Introduction

Peripheral artery disease, abbreviated as PAD, is a medical condition characterized by the build-up of fats and cholesterol within the arteries of the limbs (legs or arms). Peripheral artery disease is also called peripheral vascular disease or peripheral arterial disease. The accumulation of plaque within these arteries that supply the limbs with nutrients and oxygen causes them to become narrowed, sometimes leading to blockage. These effects reduce rate of blood flow through these arteries.

PAD can happen in any blood vessel. It is common in the legs than in the arms.

Plaque consists of fat, cholesterol and other materials. It narrows the arteries. Most plaque deposits are hard on the outside and soft on the inside. When the hard surface tears or cracks, platelets are attracted to the area. This can cause clots to form around the plaque, making the artery even narrower.

Due to narrowing and blockage of the artery, organs and tissues located beyond the area where the plaque formed will get little nutrients and oxygen, resulting in tissue death (gangrene).

 

 Key Data & Insights

What are the facts and figures that surround PAD?

• The condition is common. Averagely, 10 million US citizens are affected. Most of these are aged over 40 years.
• Smoking tobacco is a significant risk factor for development of PAD. Smoking increases this risk four-fold.
• Patients suffering from PAD have a cardiovascular risk that is equivalent to those who previously had myocardial infarction.
• PAD increases the risk of stroke, thrombosis and myocardial infarction.

 

 Understanding Causes

What are the causes of PAD?

• Atherosclerosis is the most common cause of PAD. It can also cause coronary artery disease.
• Atherosclerosis developing within the arteries of the limbs causes PAD.

 

Associated Risk Factors

What are the risk elements for PAD?

There are several risk factors that increase likelihood of developing and suffering from this condition. They are:

• Hypertension.
• Diabetes mellitus. Both type 1 and type 2.
• Chronic kidney disease (CKD).
• Being obese.
• Positive family history of stroke, atherosclerosis, heart disease or PAD.
• Smoking tobacco products.
• Having a sedentary lifestyle.
• Having a blood clotting disorder.
• High cholesterol (hyperlipidemia).
• Increased levels of homocysteine (an amino acid) in the blood.
• Old age. Being 65 years old and above.

 

Signs & Symptoms

What are the signs and symptoms of PAD?

Sometimes, there are patients who are asymptomatic. however, others develop several clinically relevant manifestatios such as:

• Intermittent claudication
• Hair loss on your legs and feet
• Numbness or weakness in the legs
• Brittle, slow-growing toenails
• Ulcers (open sores) on your feet and legs, which do not heal
• Changing skin colour on your legs, such as turning paler than usual or blue – this may be harder to see on brown and black skin
• Shiny skin
• In men, erectile dysfunction.
• The muscles in your legs shrinking (wasting)

 

Types

What are the forms of presentation of PAD?

There are two types of PAD. These are:

• Lower-extremity PAD. It is characterized by reduced flow of blood to the legs and feet.
• Upper-extremity PAD. It is less common, but it is known to affect 10% of the population.

 

Stages

What are the stages of PAD?

Fontaine and Rutherford systems are two different used when assigning a stage to a PAD patient. Fontaine stages are relatively simpler and they are:

• I: Asymptomatic
• IIa: Mild claudication
• IIb: Moderate to severe claudication
• III: Ischemic rest pain
• IV: Ulcers or gangrene

 

 Diagnostic Methods

How is PAD diagnosed?

• Review of patient history.
• Physical examination of the patient.
• Non-invasive tests such as:

1.  Pulse volume recording (PVR)
2.  Vascular ultrasound.
3.  Ankle-brachial index.
   

   Peripheral artery disease measuring for patient ankle-brachial index (ABI) test.

• Invasive test- angiogram. It helps to find blockages within the arteries.

 

Differential Diagnosis

• Low back pain.
• Deep vein thrombosis.
• Reynaud’s phenomenon.
• Sciatica.
• Superficial thrombophlebitis.

 

Management & Treatment Options

How is PAD treated and managed?

Treatment is usually aimed at decreasing cardiovascular risk and improving the ability to walk.

The following are strategies that are employed:

• Lifestyle changes. These include strategies such as:

1.  Ceasation of smoking.
2.  Controlling high blood pressure and diabetes..
3. Lowering cholesterol.

• Exercise therapy. In exercise therapy, the patient is allowed to walk until they reach a pain tolerance. They stop to rest for a short period of time. When the pain resolves, they resume walking.
• Cilostazol can be used to treat claudication. It promotes vasodilation apart from suppressing vascular smooth muscle cell proliferation. Being a phosphodiesterase type-3 inhibitor, it cannot be administered to patients with a history of congestive heart failure (CHF).
• Antiplatelets such as clopidogrel.
• Administration of anti-hypertensive agents for high blood pressure, HMG CoA reductase inhibitors (statins) for high cholesterol and anti-diabetic agents for diabetes. These drugs will treat risk elements for PAD and therefore decrease the chances of strokes and heart attacks.

 

 Complications & Challenges

• Infection.
• Blood clots.
• Heart attack and stroke.
• Ulceration.
• Amputation.
• Gangrene.
• Erectile dysfunction.

 

 Strategies for Prevention

How to prevent PAD?

 

• Avoid smoking tobacco products such as cigarettes.
• Keep a healthy weight range, with a normal body mass index.
• Engage in regular physical activity such as running for 15 minutes on a regular basis.
• Control high blood pressure and diabetes.