Peripheral Arterial Disease

What is Peripheral Arterial Disease?

• Peripheral Arterial Disease (PAD) is a condition in which blood flow to lower limbs is affected due to narrowed or blocked arteries.
• Arteries are blood vessels that carry oxygen-rich blood and essential nutrients from heart to all parts of the body.
• PAD is also known as Peripheral Vascular Disease (PVD).
• The common cause of PAD is fatty deposits in the arteries that affect blood flow to extremities. This condition is known as atherosclerosis.

What are the causes of Peripheral Arterial Disease?

• Atherosclerosis
• Blood vessel inflammation
• Limb injury
• Exposure to radiation
• Anatomical abnormalities of ligaments or muscles

Who are at risk of Developing Peripheral Arterial Disease?

• Older age
• Smoking
• Diabetes
• Kidney Failure
• Presence of atherosclerosis in other blood vessels such as heart, brain etc.
• A Patient who underwent bypass surgery or angioplasty in the past
• Obesity
• High blood pressure
• High cholesterol
• Increased levels of C-reactive protein or homocysteine

What are the peripheral arterial disease symptoms?

• Painful cramps in one or both of hips, thighs, or calf muscles after walking and relieved on rest (Claudication)
• Numbness or weakness of legs
• The Coldness of lower leg or foot
• Progressing sores on toes, feet or legs
• Discoloration of legs
• Slower growth of toe nails
• Erectile dysfunction in men
• The slow hair growth or hair loss on feet or legs
• Weak pulse or no pulse  in legs or foot
• Shiny skin on legs

What are the complications of peripheral arterial disease?

• Critical limb ischemia: In this condition, open sores are formed initially and that does not heal on feet or legs. This can further progress into tissue death (gangrene) and sometimes requiring amputation of the affected limb.
• Stroke and heart attack: Fatty deposits can also block arteries that supply blood to heart and brain. They are co-existent issues rather than caused by PAD.

Challenges to overcome amputation in peripheral arterial disease

• Amputation of a small part of the limb without a structured care plan can lead to limb amputation in up to 60%.
• Wounds on the limbs are caused to pressure at an abnormal location that could be painless due to diabetes-associated nerve damage. Diabetes also affects the vascular supply to the affected part leading to non-healing of ulcer or sore.
• The time needed to heal wounds – 150-300 days depending on the location.
• Unless the blood supply to the affected area is improved amputation leads to further and higher amputation again.

How is The Peripheral Arterial Disease Diagnosed?

• Ankle-brachial index: This test compares the blood pressure in the ankle and in the arm.
• Doppler and Ultrasound imaging: This test measures the blood flow in the arteries to identify the presence of a blockage.
• CT scan and MRA (Magnetic Resonance Angiography): This test images the arteries in abdomen, pelvis, and legs identifying the exact location of the block
• Angiography: The contract agent is inserted into the artery through the catheter and X-rays are taken to identify the blockage and cause reduced blood flow.

How is Peripheral Arterial Disease Treated?

Treatment of Peripheral Arterial Disease (Peripheral Vascular Disease).

• Quit smoking
• Excellent control of diabetes, hypertension, high cholesterol levels that are responsible for PAD.
• Endovascular treatment: Often in the groin, leg or arm area. The Doctor will make an incision into the artery in order to reach the area of blockage. Then procedures like angioplasty-stent, laser atherectomy, and directional Atherectomy would be performed.