What is Peripheral Arterial Disease?

Is peripheral arterial disease dangerous?
Yes. Any artery narrowing in any part of the body is associated with a nearly equal risk of heart attack,
stroke, or death. Yet, peripheral arterial disease also places other vital organs at risk. Inasmuch as PAD
defines the narrowing of arteries that carry blood to the legs, arms, stomach or kidneys, each of these
critical organs can be damaged. Often, the disease progresses silently for years until the damage
becomes evident.

Yes. Any artery narrowing in any part of the body is associated with a nearly equal risk of heart attack,
stroke, or death. Yet, peripheral arterial disease also places other vital organs at risk. Inasmuch as PAD
defines the narrowing of arteries that carry blood to the legs, arms, stomach or kidneys, each of these
critical organs can be damaged. Often, the disease progresses silently for years until the damage
becomes evident.

What are the symptoms?
PAD can cause a diversity of symptoms, depending on which arteries are affected. Most individuals
with PAD have blockages to the leg arteries, For these individuals, common symptoms of poor leg
circulation are discomfort, cramping, fatigue, heaviness, or pain in the buttock, thigh, or calf muscles
during activity, that usually promptly subsides with rest. This hallmark symptom is called ¡§intermittent
claudication¡¨ or simply ¡§claudication¡¨, and is comparable to ¡§angina of the legs¡¨ Symptoms of poor
kidney circulation include sudden high blood pressure, or blood pressure that is hard or impossible to
control with medications alone. Severe blockage of the kidney arteries may result in loss of kidney
function or kidney failure. Artery blockages to the intestinal (or ¡§mesenteric¡¨ arteries) can lead to
abdominal discomfort that is provoked by eating, and may lead to weight loss, malnutrition, or death.
Aortic aneurysms usually do not cause symptoms, but may sometimes be associated with abdominal or
back pain. They are dangerous and deadly when they are not detected and grow large enough to
rupture.  

PAD can cause a diversity of symptoms, depending on which arteries are affected. Most individuals
with PAD have blockages to the leg arteries, For these individuals, common symptoms of poor leg
circulation are discomfort, cramping, fatigue, heaviness, or pain in the buttock, thigh, or calf muscles
during activity, that usually promptly subsides with rest. This hallmark symptom is called ¡§intermittent
claudication¡¨ or simply ¡§claudication¡¨, and is comparable to ¡§angina of the legs¡¨ Symptoms of poor
kidney circulation include sudden high blood pressure, or blood pressure that is hard or impossible to
control with medications alone. Severe blockage of the kidney arteries may result in loss of kidney
function or kidney failure. Artery blockages to the intestinal (or ¡§mesenteric¡¨ arteries) can lead to
abdominal discomfort that is provoked by eating, and may lead to weight loss, malnutrition, or death.
Aortic aneurysms usually do not cause symptoms, but may sometimes be associated with abdominal or
back pain. They are dangerous and deadly when they are not detected and grow large enough to
rupture.
 

How is PAD diagnosed?
Diagnosing PAD begins with a vascular-focused medical history and physical examination. To detect
lower extremity PAD, doctors can also perform or order a simple test called the ABI (ankle brachial
index). After that, other tests may be done. They include:  

„h duplex ultrasound
„h magnetic resonance angiogram
„h CT angiogram
„h regular (catheter-based) angiogram

How is PAD treated?
All individuals with PAD in any location require treatment to lower their risk of heart attack and
stroke. This can be accomplished by lifestyle changes, use of risk-reducing medications or both.  

Every individual with PAD should promptly lower their risk by taking action to:

„h stop smoking (smokers are 2 to 25 times more likely to get PAD and all PAD-related
outcomes occur earlier, are more severe, and are less likely to be effectively treated in those
who continue to smoke)

„h control diabetes
„h control blood pressure
„h eat a low-saturated-fat, low-cholesterol diet and control cholesterol levels
„h be physically active (including use of a supervised exercise program)
„h use an antiplatelet (clot preventing) medication

PAD may require treatment and the exact treatment will depend on the site and severity of the artery
blockages. For individuals with lower extremity PAD, effective treatments include:

„h medicines to help improve walking distance
„h supervised exercise programs
„h angioplasty
„h vascular surgical bypass

For most individuals with lower extremity PAD, lifestyle modifications alone (including an exercise
program) can usually both lower heart attack and stroke risk, and simultaneously improve symptoms, or keep them from getting worse. In a minority of patients, lifestyle changes alone are not sufficient. Then angioplasty or surgery may be needed. Angioplasty is a non-surgical procedure that widens narrowed or blocked arteries. A thin tube, called a catheter, with a deflated balloon on its tip is passed into the narrowed artery segment. Then the balloon is inflated. This pushes open the narrowed segment. Then the balloon is deflated and the catheter is withdrawn.

Often a stent¡X a wire mesh tube¡X is placed in the narrowed artery with a catheter. There the stent
expands and locks open. It stays in that spot, keeping the diseased artery open.

If a long part of an artery is narrowed, vascular surgery may be needed. A vein from another part of
the body or a synthetic blood vessel is attached above and below the blocked area to detour blood
around the blocked spot.

For most individuals with lower extremity PAD, lifestyle modifications alone (including an exercise
program) can usually both lower heart attack and stroke risk, and simultaneously improve symptoms, or keep them from getting worse. In a minority of patients, lifestyle changes alone are not sufficient. Then angioplasty or surgery may be needed. Angioplasty is a non-surgical procedure that widens narrowed or blocked arteries. A thin tube, called a catheter, with a deflated balloon on its tip is passed into the narrowed artery segment. Then the balloon is inflated. This pushes open the narrowed segment. Then the balloon is deflated and the catheter is withdrawn.

Often a stent¡X a wire mesh tube¡X is placed in the narrowed artery with a catheter. There the stent
expands and locks open. It stays in that spot, keeping the diseased artery open.

If a long part of an artery is narrowed, vascular surgery may be needed. A vein from another part of
the body or a synthetic blood vessel is attached above and below the blocked area to detour blood
around the blocked spot. 

All individuals with PAD in any location require treatment to lower their risk of heart attack and
stroke. This can be accomplished by lifestyle changes, use of risk-reducing medications or both.  

In Summary:
PAD is common, affecting millions of individuals, as it affects blood flow to vital arteries outside the
heart. All individuals with PAD face a very high short term risk of heart attack and stroke, and PAD
can be associated with major symptoms that can impair quality of life, lead to loss of independence,
limb loss, or death.

PAD represents one of the most common, morbid, and mortal, yet poorly known,
cardiovascular illnesses in the world. PAD is easily detected and a wide range of effective
treatments exist.

PAD represents one of the most common, morbid, and mortal, yet poorly known,
cardiovascular illnesses in the world. PAD is easily detected and a wide range of effective
treatments exist.  

Source:  Diabetes In Control