What is PAD?
PAD or peripheral artery disease involves the narrowing of peripheral arteries usually in the legs and the pelvis. Approximately 8 million people in the United States have PAD. It is more prevalent amongst the elderly than young people.
Causes of Peripheral Artery Disease
PAD is usually the result of atherosclerosis when fats build up in the arteries and cause a reduction in blood flow. When atherosclerosis affects the arteries in the limbs it is called peripheral artery disease. PAD can also be caused by inflammation of the arteries. Injury to the arms and legs may also lead to peripheral artery disease. Rare genetic disorders of the muscles or ligaments in the extremities can also lead to peripheral arterial disease. Another rare cause of PAD is exposure to radiation.
Medications for PAD
Pletal and Trental can both be used to increase the blood flow to the limbs. This helps reduce the muscle pain. To help prevent blood clots, aspirin may be prescribed. Or, the doctor can recommend clopidogrel or Plavix to prevent the clots. Medication may also be used to treat ancillary diseases such as high cholesterol medication, insulin for diabetes and drugs for high blood pressure.
Prevention of Peripheral Artery Disease
To prevent peripheral artery disease quit smoking. This may be the most important action an individual can take to prevent this disease. Try to exercise on a regular basis at least 30 minutes three times a week. Eat a diet low in salt, cholesterol, and saturated fat. Instead try to eat foods with a high fiber content and loose weight. Even a 5 pound weight loss can reduce the risk for peripheral arterial disease.
Risk Factors of Peripheral Artery Disease
This disease occurs mostly in the elderly. Smokers and former smokers may also be predisposed to PAD. Type 1 and Type 2 Diabetes can also lead to peripheral arterial disease. PAD is also prevalent in individuals who have high blood pressure, atherosclerosis, high cholesterol and increased homocysteine levels. Individuals who are sedentary or obese are also more likely to get PAD.
Symptoms of PAD
- Muscle cramps in the calves, hips or thighs, when climbing stairs, exercising or walking is the first indication of peripheral artery disease. This pain decreases once the activity ceases. This cramping is referred to as intermittent claudication. It is the body's way of letting the individual know more blood flow is required.
- Symptoms of advanced peripheral arterial disease include chronic leg pain, sores on the feet or toes that will not heal, gangrene, or a decrease in temperature in the affected limb. Severe blockage can also cause numbness of the arms or legs and muscles may actually atrophy. The appendages may also turn blue and it can be difficult to find a pulse. Other rarer symptoms include a decrease in growth of the nails and hair on the PAD limb.
- With peripheral artery disease that actually blocks the lower aorta both legs can experience pain, numbness or a decrease in temperature. In less severe cases pain can occur alternately in the thighs and buttocks. The legs may also be pale or feel cool to the touch. Men may experience erectile dysfunction. This group of symptoms is called Lerich Syndrome.
- Narrowing of the arteries of the kidney will usually display no symptoms but severe blockage can result in renal failure with sudden side pain and blood in the urine.
- The superior mesenteric artery that supplies the gut can also narrow or become blocked. Vomiting and a sudden need for a bowel movement are initial symptoms. Acute abdominal pain will occur in severe cases. With only a slight narrowing of this artery pain occurs around 45 minutes after a meal because this is when the intestine requires more blood to aid digestion. As a result the patient may refuse to eat and this can lead to weight loss.
- Narrowing or blockage of the arteries to the liver and spleen can cause damage to each organ but there are rarely symptoms
Treatments of PAD
Peripheral artery disease is treated using drugs to reduce the general pain and dissolve clots. Angioplasty and surgery are also alternative treatments. The degree of narrowing determines the treatment. Simple claudication can be treated with exercise and drugs. Angioplasty is used to decrease the painful symptoms of the disease and is done by weaving a catheter that has a balloon attached into the narrowing artery. The balloon is inflated and that clears the blockage. A stent is then inserted to keep the artery open. In place of the balloon, a laser, cutter, sander or ultrasonic catheter can be used. Surgery is done to get rid of blood clots and other blockages. Another optional treatment is bypass surgery or removal of the section of narrowed artery. In dire circumstances amputation may be necessary.
Types of Peripheral Arterial Disease
- Occlusive peripheral artery disease is partial narrowing of the arteries as a result of behavioral tendencies.
- Obstructive peripheral arterial disease is such a dire narrowing of the arteries such that blockage occurs resulting in ischemia of the surrounding tissue.