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Peripheral arterial disease

Introduction

Peripheral Arterial Disease (PAD) is a manifestation of systemic atherosclerosis and affects 10-15% of the general population; about half of these patients are asymptomatic. Patients with peripheral arterial disease have a greatly increased risk of dying from cardiovascular disease (heart attack).

Peripheral arterial disease can cause problems by compromising the blood flow to the limb, usually the leg. This happens either secondary to severe narrowing of the blood vessel (usually this has to be at 3 levels to cause a critical drop in blood flow) or secondary to plaque rupture and the embolization of debris further down the leg blocking the smaller vessels in the leg.

Early detection and intervention (especially diet and lifestyle) are important. The mainstays of treatment are lifestyle modification, exercise, diet, and medication. Endovascular or surgical options are considered for critical ischaemia (where the viability of the limb is threatened i.e. a risk of limb loss). Only 1 in 4 people will progress to critical ischaemia.

Causes

  • Artherosclerosis.
  • Risk factors:
    • Smoking.
    • High blood pressure.
    • High bad cholesterol.
    • Obesity.
    • Diabetes.
    • Metabolic Syndrome.
    • Diet.
    • Lifestyle.
    • Blood vessel inflammation.
    • Limb injury.

Signs and Symptoms

  • Claudication, painful cramping in your hips, calf or thigh after activities.
  • Leg weakness or numbness.
  • Coldness in foot or lower leg.
  • Foot or leg sores.
  • Colour changes in legs.
  • Hair loss on legs and feet.
  • Weak or no pulse in feet or legs.

Diagnosis

  • Physical examination.
  • Ankle-brachial index (ABI).
  • Ultrasound.
  • Angiography.
  • Blood tests.

Treatment

  • Changes to diet and exercise.
  • Blood pressure control.
  • Cessation of smoking.
  • Medication.
  • Endarterectomy and bypass grafts.