Peripheral artery disease, also known as PAD, is a common vascular condition involving a buildup of plaque within the peripheral arteries of the limbs, usually the legs and feet. Plaque is an accumulation of fat, cholesterol, calcium and other substances in the blood. The buildup of plaque can severely narrow or block the arteries and limit the flow of oxygen-rich blood to the body.
Causes of PAD
There are many causative factors involved in the development of PAD. Causes or risk factors for PAD may include the following:
- Increasing age
- Lack of exercise
- High blood pressure
- High cholesterol
- Family history of PAD or other circulatory problems
More uncommon causes of PAD may include limb injury, anomalies of anatomy, blood vessel inflammation or radiation exposure.
Symptoms of PAD
Patients with PAD may be asymptomatic.
Even in asymptomatic patients, this is associated with increased risks for heart attacks, strokes, death long term. For those who experience symptoms, those symptoms may vary in kind or severity from patient to patient. Symptoms in the affected area may include:
- Claudication which is discomfort such as pain or cramping when walking
- Numbness or weakness of extremities
- Wounds on the skin that don't heal
- Discoloration or change of texture of the skin
- Hair loss
- Weak pulse or coldness to the touch
- Erectile dysfunction in men
If peripheral artery disease progresses, pain may even occur while a person is resting, known as ischemic rest pain.
Diagnosis of PAD
Peripheral artery disease may be effectively diagnosed using the following:
- Physical examination
- Ankle-brachial index (ABI)
- Doppler ultrasound
- CT or MRI angiogram
- Invasive Angiography
Treatment of PAD
Treatment for peripheral artery disease is a two-pronged effort, designed not only to relieve symptoms, but to stop the progression of vascular disease. It is important to get atherosclerosis under control since this disease puts the patient at risk for heart attack or stroke. Treatments for PAD may include any and all of the following:
Before any additional medical treatment is undertaken, patients are advised to make changes in their habits which may be lifesaving. The most important of these is for patients who smoke to stop smoking. Other beneficial changes include losing weight, eating a healthier diet, making sure to get regular exercise and alleviating stress wherever possible. Particular exercise and walking programs to assist in treating PAD are sometimes recommended.
Several types of medications may be helpful in treating PAD. These may include:
- Cholesterol-lowering drugs known as statins
- Medications to lower blood pressure
- Medications to control glucose levels in patients with diabetes
- Blood thinners to minimize clots
- Medications to relieve symptoms such as claudication
- Drugs injected into the artery to dissolve clots, or thrombolytics
In some cases, surgical interventions may be necessary to treat PAD, including catheter based interventions such as angioplasty, stenting to reopen the blocked artery and increase blood flow or bypass surgery to circumvent the blocked artery.
Risks of Surgery for PAD
While surgeries for PAD are generally considered safe, there are always risks involved in any surgical procedure. In additions to the risks inherent in any surgical procedure which may include allergic reactions to anesthesia or medications, breathing problems and the possibility of infection, angioplasty and bypass for PAD may include the following complications, all of which are greater in older patients:
- Heart attack
- Incapacity of blood vessels
- Impermanence of the bypass
- Leg problems
There is often swelling in the leg that has been operated on. In some cases, the swelling may be more severe. Such swelling may subside with time, but mild permanent swelling is a common result of bypass surgery. Thrombophlebitis in the affected limb is also possible.
Recovery from Surgery for PAD
After a surgical procedure for PAD, the wound in the groin where the catheter was inserted must be tended. After a period of initial rest, gradual increase in walking and physical activity is advised. It is important for patients recovering from angioplasty for PAD to maintain a healthy lifestyle and to take prescribed medications to minimize the risk of restenosis, or recurring blockage of arteries.