Peripheral Arterial Disease

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Peripheral Arterial Disease

Peripheral artery disease is a condition of the blood vessels that leads to narrowing and hardening of the arteries that supply the legs and feet.

The narrowing of the blood vessels leads to decreased blood flow, which can injure nerves and other tissues.

Peripheral artery disease is caused by arteriosclerosis, or "hardening of the arteries." This problem occurs when fatty material (plaque) builds up on the walls of the arteries. This causes the arteries to become narrower. The walls of the arteries also become stiffer and cannot widen (dilate) to allow greater blood flow when needed.

As a result, when the muscles of the legs are working harder (such as during exercise or walking) they cannot get enough blood and oxygen. Eventually, there may not be enough blood and oxygen, even when the muscles are resting.

Peripheral artery disease is a common disorder that usually affects men over age 50. People are at higher risk if they have a history of :

Smoking
Diabetes
Abnormal cholesterol
Heart disease (coronary artery disease)
High blood pressure (hypertension)
Kidney disease involving hemodialysis
Stroke (cerebrovascular disease)

Symptoms:

The classic symptoms are pain, achiness, fatigue, burning, or discomfort in the muscles of the feet, calves, or thighs

These symptoms usually appear during walking or exercise and go away after several minutes of rest. At first, these symptoms may appear only while walking uphill, walking faster, or walking for longer distances. Slowly, these symptoms come on more quickly and with less exercise. Legs or feet may feel numb even at rest. The legs also may feel cool to the touch, and the skin may look pale. When peripheral artery disease becomes severe, one may have:

Impotence
Pain and cramps at night
Pain or tingling in the feet or toes, which can be so severe that even the weight of clothes or bed sheets is painful
Pain that is worse when the leg raised and improves when the leg is dangled over the side of the bed
Skin that looks dark and blue
Sores that do not heal
A small injury can precipitate nonhealing ulcer or gangrene in the toe or foot. This leads to severe pain at that site even at rest

Majority of the blocks can be diagnosed by simple clinical examination- inability to feel the pulses in the foot.
Arterial blocks can be diagnosed by color Doppler a noninvasive painless method.
Angiogram provides a road map of the arterial tree and it helps to plan the method of treatment.
It is important for the high risk population namely smokers, those with diabetes, high blood pressure,and high cholesterol to have periodic check up of the vascular system to pick up vascular blocks early so that corrective measures can be taken before complications set in.

Medical TREATMENT

All patients with mild blocks can be treated medically. Stopping smoking and all forms of tobacco is the most important step towards recovery

Regular exercises and walking help to improve the blood flow and control sugar and cholesterol. Proper foot wear and foot care,

Blood thinners like aspirin, clopidogrel,

Control of risk factors like sugar, blood pressure and cholesterol

Life style modification

Those who have advanced blocks presenting with gangrene or severe pain require intervention

An angiogram is done to locate the level of block and the status of the artery beyond (like a road map) to plan the type of intervention