Peripheral artery disease, also known as PAD, is a condition characterized by blockage or narrowing of the arteries that supply blood to the legs from the heart. This narrowing occurs due to the build-up of fatty tissue or plaque within the blood vessels, known as atherosclerosis or arteriosclerosis. Although it commonly affects the lower limbs, it can affect any blood vessel in the body, such as the arms, stomach, head, or kidneys. While it is more common in older populations, it can occur at any age. One warning sign of PAD is cramping in the legs that subsides on rest. Left untreated, PAD can lead to stroke or heart attack. Despite its high prevalence, PAD is one of the most underdiagnosed and undertreated diseases.
PAD may not cause any symptoms in many patients. However, those with compromised blood flow may experience leg pain or cramps, known as claudication, during movement that subsides with rest. Commonly affected areas include thighs, buttocks, and calves. Advanced cases may show symptoms such as weakness in the legs, burning or aching pain in the feet at night, fatigue after activities such as walking, delayed wound healing, and changes in the skin such as decreased skin temperature, loss of hair on the legs, shiny skin, thin and fragile skin on the legs and feet, and slow toenail growth. Erectile dysfunction is also observed in diabetic men with PAD.
Plaque buildup around the walls of blood vessels is a common consequence of high blood cholesterol levels. This wax-like substance made up of fat may accumulate slowly and without any noticeable symptoms, gradually narrowing the vessel lumen. Over time, the plaque hardens and constricts the vessels, impeding blood flow and reducing the supply of oxygen to the body's cells.
During the initial consultation, a physical exam and symptom assessment are typically performed to diagnose PAD. The doctor may look for changes in leg color, abnormal sounds in leg arteries, weak pulses, slow wound healing, and reduced blood flow to the legs. Additional tests may be suggested to confirm the diagnosis, such as blood tests to assess cholesterol and triglyceride levels, angiography to view blood flow, ultrasound tests to detect artery blockages, or ankle-brachial index testing to compare blood pressure in the ankle and arm. If diagnosed with PAD, treatment options may include lifestyle changes, medication, or surgery depending on the stage of the disease.
PAD typically involves symptomatic treatment, but if this fails, surgery may be necessary. Making lifestyle changes, such as weight loss, controlling diabetes, exercising regularly, and adopting healthy habits, can help prevent the disease. Smoking plays a crucial role in the development of plaques in blood vessels.
In addition to lifestyle modifications, a doctor may recommend medication to manage underlying conditions, such as high blood pressure, diabetes, or high cholesterol, which may exacerbate PAD symptoms.
Anti-hypertensive medications may be prescribed to reduce the risk of developing cardiovascular disease in patients with high blood pressure. The normal range for blood pressure is 120/80 mmHg +- 20/10 mmHg.
To lower cholesterol levels and prevent the risk of heart attack and stroke, statins are typically prescribed. The recommended LDL (low-density lipoprotein) level for those with PAD is less than 100 mg/dL. For individuals with major risk factors for heart attack and stroke, such as diabetes and smoking, these levels should be even lower.
Controlling blood sugar levels is critical for diabetics to prevent the progression of PAD, as well as to aid in wound healing.
Blood thinners may be prescribed to prevent embolism or blood clotting, increasing blood flow through the vessels of the lower limbs.
Symptomatic relief medications such as analgesics and muscle relaxants may be prescribed to alleviate pain in the limbs, the most common symptom of PAD.
In cases where the aforementioned treatment options do not provide relief, surgical interventions such as angioplasty, bypass, or thrombolytic therapy may be recommended by doctors.
Angioplasty involves using a catheter to inflate a balloon within the vessel and flatten the plaque in the artery wall. This procedure widens the artery and allows for improved blood flow. Additionally, a mesh tube may be inserted into the artery to prevent it from collapsing.
Bypass surgery involves creating an alternate path around the blocked artery using a blood vessel from another part of the body or a synthetic vessel. This intervention aids in improving blood flow through the vessels.
Thrombolytic therapy is recommended if a blood clot is obstructing the artery. An anti-platelet or clot-dissolving drug may be injected into the artery at the point of the clot to dissolve it.
The risk of developing PAD is increased by smoking, high blood pressure, high cholesterol or triglyceride levels, diabetes, renal failure, and obesity. To prevent the onset of this disease, following a healthy lifestyle is recommended, including quitting smoking, exercising regularly, adopting a healthy diet, avoiding alcohol, and maintaining a healthy weight.
PAD complications are primarily due to reduced or absent blood flow, leading to amputation, delayed wound healing, severe limb pain, limited mobility, and increased risk of stroke and heart attack. Prompt diagnosis and strict adherence to preventive measures can be helpful in treating PAD effectively.
Early diagnosis of PAD is crucial, as it increases the risk of heart attack and stroke. The prognosis depends on various factors, but making changes to one's lifestyle can greatly improve the outlook. Medications and lifestyle modifications are essential in preventing the onset or progression of PAD.
It is recommended to consult a doctor if there is a family history of peripheral artery disease, high cholesterol, diabetes, stroke, or heart attack, if there is a risk of high blood pressure and high cholesterol, if there is a history of smoking, or if one is obese.