Peripheral Arterial Disease (PAD)
Introduction to PAD
Peripheral Arterial Disease (PAD) is a condition characterised by the accumulation of plaque within the arteries that transport blood to various parts of the body, including the head, organs, and limbs. This plaque, comprising fat, cholesterol, calcium, and fibrous tissue, can harden and constrict the arteries, thereby restricting the flow of oxygen-rich blood from the heart. Our focus here is on PAD’s impact on leg blood flow.
Causes of PAD
PAD can be triggered by a range of factors, including:
- Smoking
- Diabetes
- High levels of fats and cholesterol in the blood
- Tobacco use in any form
- High blood pressure
- Genetic predisposition to blood clotting
- Advanced age
- Obesity
In some cases, the cause remains unknown (Idiopathic)
The risk of PAD increases when plaque ruptures, potentially causing a blood clot at the site.
Associated Health Risks
PAD significantly elevates the risk of Coronary heart disease, Heart attack, stroke,Transient ischemic attacks (mini-strokes).
Symptoms and Clinical Features
Many individuals with PAD may not exhibit any symptoms. When present, symptoms can include:
- Weak or absent pulses in the legs or feet
- Intermittent claudication, characterized by pain, numbness, or heaviness in leg muscles during activities like walking or stair climbing
- Resting toe-tip pain
- Slow-healing sores or wounds on the lower extremities
- Gangrene, indicated by blackened skin and tissue
- Infected wounds
- Color changes to pale or bluish skin
- A noticeable temperature difference between legs
- Poor nail and leg hair growth
- Erectile dysfunction
- Diagnostic Tests
The Diagnosis of PAD Involves Several Tests
- Ankle-Brachial Index (ABI) and Toe-Brachial Index (TBI): Compares blood pressure in the arms and legs.
- Doppler Ultrasound: Screens for reduced blood flow.
- Magnetic Resonance Angiogram (MRA): Provides detailed information, suitable even for those with reduced kidney function.
- Computerized Tomographic Angiogram (CTA): Another standard test for detailed disease insights.
- Angiogram: An invasive option for unclear cases, allowing for simultaneous treatment.
- Pulse Volume Recording: Measures pressure waveforms in the legs.
- Treadmill Test: Documents walking distance for those with claudication.
Treatment Goals and Options
Treatment is tailored to individual symptoms, risk factors, and diagnostic results, aiming to:
- Enhance mobility and quality of life
- Alleviate claudication symptoms
- Promote wound healing and infection control
- Reduce the risks of heart attack, kidney failure, and stroke.
Specific Treatments Include
- Lifestyle Changes: Encouraging physical activity, smoking cessation, and heart-healthy eating habits.
- Bypass Grafting Surgery: Uses either the patient’s own vein or a synthetic tube for the bypass.
- Angioplasty and Stent Placement: A less invasive option that often ensures quicker recovery.
- Hybrid Procedures: Combines surgery with angioplasty/stent placement for optimal outcomes.
Living with PAD
Managing PAD Involves:
Pushing yourself to walk as far as possible before resting to alleviate pain, gradually increasing your pain-free walking distance.
Regularly inspecting feet and toes for sores or infections and maintaining proper foot hygiene.
Wearing comfortable, well-fitting shoes and seeking medical treatment for foot issues like corns, bunions, or calluses.
By understanding and addressing PAD through comprehensive care and lifestyle adjustments, individuals can significantly improve their quality of life and reduce the risk of serious complications.