Peripheral Artery Disease is also known as Peripheral Arterial Disease. This is a common circulatory problem which involves narrowing of arteries which effectively reduce blood flowing into limbs. When people develop PAD or peripheral artery disease, their extremities which are usually the legs, do not receive enough flow of blood so as to keep up with the demand. This condition will cause symptoms amongst which the most notable is claudication, or leg pain while walking. Peripheral artery disease also can likely be a sign of more widespread accumulation of fatty deposits in arteries which is medically known as atherosclerosis. This medical condition can also reduce flow of blood to heart & brain & legs as well. Peripheral artery disease patients often can successfully treat this condition by exercising, quitting tobacco & consuming a healthy diet.
Signs & Symptoms of Peripheral Artery Disease
Although many people suffering from peripheral artery disease experience mild or no symptoms at all, some people experience pain in legs while walking. Symptoms of claudication include cramping or muscle pain in arms or legs which are triggered by activities like walking & which usually disappear after a few minutes of resting. Location of pain generally depends upon location of clogged or narrowed arteries. Pain in calf is one of the most common locations of claudication. However, severity of claudication widely varies from mild discomfort to debilitating pain. Moreover, severe claudication can also make it hard for people to walk or perform any other type of physical activity.
Other Symptoms of Peripheral Artery Disease
- Painful cramping in calf, thigh or hip muscles after certain activities like walking or climbing stairs.
- Weakness or numbness in legs.
- Coldness in foot or lower leg, especially when it is compared with the other side.
- Sores on legs, feet or toes which do not heal.
- Change in color of legs.
- Slow growth of hair or hair loss on feet & legs.
- Slow growth of toenails.
- Shiny skin on legs.
- Weak or no pulse in feet or legs.
- Erectile dysfunction among men.
Pain may also occur when patients are at rest or when they are lying down (ischemic rest pain) with progression of peripheral artery disease. This pain can also be extremely intense so as to disrupt sleep. Walking around the room or hanging legs over the edge of bed may however temporarily relieve pain.
Time to Seek Medical Help for Peripheral Artery Disease
It is time to see a doctor when people experience pain in legs, numbness & other symptoms associated with peripheral artery disease. Make an appointment & do not dismiss this as a normal course of aging. It would however be better to get screened even when people do not show symptoms of peripheral artery disease. People in the following groups should be the first to opt for screening tests.
- People over age 70 years.
- People over age 50 years & having a history of smoking or diabetes.
- Under age 50 years but having diabetes & peripheral artery disease risk factors like high blood pressure or obesity.
Causes of Peripheral Artery Disease
Peripheral arterial disease is often caused due to atherosclerosis in which fatty deposits or plaques build up inside arterial walls & which eventually reduce the flow of blood. Although, it is the heart which is usually the focus of discussion in atherosclerosis, this condition can & invariably does affect arteries throughout the human body. That is why whenever atherosclerosis occurs in arteries supplying blood to limbs, it causes peripheral arterial disease. Less commonly, peripheral artery disease is also caused by other reasons like radiation exposure, unusual anatomy of muscles or ligaments, injury to limbs & inflammation of blood vessels.
Risk Factors for Peripheral Artery Disease
Factors which increase risk of developing peripheral arterial disease include the following.
- Obesity – body mass index over 30
- High Cholesterol
- High Blood Pressure
- Increasing Age – especially people over 50 years of age
- High Level of Homocysteine – which is a protein component helping build & maintain body tissue
- Family history of stroke, heart disease or peripheral arterial disease
People who are having diabetes or smoke pose greatest risk of developing peripheral arterial disease, which is due to reduction of blood flowing in the region.
Complications Associated with Peripheral Artery Disease
When peripheral artery disease is caused by atherosclerosis or buildup of plaques in blood vessels, patients are also at risk of developing the following conditions.
- Critical Limb Ischemia – This medical condition starts as open sores which do not heal, but causes an injury or infection of feed or legs. Critical Limb Ischemia occurs when these infections or injuries progress so as to cause gangrene or tissue death & which can sometimes require amputation of the affected limb.
- Heart Attacks & Strokes – Atherosclerosis which causes signs & symptoms of peripheral arterial disease is not limited to legs alone. Plaques or fat deposits can also build up within arteries supplying blood to the brain & heart.
Diagnosing Peripheral Artery Disease
These are some of the tests doctors rely upon so as to diagnose peripheral artery disease.
- Physical Examination – Doctors may be able to find signs of peripheral artery disease during a physical examination of the patients. These signs include an absent or weak pulse below narrowed area of artery, bruits or whooshing sounds over arteries & which can be heard using a stethoscope, decreased blood pressure in affected limb & evidence of poor wound healing in areas where blood flow is restricted.
- ABI – Ankle-Brachial Index – This is a common test which is used so as to diagnose peripheral artery disease. ABI compares blood pressure in ankles with blood pressure in arms. Doctors for getting a blood pressure reading use a regular blood pressure cuff & special ultrasound device so as to evaluate blood pressure & blood flow. Patients are also made to walk on a treadmill & have readings which are taken before & immediately after exercising in order to capture severity of narrowed arteries during walking.
- Angiography – This procedure is conducted by injecting a dye as contrast material into blood vessels. This allows doctors to view blood flow through arteries in real time. Doctors are thereby able to trace flow of contrast material using imaging techniques like X-ray or MRA – magnetic resonance angiography or CTA – computerized tomography angiography. Catheter angiography is another procedure which is more invasive & involves guiding a catheter through artery in groin region to affected areas & by injecting dye in the process. Even though catheter angiography is invasive, it allows simultaneous diagnosis & treatment by finding the narrowed area of blood vessel first & then widening the same with a dilating procedure or by administering medications so as to improve flow of blood.
- Ultrasound – Special ultrasound imaging techniques are applied in this procedure, like the Doppler ultrasound which can help doctors evaluate blood flowing through blood vessels & also enable them identify narrowed or blocked arteries.
- Blood Tests – Sample of patient’s blood can also be utilized so as to measure triglycerides & cholesterol in order to check for diabetes.
Treatments for Peripheral Artery Disease
Treatment of peripheral arterial disease has two major goals. One is to manage symptoms like leg pain so that patients can resume physical activities & the other is to stop progression of atherosclerosis throughout the body in order to reduce risk of stroke & heart attacks. Patients may be able to accomplish these twin goals with changes in lifestyle. They will also need to quit smoking which is the single most important thing they can do so as to reduce risk of complications. Patients will also need additional medical treatment when these lifestyle changes are not sufficient. Doctors often prescribe medicines so as to prevent blood clots, lower cholesterol & blood pressure & to control pain & other symptoms associated with peripheral artery disease.
Medications for Peripheral Artery Disease
- Medications for Lowering Cholesterol – Patients are normally given a cholesterol lowering drug called statin so as to reduce risk of stroke & heart attack. Goal of peripheral arterial disease patients is to reduce the bad low-density lipoprotein (LDL) to less than 2.6 millimoles per liter (mmol/L) or 100 milligrams per deciliter (mg/dL). This goal is even lowered when peripheral artery disease patients are having additional major risk factors for stroke & heart attack, especially when they continue to smoke or are having diabetes.
- Medications for High Blood Pressure – When patients are also having high blood pressure, doctors may address this by prescribing medications to keep it under control. Basic goal of this therapy is to reduce systolic blood pressure to 140 millimeters of mercury (mm Hg) or lower & the diastolic blood pressure to 90 mm Hg or lower. Patients having diabetes must target their blood pressure to be under, 130/80 mm Hg.
- Medications to Control Blood Sugar – It becomes even more important to control glucose blood sugar levels when patients are also having diabetes. They must therefore talk to their doctors about fixing blood sugar level goals & the steps they need to take so as to achieve them.
- Medications to Prevent Blood Clots – Since peripheral arterial disease is related to reduced-flow of blood to limbs, it is important for patients & doctors to improve the flow. Doctors for this purpose often prescribe daily aspirin therapy or some other medications like clopidogrel (Plavix) in order to achieve these goals.
- Medications to Relieve Symptoms – Drugs like cilostazol (Pletal) increase flow of blood to limbs both ways, by widening blood vessels & keeping blood thin. This specifically helps treat symptoms of claudication like pain in leg of people who are suffering from peripheral artery disease. Common side effects resulting from this medication include diarrhea & headache. Pentoxifylline (Trental) is an alternative to cilostazol, but is generally less effective. However, side effects are quite rare with pentoxifylline.
Surgical Interventions for Peripheral Artery Disease
In some cases of peripheral artery disease, angioplasty or surgery may be quite necessary in treating the condition which is causing claudication.
- Angioplasty – In angioplasty, small hollow tube called catheter is threaded through the blood vessel to the affected artery in this procedure. A small balloon fitted on the tip of catheter in angioplasty is inflated so as to reopen the artery & flatten blockage into artery wall, while stretching the artery to open & increase flow of blood at the same time. Surgeons may also insert a mesh framework in the artery known as stent & which will help the artery remain open when the balloon is deflated & withdrawn. This is exactly the same procedure which surgeons use to open arteries of the heart.
- Bypass Surgery – Surgeons may also create a graft bypass by using a blood vessel from another part of the body or another blood vessel made from a synthetic fabric. This bypass surgical technique will allow blood to flow around or bypass the narrowed or blocked artery.
- Thrombolytic Therapy – This is for patients who are having a blood clot which is blocking the artery. Surgeons will inject a clot dissolving drug into the artery at the point of clot so as to break it up & free the blockage.
Supervised Exercise Program for Peripheral Artery Disease
In addition to surgery & medications, doctors may also prescribe a supervised exercise training regimen targeted at increasing the distance patients can walk free of pain. Regular exercises can help improve symptoms of peripheral artery disease in a number of ways including helping patients use oxygen more efficiently.
Alternative Medicine for Peripheral Artery Disease
Blood thinning effects of ginkgo & some homeopathic remedies may allow peripheral artery disease patients with intermittent claudication to walk longer distances with lesser pain. However, some of these remedies may also cause bleeding if taken in high doses. Therefore, they can also be dangerous when paired with anti-platelet medications like aspirin which are routinely prescribed for people with peripheral artery disease. PAD patients should talk to their doctors before considering taking alternative medicine for relief from pain in legs.
Affordable Treatment for Peripheral Arterial Disease in India
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