Peripheral Artery Disease
What is peripheral artery disease?
Peripheral artery disease (PAD), also referred to as peripheral vascular disease (PVD) results from the build-up of plaque inside the lining of arteries. PVD generally refers to blockages in the arteries that supply blood to the legs. These plaque deposits gradually harden and narrow the arteries, limiting oxygen-rich blood supply to your body.
What causes peripheral artery disease?
PAD can also occur due to
- Formation of blood clot (thrombus/emboli) that may blockage a blood vessel
- High blood sugar levels with associated high cholesterol, which may damage the blood vessels over a long term
- Inflammation of the arteries (arteritis), which can weaken and narrow down the arteries
- Infections such as salmonellosis and syphilis, which can infect and damage the blood vessels. Very rare.
Several factors are considered to increase the risk of developing PAD; they include family history of heart attacks or strokes, increased age (>50 years), overweight, sedentary lifestyle, smoking, diabetes, hypertension, high cholesterol, and past history of coronary heart disease, heart attack or stroke.
What are the symptoms of peripheral artery disease?
PVD in the legs is characterized by two primary symptoms:
- Claudication: a dull, cramping type of pain in the calf muscles, thighs or hips. The pain appears while walking or climbing up the stairs and goes away on rest, but slowly with time, they may appear quickly with little exercise and feeling of numbness is also felt in the feet during rest. This pain is also called intermittent claudication as the symptoms come and go.
This fluctuation occurs as a result of the narrowing of the arteries resulting in the decreased supply of oxygen to the leg muscles, especially during exercise when the demand of oxygen is higher. The narrowing of arteries can be temporary due to contraction of muscles known as vasospasm, or permanent due to fat deposition in arteries known as atherosclerosis, or complete occlusion of arteries supplying the legs.
- Severe leg ischemia: pain in your toes or feet even when you are not walking. This is a symptom of advanced peripheral artery disease and occurs due to the lack of oxygen to your legs when at rest. Leg ischemia is also associated with sores or wound on the feet or legs that do not heal or heal slowly.
Other symptoms experienced by patients with PAD are tingling sensation, weak or absent pulses in the feet or legs, burning sensation during rest, discoloration of skin on the legs, poor growth of toe nails and hairs on the legs, and erectile dysfunction in men who also have diabetes.
How is peripheral artery disease diagnosed?
When you present to the clinic with these symptoms, your doctor will perform a thorough examination of your medical and family histories, and conduct a physical examination including checking for weak or absent pulses, abnormal sounds (bruits) in the narrowed artery and comparison of blood pressure between affected and the normal limb. Your doctor may order some of the following diagnostic tests to confirm PAD:
- Ankle-brachial index (ABI): compares the blood pressure of your ankle to the blood pressure in the arm.
- Doppler ultrasound: checks for a blocked artery, where blood flow through the artery is determined. It also helps in determining the severity of PVD.
- Treadmill test: gauges the severity of symptoms and monitors the level of exercise that elicits the symptoms
- CT Angiogram (CTA): A special CT scan that can provide a detailed image of the arteries anywhere in the body. It can detect the location of the blockage in a blood vessel.
- Arteriogram: The test involves the injection of a dye into your artery, followed by which an X-ray is taken. X-ray shows the location and extent of blockage in the artery.
- Blood Tests: diagnose conditions such as diabetes and high blood cholesterol
How is peripheral artery disease treated?
Based on these diagnostic tests, your doctor will plan the best treatment for your condition. The goals of PVD treatment are to reduce symptoms, improve quality of life and to prevent complications. The treatment for PVD includes lifestyle changes, medicines, and surgery.
Lifestyle changes: Stop smoking, as smoking increases your risk of PVD by four times. Exercise regularly and be physically active. Get your blood pressure, cholesterol, and blood sugar level monitored regularly to avoid the risk of stroke, heart diseases and death. Eat a well-balanced diet with lower amount of fats and salt.
Medicines: Your doctor may prescribe medicines to lower high cholesterol and blood pressure levels. You may also be prescribed medicines that prevent the formation of blood clots and relieve pain.
Surgery: Your doctor will recommend surgery when the conservative treatments fail to alleviate symptoms of PAD. These may include:
- Bypass grafting: This surgery is performed when the blood flow to your leg is totally blocked. In this procedure, a graft (blood vessel taken from another part of your body or an artificial tube) is placed to bypass the blood flow around the blockage.
- Angioplasty, stenting: Angioplasty is a procedure performed to restore blood flow through a blocked artery. It involves the passage of a catheter with a deflated balloon at its tip into a blocked artery. The balloon is then inflated in order to displace the plaque outwards. This restores the blood flow by widening the artery. In addition, a stent may be placed in the artery to keep it open after angioplasty is done.
- Atherectomy: Atherectomy is a procedure in which a catheter with a small cutting device is passed into the blocked artery. This device breaks up the plaque into bits, which are washed away with the bloodstream or through the catheter.