Peripheral Arterial Disease (PAD)

Definition

Peripheral artery disease is a medical condition characterized by obstruction of blood flow in large arteries especially in the legs leading to symptoms of leg pain usually during walking, ulceration of the foot and eventual gangrene of the foot if not treated in time. The large arteries become narrow in peripheral artery disease due to number of causes like fat deposits on the inner wall of the arteries known as atherosclerosis or an inflammatory reaction.

Smoking, uncontrolled diabetes, high cholesterol level and high blood pressure increases the risk of developing peripheral artery disease. Treatment includes management of underlying causes and surgical intervention. Regular exercise also improves the symptoms. Peripheral artery disease is treatable but requires prompt attention to prevent complications.


Symptoms

The symptoms of peripheral artery disease depend upon the severity of the disease. Often mild cases do not produce any symptoms. More severe cases present with :

  • Cramping leg pain when walking known as intermittent claudication commonly affects the calf muscles. However, the site of pain depends upon the location of the narrowed artery. The pain is usually triggered by physical activity like walking. With time the severity of pain increases to the point that it can occur even at rest. This time of rest pain typically occurs in the middle of the night thereby waking the patient from sleep and is relieved by hanging the leg over the edge of the bed.
  • Weakening and numbness of the legs.
  • Affected feet appear cold.
  • Treatment resistant ulcer in the toes, feet or legs.
  • Change in skin color of the affected area along with loss of hair. Toe nails grow slowly.
  • Pulse of the affected legs becomes weak and may even be absent.

Untreated peripheral artery disease slowly progresses over time leading to gangrene of the limbs which eventually require amputation. If atherosclerosis is the cause behind the peripheral artery disease then other arteries of the body are also affected leading to chest pain, heart attacks, sudden blackouts, stroke and erectile dysfunction.

Causes

The large arteries maintains the supply of blood to the leg muscles. During exercise like walking or climbing stairs the oxygen demand of the active muscle also increases. To meet this demand there is increase in blood flow through the arteries. In peripheral artery disease  the resting blood flow to the muscles is maintained but cannot cater for increased physical activity. During exercise the increase demand for blood by the muscles cannot be met leading to symptoms of ischemia. Symptoms like intermittent claudication during walking may arise.

Long term reduced blood supply leads to poorly healing ulcers and eventual gangrene of the limbs. Atherosclerosis is the most common cause and other less common causes include  inflammation of the arterial walls, injury to the limbs, unusual location of the muscles of the limbs and exposure to radiation.

Risk factors

  • Smoking.
  • Uncontrolled diabetes.
  • Obesity.
  • Raised blood pressure and cholesterol level.
  • Elderly people commonly after 50 years.
  • Family history of peripheral artery disease, heart disease and stroke.

Treatment

Treatment for peripheral artery disease includes :

  • Life style modification by stopping smoking, weight reduction, intake of low fat diet and regular exercise as advised by the doctor.
  • Management of underlying diseases like intake of cholesterol-lowering drugs, blood pressure lowering drugs and antidiabetic medicines, drugs reducing the risk of clot formation like low dose aspirin, clopidogrel and drugs which increases the blood flow like cilostazole and pentoxifyline.
  • Surgical intervention like angioplasty and, injection of clot-dissolving drug directly in the artery is reserved for severe cases.

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