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Peripheral Artery Disease

Definition

Peripheral Artery Disease (PAD) and more specifically lower limb, peripheral artery disease is a reduction in blood supply to the legs and foot due to disease within the arteries. This condition may lead to pain and ulcers that do not heal, or amputation of a limb.

Early identification of PAD is essential since this condition is known to be an indicator of widespread artery disease and therefore a precursor for major cardiovascular events such as stroke, heart attack and also death. Early diagnosis therefore leads to in time preventive measures which lead to lower risks. 

 

Cause

Peripheral Artery Disease (PAD) is caused by a condition known as atherosclerosis that occurs in the diseased arteries. This narrows the arteries reducing the blood flow in the affected leg and foot. There are many risk factors that may cause atherosclerosis but the most common risks include:

  • Diabetes (especially uncontrolled Diabetes)
  • Smoking (increased dose of smoking is also related to increased risk)
  • Obesity (particularly a Body Mass Index over 30 and higher)
  • High Cholesterol levels
  • High Blood Pressure
  • Male sex (particularly, black males)
  • Age (elderly people are particularly at risk)

The majority of patients with PAD do not feel any symptoms. When symptoms occur these are characterised as muscle cramps (e.g. in the calf muscles) experienced during walking or exercise. Rest pain (lower leg pain during rest) may also be experienced, and this indicates advanced disease and limb ischemia.

 

Treatment

People who experience regular cramps in their legs during walking and/or are over 50 and suffer from one or multiple risk factors known to affect PAD should ask there Podiatrist or doctor for a check-up of their pedal circulation. This may include, pulse palpation of the principal foot arteries and if required Doppler and ABPI analysis.

Treatment for PAD may be either conservatively (with medications, risk control and management) or surgical (angioplasty, bypass).

Oral medical treatment may include cholesterol- lowering drugs (statins), anti-coagulants, and drugs to control other risk factors known to affect PAD (e.g. diabetes, high blood pressure). Symptom relief medication may also be prescribed in order to help treat symptoms of claudication (leg cramps). Patients suffering from PAD are also at an increased risk of ulceration that does not heal leading to amputation (especially if accompanied with diabetes). Therefore a comprehensive foot assessment should also include a biomechanical examination in order to identify possible high pressure areas which indicate potential ulcerative sites. A podiatrist would than advice and prescribe footwear, insoles and/ or orthotics depending on these results to reduce such risks.

In some cases, angioplasty or surgery may be necessary to treat peripheral artery disease.

Angioplasty. In this procedure, a small hollow tube (catheter) is threaded through a blood vessel to the affected artery. There, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. Your doctor may also insert a mesh framework called a stent in the artery to help keep it open. This is the same procedure doctors use to open heart arteries.

Bypass surgery. Your vascular surgeon may create a graft bypass using a vessel from another part of your body or a blood vessel made of synthetic fabric. This technique allows blood to flow around — or bypass — the blocked or narrowed artery.

Thrombolytic therapy. If you have a blood clot blocking an artery, your specialist may inject a clot-dissolving drug into your artery at the point of the clot to break it up.

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