About Peripheral Arterial Disease:
Peripheral arterial disease (PAD) is a widespread condition that affects millions of people throughout the world. Education and awareness of PAD is limited among the international population, which leads to many people who go undiagnosed and untreated. Also be referred to as PVD (peripheral vascular disease), PAD is the narrowing or blockage of arteries in critical regions of the body, outside of the heart.
Cause
PAD is caused by a buildup of plaque (fatty material), along the walls of peripheral arteries. This plaque buildup is also referred to as atherosclerosis the hardening of the arteries.
- Plaque deposits (calcifications), cause peripheral arteries to stiffen and become narrowed or blocked, limiting the flow of oxygen-rich blood. Depending on the area of calcified arteries, plaque buildup can lead to various health complications.
Risk Factors
Though a large number of people worldwide suffer from PAD, or are at risk for PAD, many are never diagnosed or treated for the condition. While some arterial hardening and plaque buildup is normal with the aging process, certain behaviors, conditions, and habits can lead to early development of PAD. These risk factors include:
- Age (over 50 years old)
- Family history of heart disease
- Smoking
- High blood pressure
- High levels of LDL cholesterol and low HDL cholesterol
- Certain diseases, such as diabetes
- Being overweight or obese
- Lack of exercise
- Certain types of radiation therapy to the chest
- Stress
Lower Extremity PAD: Lower Extremity PAD occurs in the arteries that supply blood to the legs. The three major arteries most often affected by Lower Extremity PAD are: the Iliac Artery, Superficial Femoral Artery (SFA), and Infrapopliteal Arteries. When the main arteries in the legs harden or become blocked, blood begins to flow to the leg muscles through alternative, smaller arteries. These small arteries cannot supply adequate blood flow to the lower extremities when the body is fully active, as the leg muscles need more blood and oxygen.
- Those with Lower Extremity PAD may experience pain or discomfort when performing physical activity such as talking and performing daily tasks. Symptoms of discomfort may increase in severity over time.h
- Pain or discomfort in lower extremities
- Buttocks pain
- Tingling in the lowest extremities (feet, toes)
- Sores/ breaks in the skin of lower extremities
- *Consult your physician if you think you have symptoms PAD; if you think you might be experiencing a heart attack, seek immediate medical attention.
Diagnosis
If your doctor suspects you have PAD, your healthcare provider will ask about your symptoms, medical history, and assess your environmental risk factors. In addition, your doctor may administer diagnostic tests. These tests or examinations may include:
- Ankle-Brachial Index (ABI): compares the blood pressure measured at the ankle to the blood pressure measured at the arm, using a blood pressure cuff and ultrasound tool
- Stress Test: Involves walking on a treadmill for a period of time (about 5 minutes), while vital measurements are taken throughout the body & lower extremities
- Ultrasound: Uses high-frequency sound waves to assess blood flow in the lower extremity vessels, and look for narrowing or blockages
- Magnetic Resonance Imaging (MRI): Uses magnetic fields and radio waves to show blockages and narrowing of the vessels
- Angiography: Uses fluoroscopy technique (using contrast dye) to monitor blood flow through the vessels. These images produces by fluoroscopy show the locations of any narrowing or blockages throughout the body
- Computed Tomography (CT): X-ray scans
take are used to view & detect blockages
Treatment Options for Peripheral Arterial Disease:
When treating PAD, the goal is to restore blood flow to the peripheral vessels. Changes to your lifestyle, as well as medications can be highly effective, however stenting or surgical procedures may be the best option for relieving symptoms & pain
Lifestyle Changes & Medication:
Surgery or other invasive procedures may be
avoidable with the implementation of lifestyle
changes and/or medications, which provide an
alternative to additional health risks and high
costs. Behavioral changes alone may not be able
to fully treat PAD, however they can be helpful
in managing the condition
Lifestyle Changes: PAD has been found
to be more common among smokers and those with
diabetes, which is why important lifestyle
changes include smoking cessation and taking
steps to lower blood sugar. Those with PAD are
also highly encouraged to protect their feet
from injury; due to the narrowing of the
arteries that frequently leads to decreased
blood flow, injuries to the lower extremities
have a tendency to heal poorly. Most
importantly, a healthy and active lifestyle is
essential to help control PAD
Medications: Along with recommending
lifestyle changes, physicians may prescribe
medications to slow the progress of the disease,
or to ease symptoms. Medications to help control
cholesterol, blood sugar, or blood pressure, are
common options. Other medications may be
prescribed to prevent prevent clots from forming
within narrowed blood vessels.
Drug-Coated Balloon (DCB) Angioplasty:
DCB is similar to POB (Plain Old
Balloon) Angioplasty, however it involves and
additional anti-proliferative medication coating
on the balloon to help prevent restenosis. The
drug-coated balloon can inhibit cell division,
which limits the amount of restenosis (blockage
re-growth) after treatment
Angioplasty: Angioplasty procedures
with a drug-coated balloon are performed in a
catheterization lab ( Cath Lab ). A contrast dye
in injected into the bloodstream through a
catheter; the dye allows your arteries to be
viewed using an x-ray monitor. A small
balloon-tipped device is inserted through an
artery in the leg, and is moved through to reach
the blocked area. The balloon is then inflated,
which reforms the plaque within the artery,
opening up the artery to restore blood flow.
That balloon is deflated & removed, followed by
a new balloon, which is coated with an
anti-proliferative medication. When the second
balloon is inflated, the medication is delivered
to the blocked area.