Peripheral artery disease (PAD)
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Peripheral artery disease (PAD), also known as peripheral arterial disease, is a medical condition that results in decreased blood flow to the arms or legs, particularly the legs, leading to symptoms such as claudication. Typically, this condition occurs due to the accumulation of fatty deposits in the arteries, a process called atherosclerosis, which can narrow the blood vessels and reduce blood flow to the limbs.
The treatment for PAD usually involves lifestyle modifications such as engaging in physical activity, maintaining a healthy diet, and quitting smoking or nicotine use. These interventions can help improve symptoms and prevent further progression of the disease.
Symptoms
Many individuals with peripheral artery disease may not experience any significant symptoms. However, some may experience leg pain when walking, a condition known as claudication.
Muscle aches or cramps in the arms or legs that start during exertion and stop with rest are signs of claudication. The calf is where the pain is most frequently felt. From little to severe pain is experienced. It could be difficult to walk or engage in other physical activities if you have severe leg discomfort.
Additional signs of peripheral artery disease could be:
- The leg becomes weak or numb
- The legs or feet with no pulse or a faint pulse
- The lower leg or foot feeling colder than the other side, especially in comparison
- Cramping pain in one or both hips, thighs, or calf muscles after engaging in specific activities such as walking or climbing steps
- Non-healing sores on the toes, foot, or legs
- Leg hair loss or sluggish hair growth
- The leg’s skin looks glossy or its color changes
- The toenails has sluggish growth
- Aches and cramps in the arms when using them to perform manual chores like knitting or writing
- Erectile dysfunction
In the event that peripheral artery disease worsens, discomfort may be felt during resting or sleeping. Sleeping difficulties could result from the pain. Walking or hanging the legs over the edge of the bed may provide momentary pain relief.
If you have leg pain, numbness, or other peripheral artery disease symptoms, contact your doctor right away.
Causes
A development of fatty, cholesterol-containing deposits (plaques) on arterial walls frequently results in peripheral artery disease. Atherosclerosis is the name of this process. Blood flow through the arteries is decreased.
All of the body’s arteries are affected by atherosclerosis. Peripheral artery disease results when it affects the blood vessels that supply the limbs.
Peripheral artery disease can also result from less frequent sources like being exposed to radiation, inflamed blood vessel, arm or leg trauma, and changes in the ligaments and muscles.
Risk factors
Peripheral artery disease is at a higher risk of developing in individuals who smoke or have diabetes. Additionally, the likelihood of developing peripheral artery disease increases due to the following factors:
- African Americans are more likely to get PAD. Comparing Hispanics to non-Hispanic white people, Hispanics may have comparable to slightly higher rates of PAD.
- Aging, particularly beyond 65; (or after 50 if you have risk factors for atherosclerosis)
- A history of heart disease, stroke, or peripheral artery disease in the family
- Being obese (>30 body mass index)
- Elevated cholesterol or blood pressure
- Elevated amounts of homocysteine, an amino acid that raises coronary artery disease risk.
If you have PAD, you run the risk of developing coronary artery disease and cerebrovascular disease, both of which increase your risk of having a heart attack or stroke.
Diagnosis
A medical professional will examine you to determine if you have peripheral artery disease. Typically, questions about your symptoms and medical background will be asked of you.
If you have peripheral artery disease, the affected area’s pulse can be absent or feeble.
Tests
The following examinations could be performed to identify peripheral artery disease:
- Blood tests. Blood tests are used to check for diseases like diabetes, high triglycerides, and high cholesterol that are linked to PAD.
- Ankle-brachial index (ABI). This is a typical test to identify PAD. It contrasts the ankle’s blood pressure with the arm’s blood pressure. You could be required to use a treadmill. To evaluate the arteries during walking, blood pressure readings can be done before and right away after exercising.
- Ultrasound of the legs or feet. This examination examines the flow of blood through the blood arteries using sound waves. Doppler ultrasonography is a specialized form of ultrasound that can detect narrowed or blocked arteries.
- Angiography. In order to look for artery blockages, this test employs X-rays, Magnetic Resonance Imaging (MRI) scans, or Computerized Tomography (CT) scans. A blood vessel is injected with dye (contrast) prior to taking the photographs. The dye enhances the visibility of the arteries on the test images.
Treatment
The following are the aims of therapy for peripheral artery disease:
- Treat symptoms, such as leg discomfort, to make exercise more bearable
- To lower the risk of heart attack and stroke, improve arterial health.
Management of peripheral artery disease typically involves modifications to one’s lifestyle, and in certain cases, pharmaceutical interventions may also be recommended.
When peripheral artery disease is in its early stages, making lifestyle changes can be beneficial in alleviating symptoms. The most important step to reduce the risk of complications is to quit smoking. It’s recommended that you seek advice from your doctor on how to quit smoking. Engaging in regular physical activity such as walking or supervised exercise training can significantly improve symptoms.
Medications
Your doctor can recommend medication if signs of peripheral artery disease (PAD) are present. Medicines for PAD could consist of:
- Medications to lower cholesterol levels. Peripheral artery disease patients frequently receive statin prescriptions. Statins aid in lowering bad cholesterol and preventing the buildup of arterial plaque. The medications also reduce the risk of stroke and heart attacks. Ask your doctor what your cholesterol levels should be if you have PAD.
- Medications to control blood pressure. Uncontrolled hypertension can cause arteries to harden and become stiff, which can lead to reduced blood flow. It’s important to consult with your doctor to determine the ideal blood pressure target for your specific needs. If your blood pressure is high, your doctor may recommend medications to lower it.
- Medications to control blood sugar. Controlling your blood sugar becomes much more crucial if you have diabetes. Discuss your blood sugar goals and how to achieve them with your healthcare practitioner.
- Medications to prevent blood clots. Reduced blood flow to the limbs is connected to peripheral artery disease. Hence, medications may be administered to increase blood flow. For the purpose of preventing blood clotting, aspirin or another drug, such as clopidogrel (Plavix), may be taken.
- Leg pain medications. Cilostazol is a medication that possesses blood-thinning properties and can also promote vasodilation, which widens blood vessels. Blood flow to the limbs is increased by it. Patients with peripheral artery disease who use this medication are specifically helped with their leg pain. Headaches and diarrhea are frequent negative effects of this drug. The medicine pentoxifylline is an alternative. Although this medicine rarely causes side effects, in general it doesn’t function as effectively as cilostazol.
Surgical management or other procedures
Angioplasty or surgery may occasionally be required to treat peripheral artery disease that is the cause of claudication:
- Angioplasty and stenting. This medical procedure is designed to clear blocked arteries by simultaneously diagnosing and treating the clogged vessel. A healthcare professional guides a thin and flexible tube (catheter) to the narrowed section of the artery. To improve blood flow and widen the narrowed artery, a small balloon is inflated. In some cases, a tiny wire mesh tube (stent) may be placed in the artery to keep it open.
- Bypass. In this surgical procedure, the surgeon creates a new pathway around the blocked artery using a healthy blood vessel from another part of the body or a synthetic vessel.
- Thrombolytic therapy. A clot-dissolving medication may be injected directly into the afflicted artery, if a blood clot is obstructing it.
