Definition and Overview

Peripheral artery disease (PAD) is a medical disorder in which the arteries become narrowed or clogged. The most common cause is plaque buildup. Plaque is made up of different substances found in the blood. These include calcium, fat, and cholesterol. A very small amount of these substances can be left behind on the arterial walls as the blood circulates the body. Over time, they can accumulate and cause an obstruction. This reduces the amount of blood that flows to different parts of the body. If the plaque is big enough, the blood flow may be completely cut off.

PAD affects the peripheral arteries in the head, stomach, and limbs. But it most commonly affects the blood vessels that supply blood to the legs. It causes cramping, numbness, and pain. It also increases the risk of serious infections that can lead to tissue death and amputation. This can happen if the legs do not receive enough nutrients and oxygen they need to fight infections.

People with an increased risk for PAD are those who have uncontrolled diabetes and high blood pressure. The risk is also high for people who are obese and who smoke.

Causes of Condition

In most cases, PAD occurs due to atherosclerosis. This is the term used when plaque builds up in an artery and obstructs blood flow. It increases the risk of many medical conditions because it prevents oxygen-rich blood from reaching different parts of the body. Aside from PAD, it can also cause a stroke and heart attack.

What causes plaque to build up in the arteries is unknown. However, many factors have been proven to play a role. These include lack of physical activity and an unhealthy diet. Other factors are a family history of heart disease, diabetes, smoking, and obesity.

Less common causes of PAD are blood clots and injuries to the affected body part.

Key Symptoms

Many people with PAD do not have symptoms in the early stages. But as the artery becomes narrower, they start to get cramps and feel leg pain. The severity of symptoms depends on the amount of blood that gets through to their legs. The lesser the amount, the worse are the symptoms. In mild cases, the leg pain goes away after a few minutes of rest. Severe cases, on the other hand, can cause excruciating pain even while the person is sitting or lying down.

Other symptoms include leg weakness, coldness, and discolouration. These occur due to the inadequate supply of oxygen. Patients may also notice that their toenails grow very slowly. In men, the disease can also cause erectile dysfunction.

Who to See and Types of Treatments Available

Diagnosis of PAD starts with a physical exam to look for signs of the disease. These include dead tissue as well as wounds in the foot or toe that are slow to heal. The doctor will also check for weak pulses in the legs and measure the blood pressure in the area.

Imaging tests are also used. Ultrasound and angiography can show how well blood flows through the arteries. They can also confirm if there is a blockage and identify its exact location.

Doctors also use other tests to determine if the blockage is caused by a blood clot, plaque build-up, or scar tissues. This information is used to determine the best treatment for the patient.

Mild cases may not need treatment. Poor blood flow to the limbs can be improved with some lifestyle changes. Patients are advised to eat a healthy diet, exercise often, and quit smoking (if they are smokers). They are also advised to seek treatment for any underlying medical condition they may have, such as diabetes. If there are no improvements, medical treatment becomes necessary.

Certain medications are used to relieve symptoms and prevent the disease from progressing. They are also used to prevent serious complications, such as strokes and heart attacks. Medications are used to lower a person’s cholesterol and blood pressure levels. They are also used to prevent blood from clotting and make the blood vessel wider.

In most severe cases, PAD may be treated with angioplasty. The procedure uses a catheter to remove plaque buildup and make the blood vessel wider. The catheter is inserted into a vein and threaded into the blocked blood vessel. The balloon on its tip is then inflated to push the plaque against the walls of the arteries. This allows more blood to flow through it. A stent can be used to prevent the blood vessel from collapsing. Another option is called bypass surgery in which a vessel taken from another part of the patient’s body is used to reroute the blood flow.

References:

  • Prevention and treatment of PAD. American Heart Association. http://www.heart.org/HEARTORG/Conditions/More/PeripheralArteryDisease/Prevention-and-Treatment-of-PAD_UCM_301308_Article.jsp.

  • Peripheral arterial disease. The Merck Manual Professional Version. http://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-arterial-disorders/peripheral-arterial-disease.

  • Hirsch AT, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease. Journal of the American College of Cardiology. 2006;47:e1.

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