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Peripheral Artery Disease (PAD)

Overview

Peripheral artery disease (PAD) occurs when the arteries that deliver blood from the heart to the limbs constrict or get blocked. The primary reason is the accumulation of lipid plaque in the arteries, known as atherosclerosis. PAD may affect any blood vessel, but it affects the legs more frequently than the arms. Daily exercise, eating a nutritious diet and quitting smoking are all effective ways to prevent peripheral artery disease.

Cause

Atherosclerosis is the most common causative factor of peripheral artery disease. Atherosclerosis is a condition in which fatty deposits accumulate on the inside layers of the arteries, decreasing blood flow.

Risk Factors

Following are some of the risk factors associated with peripheral arterial disease:

·         Smoking

·         Blood pressure that is too high

·         High Cholesterol levels

·         Old age

·         Atherosclerosis

·         Diabetes

Epidemiology

PAD affects both men and women, although African Americans are at a higher risk of developing it. When compared to non-Hispanic white people, Hispanics may have a comparable or slightly greater incidence of PAD. In the United States, approximately 6.5 million individuals aged 40 and above have PAD.

Signs And Symptoms

Many patients with peripheral artery disease have little or no symptoms, although some people feel discomfort in their legs when walking. Muscle soreness or aching in your legs or arms brought on by physical activity, such as walking, but goes away after a few minutes of rest is called claudication. Calf muscles are affected most of the time. Claudication has a wide range of severity. If you have severe claudication, you may find it difficult to move or engage in other forms of physical exercise. If your peripheral artery disease advances, you may feel discomfort while resting or lying in bed.

The following are characteristics of peripheral artery disease:

·         Muscle cramping occurs after particular exercises, such as running or even walking.

·         When stitching, writing, or doing other hand duties, you may have soreness

·         Hair loss or a slowing of hair development may be noticed on the feet

·         In your legs and ankles, there is no or a feeble pulse

·         Numbness or weakness in the legs

·         Lower limbs feel cold.

·         Unhealing ulcers on your toes, feet, or legs

·         Altered skin coloration of the legs.

·         Toenail development will be delayed.

·         Legs with a lustrous shine

·         Erectile dysfunction

Diagnosis

Ankle-brachial Index: This is a frequent test for detecting PAD. The blood pressure of the ankle is compared to the blood pressure in the arm. Your doctor will take your blood pressure using a standard blood pressure monitor device and a specific ultrasound instrument to assess blood pressure and flow.

Doppler ultrasound: Doppler ultrasound is a special imaging technique that can assist your doctor in assessing blood flow across your vascular system and locating blocked or constricted arteries.

Angiography: This test lets your doctor see blood flow via your blood channels as it occurs by injecting a dye into your blood vessels. Using imaging tools, your doctor can track the dye's passage.

Catheter angiogram: A catheter angiogram is an invasive treatment that entails inserting a tiny hollow tube into an artery in your pelvis and infusing dye into the damaged region. This enables your doctor to repair a clogged blood vessel while still diagnosing it. Your doctor can then expand it by placing a small balloon or by prescribing blood-flow-improving medicine.

Differential Diagnosis

Differential diagnoses of peripheral artery disease include:

·         Spinal Stenosis.

·         Thromboangiitis Obliterans.

·         Varicose Vein Surgery

·         Chronic Venous Insufficiency

·         Degenerative Disk Disease.

·         Osteoarthritis

Treatment

Various medications can be used to address the root causes of PAD. Some people may only require one or two of the drugs listed here, while others may require many prescriptions.

Statins: If blood tests reveal high LDL cholesterol levels, you'll be given a statin. Statins work by assisting your liver in producing less LDL cholesterol. Most people taking statins have no or very few adverse effects, while others suffer some, such as indigestion, headaches, nausea, and muscle ache.

Antihypertensives: Antihypertensives are a class of drugs used to lower blood pressure. E.g., include an ACE inhibitor or ARBs.

Clot prevention: If you have PAD, you'll most certainly be prescribed a blood thinner to help prevent blood clots. This medication thins your blood, making it less prone to clots. You may be offered the following blood-thinning medications:

·         Aspirin (low-dose)

·         Rivaroxaban

·         Clopidogrel

Medication for intermittent claudication: If you experience leg discomfort that is caused by activity, you may be prescribed naftidrofuryl oxalate.

Procedures

Revascularization: Surgery to re-establish blood flow via your legs' vessels may be advised in some circumstances. Revascularization is the term for this procedure. Revascularization may be considered if your leg discomfort is so bad that it stops you from doing everyday tasks or if your problems haven't responded to the therapies listed. For PAD, there are two basic types of revascularization treatments:

Angioplasty

Angioplasty is a procedure that involves inflating a small balloon within a vessel to expand a blocked or constricted portion of an artery. It's a less invasive alternative to a bypass. It is usually conducted under local anesthesia as a day operation and does not require substantial incisions. This indicates you'll be able to return home on the same day as your surgery, and you'll heal faster.

Bypass grafting

An artery bypass graft is a procedure in which blood arteries from another region of the body are used to bypass an obstruction in an artery. A bypass's results are typically thought to persist longer than those of angioplasty, but it is an invasive procedure.

Prognosis

The prognosis is usually fair with therapy, but the death rate is still high due to the common coexistence of coronary artery and cerebrovascular illness.

Lifestyle Modifications

Maintaining a healthy lifestyle is the easiest way to avoid claudication. Some lifestyle modifications are as follows:

·         If you're a smoker, you must try to stop smoking.

·         If you have hyperglycemia, maintain proper blood sugar control with a proper diet and medications.

·         Exercise regularly. Plan for 30 to 45 minutes of activity several times a week.

·         If necessary, reduce your fats and blood pressure levels.

·         Low-saturated-fat foods should be consumed.

 

·         Maintain a healthy body mass index (BMI).