What is peripheral arterial disease?
Peripheral arterial disease, also known as peripheral artery disease or PAD, is the narrowing or blocking of blood vessels that run from the heart to the limbs and organs; the arteries in the legs are most commonly affected.
The restricting of the arteries is caused by a buildup of plaque -- a combination of fat, cholesterol and other substances in the blood. This condition is called atherosclerosis.
PAD is dangerous because those who have it are more likely to have heart disease, heart attacks or strokes.
Some risk factors for peripheral arterial disease can’t be controlled. For example, senior citizens and those with personal or family history of PAD are most likely to have it.
However, a person can control other risk factors by modifying behavior. These include:
- Cigarette smoking
- High blood pressure
- High blood cholesterol
- Physical inactivity
All of these risk factors tend to damage the arteries. When this happens, a healing process begins that includes plaque forming at the site of the damage. The buildup of plaque narrows the artery. Also, plaque can break off at the site, causing a blood clot to form. Clots can further narrow the artery.
Effects & symptoms
Many people with PAD see no symptoms until the condition is advanced.
When blood flow is restricted, damage to the organs or limbs can result. When PAD is left untreated, tissue can die, leading to gangrene. Typical symptoms of PAD include:
- Cramping in the legs, hips or buttocks during exercise that eases while resting.
- Pain in the toes or feet while resting.
- Open wounds, often at pressure points in the feet, that heal slowly or not at all.
- Pale or bluish skin.
- Poor toenail growth.
- Decreased hair growth on the legs or feet.
In addition to the primary care doctor, a vascular specialist or cardiologist might be involved in diagnosing PAD. They will ask about the patient’s medical history and that of family members, and a physical exam will be given.
Next, a test called the ankle-brachial index might be given. The test compares the blood pressure in the ankle to the blood pressure in the arm. It might take 10 to 15 minutes. Typically, the blood pressure in the ankle is about 90 percent of that in the arm; if significant blockage is present, it might be less than 50 percent.
Prevention & treatment
Treatment focuses on managing risk factors to prevent the progression of PAD though lifestyle changes and medication. For some people with advanced PAD, a procedure or surgery might be necessary.
Steps to treat PAD and manage risk factors can slow or reverse the symptoms. These steps might include:
- Quitting smoking.
- Exercise, possibly starting with a simple walking regimen.
- Following a diet that’s low in trans fats, such as the DASH diet.
- Taking medication to reduce blood pressure and cholesterol.
- Losing weight.
Procedures to treat advanced PAD include:
- Angioplasty: A catheter with a balloon tip is inserted through a small incision and threaded through the body to the site of the blocked artery. The balloon is then inflated, widening the artery by forcing plaque outward to the arterial wall. During this procedure, a stent -- a wire mesh cylinder -- might be inserted. Medicine might be inserted through the catheter to dissolve a blood clot, or a device might be inserted to remove a clot.
- Atherectomy: Plaque is shaved or cut from the wall of the artery.
- Bypass grafting: A synthetic tube or a blood vessel from another part of the body is surgically implanted so blood can go around a closed artery.
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