Peripheral Vascular Disease

Peripheral artery disease, or PAD, is an accumulation of plaque (fats and cholesterol) in the arteries in your legs or arms. This makes it harder for your blood to carry oxygen and nutrients to the tissues in those areas.

What is Peripheral arterial disease (PAD)? #

• Peripheral arterial disease (PAD), also known as peripheral vascular disease or peripheral artery disease, is plaque buildup in your leg arteries that carry oxygen and nutrient-rich blood from your heart to your arms and legs.

• Shaped like hollow tubes, arteries have a smooth lining that prevents blood from clotting and promotes steady blood flow.

• When you have peripheral artery disease, plaque (made of fat, cholesterol and other substances) that forms gradually inside your artery walls slowly narrows your arteries.

• This plaque is also known as atherosclerosis.

Causes OF PAD #

• Atherosclerosis that develops in the arteries of your legs or, less commonly, your arms causes peripheral arterial disease.

• Like atherosclerosis in your heart (coronary) arteries, an accumulation of fatty plaque in your blood vessel walls causes peripheral vascular disease.

• As plaque builds up, your blood vessels get narrower and narrower, until they become blocked.

Symptoms of PAD #

• Half of the people who have peripheral vascular disease don’t have any symptoms, but pain or discomfort in their legs is a common symptom.

• You may also feel weak or tired while walking. Affected parts of your leg may include your calves, thighs or buttocks.

• PAD can build up over a lifetime, and the symptoms may not become obvious until later in life.

• For many people, the outward symptoms won’t appear until their artery has narrowed by 60% or more.

• A burning or aching pain in your feet and toes while resting, especially at night while lying flat.

• Cool skin on feet.

• Redness or other color changes of your skin.

• More frequent infections.

• Toe and foot sores that don’t heal.

Diagnosis of PAD #

The ankle/brachial index (ABI) #

• It is a measurement of the blood pressure in your lower legs compared to the blood pressure in your arms.

• During this test, blood pressure cuffs are placed on your arms and legs.

• The cuffs are inflated, while a hand-held device (called a Doppler) is used to listen to your blood flow.

• The ABI screening helps evaluate the amount of blood flow to your legs and feet, which is decreased in a person who has PAD.

• ABI is a highly accurate method for detecting PAD.

A pulse volume recording (PVR) #

• It is a noninvasive test that measures the blood volume changes that occur in your legs.

• During this test, a blood pressure cuff is placed on your arm and multiple cuffs are placed on your legs.

• The cuffs are inflated slightly while you’re lying down.

• As blood pulses through your arteries, the blood vessels expand, causing an increase or decrease in the volume of air within the cuff.

• A recording device displays these pulse volume changes as a waveform on a monitor.

• Blood pressures are measured before and after exercise on a treadmill and help define if your pain is due to PAD or other causes.

• The PVR test also helps locate the area of blockages in your legs.

A vascular ultrasound #

• It is a noninvasive test used to examine blood circulation.

• During a vascular ultrasound, a transducer (small hand- held device) is placed on your skin over the artery to be examined.

• The transducer emits sound waves that bounce off your artery.

• These sound waves are recorded, and an image of the vessel is created and displayed on a monitor.

• This test may be used to detect a blockage in your artery.

Treatment of PAD #

Lifestyle changes #

Initial treatment of PAD includes making lifestyle changes to reduce your risk factors. Changes you can make to manage your condition include:

• Quit using tobacco products - Ask your healthcare provider about smoking cessation programs available in your community.

• Eat a balanced diet that’s high in fiber and low in cholesterol, fat and sodium. Limit fat to 30% of your total daily calories. Saturated fat should account for no more than 7% of your total calories. Avoid trans fats, including products made with partially hydrogenated and hydrogenated vegetable oils. If you’re overweight, losing weight will help you lower your total cholesterol and raise your HDL (good) cholesterol. A registered dietitian can help you make the right dietary changes.

• Exercise - Begin a regular exercise program, such as walking. Walking is very important and can aid in the treatment of PAD. People who walk regularly can expect a definite improvement in the distance they’re able to walk before experiencing leg pain.

• Manage other health conditions, such as high blood pressure, diabetes or high cholesterol.

Medications #

• Medicines can help you with conditions such as high blood pressure (antihypertensive medications), high cholesterol (statin medications) and diabetes.

• These drugs treat the risk factors of PAD and decrease your risk of stroke and heart attack.

• An antiplatelet medication such as aspirin or clopidogrel may reduce the risk of heart attack and stroke.

• Your healthcare provider may prescribe cilostazol to improve your walking distance.

• This medication helps people with intermittent claudication exercise longer before they develop leg pain. However, not everyone is eligible to take this medication.

• Your healthcare provider will tell you if you are.

Surgery #

Treatments include:

• Balloon angioplasty: In this procedure, your healthcare provider passes a miniature balloon through a catheter into your arteries. As the balloon expands inside of your artery, it pushes against the plaque and opens up space inside of your artery.

• Stents: These are tiny metal support coils that your healthcare provider inserts into your arteries through a small opening using catheters (long, thin tubes). Once they’re in place, stents expand against the inner blood vessel wall to support it and hold it open.

• Peripheral artery bypass surgery: Similar to a heart bypass, a surgeon uses a section of your healthy vein or a synthetic replacement to create a bypass for blood flow around the blocked area in your leg artery. This is usually reserved for the most severe PAD.

• Atherectomy: Your healthcare provider uses a catheter with a blade at the end to remove plaque buildup in your blood vessel.