Peripheral Artery Disease:
By: David Raymund K. Salvador, MD
Peripheral artery disease is not as commonly known as coronary artery disease. Everybody is aware of heart attack but lay people are not aware of ‘leg attack’. It is similar to getting a heart attack but the compromised circulation involves the legs causing leg pain usually when walking (claudication) in those with chronic blockage of the leg arteries or sudden leg pain accompanied by discoloration and coldness of affected leg even at rest in acute blockage of the leg arteries. It can be limb or life threatening and must not be dismissed. They share common risk factors with coronary artery disease and in fact overlaps with the atherosclerotic diseases like cerebrovascular disease and heart disease. It can be a harbinger of more serious and extensive atherosclerosis….like a sleeping giant.
What is Peripheral Artery Disease?
Peripheral artery disease or PAD involves the buildup of cholesterol and fatty plaques in the arteries, which are the blood vessels that bring blood from the heart to the different parts of the body. This buildup, also known as atherosclerosis, may occur in any of the arteries of the body, but is referred to as PAD when it occurs in the arteries of the lower extremities. This results in narrowing or even blockage of the arteries in the legs, resulting in decreased blood flow and oxygen delivery to the tissues of the legs and feet.
What are the symptoms and signs of PAD?
Decreased blood flow and oxygen delivered to the lower extremities may result in an achy, crampy type of pain in the legs, especially felt on walking and relieved upon stopping to rest. This symptom is known as intermittent claudication. The pain may be felt anywhere from the buttocks, hips, thighs, or calves. In severe cases, leg pains may be felt even at rest. Other symptoms may include numbness of the toes or a sensation of cold legs and feet.
The muscles of the legs may appear smaller (muscle atrophy), while the skin may look shiny, show evidence of hair loss and may be cold to touch. The toenails may appear brittle. There may be decreased or absent pulses in the feet. Wounds in the feet that don’t seem to heal or take a longer time to heal may also be a manifestation of PAD. In severe cases, the feet or the toes may have a bluish to violaceous discoloration (gangrene), associated with pain or numbness. When this happens, immediate medical attention is needed.
Who are at risk to develop PAD and how is it prevented?
People who are 50 years old and above, with risk factors for atherosclerosis such as smoking, high blood pressure (hypertension), diabetes, elevated cholesterol levels (hyperlipidemia), chronic kidney disease, or those with a family history of PAD are at risk of developing PAD. Smoking cessation and proper control of hypertension, blood sugar and cholesterol levels are therefore important steps to lessen one’s risk for this condition. Maintaining a healthy lifestyle and increasing physical activity are also helpful ways to prevent PAD.
How is PAD diagnosed?
Aside from determining the presence of risk factors and the signs and symptoms of PAD, an ankle-brachial index (ABI) may be useful to screen and diagnose PAD. The ABI is a simple test that involves measuring the blood pressures in the patient’s ankles and comparing these with the patient’s brachial or arm blood pressure.
A normal ABI is a value of 1-1.4. Additional tests such as duplex scans, computed tomographic (CT) angiography or magnetic resonance angiography (MRA) may be necessary to determine the presence and extent of the PAD.
How is PAD treated?
As previously mentioned, maintaining a healthy lifestyle with increased physical activity, smoking cessation, and adequate control of blood pressure, sugar and cholesterol levels are very important, not only in the prevention of PAD, but in controlling its symptoms as well. The cholesterol lowering drugs known as statins have been shown to prevent the complications of PAD, including lessening the risk for limb amputation in these patients. Antiplatelet medications such as aspirin or clopidogrel, are also beneficial to prevent the progression of atherosclerosis and other conditions associated with PAD.
A supervised exercise program may also be recommended to reduce leg symptoms and improve the quality of life of patients. In more advanced cases, invasive treatments such as endovascular revascularization or surgical bypass procedures may be necessary to improve blood flow in the limbs and prevent possible amputation.
The physicians of the Philippine Society of Vascular Medicine are specialists who have trained in the diagnosis and management of diseases of the blood vessels, such as PAD. A consultation with any member of the PSVM may help to properly evaluate patients for the presence of PAD and recommend the needed and corresponding treatment for this condition.
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