Peripheral Arterial Disease
Peripheral arterial disease (PAD), also known as peripheral artery or peripheral vascular disease, is a condition which is characterised by a build up of fatty tissues (Atheroma) on the inside wall of various arteries throughout the body. It is closely linked to Atherosclerosis and Coronary Heart Disease.
Although it can potentially affect any artery, when it occurs in the legs it is known by this unique term.
What causes Peripheral Artery Disease ?
The condition is usually related to Atherosclerosis. The accumulation of the Atheroma causes symptoms of blocked arteries in the legs due to the plaque build-up. This is turn restricts the flow of blood to the legs, and results in a shortage of oxygen and nutrient rich blood to supply the muscles of the leg when walking or running.
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Atheroma can also affect the coronary arteries, where it can cause angina or a heart artery blockage. This can cause a heart attack or sudden cardiac arrest. When it affects the arteries that supply the brain, it can cause a brain stroke.
Symptoms of PAD
Up to half the people who have leg circulation problems, or peripheral artery disease are unaware that they have the condition.
The primary blocked artery symptoms are pain or discomfort in the legs or lower limbs when exercising, walking or running, as the muscle fed by the affected artery starts to work harder and requires more blood supply. Stopping the activity may cause the pain to subside, and this is an additional indicator for the condition. This type of temporary pain is known as ‘intermittent claudication’.
In severe cases, the pain may be felt like a squeezing of the muscle which forces the sufferer to rest until it lapses. Other symptoms may include :-
* Aching or cramping of the leg muscles
* Numbness or exhaustion of the leg muscles
* pain in the thigh or buttock
* difficulty in walking, or walking more slowly than normal
* Restricted walking distance
* Numb or cold feet and toes
* Loss of hair from legs or feet
Risk Factors
Atheroma can build up for many years before it causes problems.
Smoking is the greatest risk factor for PAD and Atherosclerosis, and artery restriction is believed to start within months for people who smoke cigarettes.
Other contributory factors are high blood pressure, high blood cholesterol levels, diabetes, poor diet, and lack of exercise. These all contribute to the development of Atherosclerosis. Being male and aged over 50 years also increases the risk.
People with peripheral arterial disease are at much greater risk of having a heart attack or a stroke. This is due to the high probability that other arteries in their body are also clogged with excess blood lipids, and arterial deposits of plaque.
Treatments for Peripheral Arterial Disease
Treatment will usually depend on the severity of the condition, and the Doctor will aim to improve the patients ability to walk without pain, and reduce the risk of further damage to the arteries. By tackling the more serious underlying causes, this can avoid the possibility of future life threatening complications such as heart attack and brain stroke.
Lifestyle Treatment
If the condition is in it’s early stages the treatment will usually aim to consist of daily exercise to improve the circulation and unclog arteries. This may involve switching to a low fat diet that is rich in fruit and vegetables with high concentrations of the antioxidant vitamins C and E. Aspirin may also be prescribed as it helps to thin the blood and prevent the formation of blood clots. Certain herbs such as Gingko biloba or a combination of Tibetan herbs have been shown to increase the distance sufferers can walk before they experience pain.
Medication
For more advanced cases medicines may be used to control the effects of the clogged arteries. If you have a high cholesterol level, you may be given a type of drug called a statin. If you have diabetes, your doctor will ensure that your diabetes is under control and being correctly managed. If you have high blood pressure, you will be given medication to treat this.
You may also be given an anti-platelet drug. These drugs prevent blood clots from forming, which can lead to coronary artery blockage, heart attack and stroke. Anti-platelet drugs include clopidogrel and aspirin.
Surgical Options for Peripheral Artery Disease
Surgical intervention is carried out by a vascular surgeon and is usually reserved for serious cases, or those that have not responded to other forms of treatment.
Angioplasty is a type of surgical procedure to relieve the symptoms of a clogged artery, where the narrowed part of the leg artery is widened by inflating a small balloon internally within the artery. The Angioplasty balloon is later removed leaving the artery wider, and able to pass an increased blood flow to the affected part of the leg.
Where the narrowing of the artery is more extensive, it may be necessary to bypass a section of it by using a replacement – either a vein from the leg or a synthetic replacement material.
In severe cases, when the blood supply cannot be restored to a limb it may have to be amputated.