peripheral artery disease can often be treated successfully by quitting tobacco, exercising and eating a healthy diet.

Why causes Peripheral artery disease?

It’s often caused by atherosclerosis. Plaque builds up in your artery walls and reduce blood flow in atherosclerosis.

Even though the heart is normally the focus of discussion of atherosclerosis, this disease can and usually it does affect arteries throughout the entire body. When it develops in the arteries supplying blood to your limbs, it causes peripheral artery disease.

The cause of peripheral artery disease may be blood vessel inflammation, injury to your limbs, unusual anatomy of your ligaments or muscles, or radiation exposure. These occurrences however, are less common.

What are the risk factors of PERIPHERAL ARTERY DISEASE?

Factors that can increase your risk include:

• Smoking
• Diabetes
• Obesity (a body mass index over 30)
• High blood pressure
• High cholesterol
• Increasing age (especially after reaching 50 years of age)
• A family history of peripheral artery disease, heart disease or stroke
• High levels of homocysteine, a protein component that helps build and maintain tissue

The risk of developing this disease is the greatest in people who smoke or have diabetes due to reduced blood flow.

PAD SYMPTOMS

Many people with peripheral artery disease have mild or no symptoms while some people may experience leg pain when walking (claudication).

Peripheral artery disease symptoms may include:

• Painful cramping in your hip, thigh or calf muscles after certain activities, such as walking or climbing stairs (claudication). Claudication symptoms may include muscle pain and cramping in your legs or arms triggered by activity such as walking but disappears after a few minutes of rest.The area of pain depends on the location of the affected artery. Calf pain is the most common location.The severity of claudication may vary widely; from mild discomfort to debilitating pain. In severe claudication, it can make become hard for you to walk or do other types of physical activity.
• Leg numbness or weakness
• Coldness in your lower leg or foot (especially when compared with the other side)
• Sores on your toes, feet or legs that won’t heal
• A change in the color of your legs
• Hair loss or slower hair growth on your feet and legs
• Slower growth of your toenails
• Shiny skin on your legs
• No pulse or a weak pulse in your legs or feet
• Erectile dysfunction in men

If the disease progresses, pain may even occur when you’re at rest or when you’re lying down (ischemic rest pain). The pain may be intense enough to disrupt sleep. Hanging your legs over the edge of your bed or walking around your room may temporarily relieve the pain.

PERIPHERAL ARTERY DISEASE TREATMENT OPTIONS

The treatment for peripheral artery disease has 2 major goals:

• Manage symptoms such as leg pain (so that you can resume physical activities)
• Stop the progression of atherosclerosis throughout your entire body to reduce your risk of heart attack and stroke

These goals can be accomplished with lifestyle changes. If you’re a smoker, quitting is the most crucial thing you can do to reduce your risk of complications.

If changing your lifestyle is not enough, you will need additional medical treatment. Medicine may be prescribed to prevent blood clots, lower blood pressure and cholesterol as well as control pain and other symptoms.

Medications

• Cholesterol-lowering medications: A cholesterol-lowering drug called a statin can be used to reduce your risk of heart attack and stroke.

The goal is to reduce low-density lipoprotein (LDL) cholesterol (bad cholesterol) to less than 100 milligrams per deciliter (mg/dL), or 2.6 millimoles per liter (mmol/L). The goal is to reduce it even lower if you have additional major risk factors for heart attack and stroke, especially diabetes or continued smoking.

• High blood pressure medications: Your doctor may prescribe medications to lower high blood pressure if you have it.

The goal is to reduce your systolic blood pressure (the top number of the two numbers) to 140 millimeters of mercury (mm Hg) or lower and your diastolic blood pressure (the bottom number) to 90 mm Hg or lower. If you have diabetes as well, your blood pressure target is under 130/80 mm Hg.

• Medication to control blood sugar: It becomes even more important to control your blood sugar (glucose) levels if you have diabetes. Consult your doctor about what your blood sugar goals are and what steps you need to take to reach these goals.
• Medications to prevent blood clots: As this disease is related to reduced blood flow to your limbs, it’s crucial to improve that flow. Daily aspirin therapy or another medication, such as clopidogrel (Plavix) may be prescribed.
• Symptom-relief medications: The drug cilostazol (Pletal) increases blood flow to your extremities by keeping the blood thin and by widening the blood vessels. It specifically help to treat symptoms of claudication such as leg pain, in people who have peripheral artery disease. Some common side effects of this medication include headache and diarrhea. An alternative to cilostazol is pentoxifylline (Trental). However, it’s generally less effective. But side effects are rare with this medication.

Angioplasty and surgery

Angioplasty or surgery may be necessary in some cases to treat peripheral artery disease that’s causing claudication:

• Angioplasty: A small hollow tube (catheter) is used in this procedure and is threaded through a blood vessel to the affected artery. A small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall and at the same time it stretches the artery open to increase blood flow. A stent may also be inserted in the artery to help keep it open.



• Bypass surgery: A graft bypass may be created using a vessel from another part of your body or a blood vessel made of synthetic fabric. This allows blood to flow around or bypass the affected artery.
• Thrombolytic therapy: Your doctor may inject a clot-dissolving drug into your artery at the point of the clot to break it up if you have blood clot blocking an artery.

Supervised exercise program

Your doctor may prescribe a supervised exercise training program to increase the distance you can walk pain-free in addition to medications or surgery. Regular exercise can improve symptoms of the disease by a number of methods. This includes helping your body to use oxygen more efficiently.

DIAGNOSING PERIPHERAL ARTERY DISEASE

• History taking and physical exam: To make a proper diagnosis, your doctor will ask you questions about your symptoms, lifestyle, habits and family history. Your doctor may ask the following questions:

• Whether you have any risk factors for the disease (for example, do you smoke or have diabetes?)
• About your symptoms including any symptoms that occur when walking, exercising, sitting, standing, or climbing
• About your diet
• About any medicines you take including prescription and over-the-counter medicines
• Whether anyone in your family has a history of heart or blood vessel diseases

Your doctor will look for signs of the disease during physical examination and may check the blood flow in your legs or feet to see whether you have weak or absent pulses. The pulses in your leg arteries may also be checked for an abnormal whooshing sound called a bruit. This sound can be heard with a stethoscope. A bruit may be a warning sign of a narrowed or blocked artery. Blood pressure between your limbs may be compared to see whether the pressure is lower in the affected limb. Poor wound healing or any changes in your hair, skin, or nails may also be checked.

• Ankle-brachial index (ABI): A common test to diagnose the disease. Blood pressure in your ankle with the blood pressure in your arm are compared. Your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow to get a blood pressure reading. You may be asked to walk on a treadmill and have the readings taken before and immediately after exercising to measure the severity of the narrowed arteries during walking.
• Ultrasound: Ultrasounds such as the Doppler ultrasound can help your doctor evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
• Angiography: A dye is injected into your blood vessels to view blood flow through your arteries as it happens. X-ray imaging or procedures called magnetic resonance angiography (MRA) or computerized tomography angiography (CTA) enables your doctor to trace the flow of the contrast material. A catheter angiography is a more invasive procedure. It involves guiding a catheter through an artery in your groin to the affected area and injecting the contrast dye.



This type of angiography enables simultaneous diagnosis and treatment. Allowing your doctor to find the narrowed area of a blood vessel and widening it with a dilating procedure or administering medication to improve blood flow.

• Blood tests: Blood sample can be used to measure cholesterol and triglycerides and to check for diabetes.