• Plaque buildup in the arteries(called atherosclerosis) that carry blood to your head, organs, and limbs.
• Plaque is made up of fat, cholesterol, calcium, fibrous tissue that can harden and narrow the arteries.
• Limits the flow of oxygen-rich blood from your heart to your hands, legs, head, kidneys, and stomach.
• Here we will here focus on P.A.D. that affects blood flow to the legs.

CAUSES

• Smoking
• Diabetes
• High amounts of certain fats and cholesterol in the blood
• Tobacco usage in any form
• High blood pressure
• Inherent blood clotting issues
• Old age
• Obesity
• Idiopathic(unknown)

Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site

ASSOCIATE HEALTH ISSUES

P.A.D. increases your risk of coronary heart disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”)

Many people don’t have any signs or symptoms.

Common signs and symptoms are-

• Weak or absent pulses in the legs or feet.
• Intermittent Claudication– symptoms when walking or climbing stairs, which may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms also may include cramping in the affected leg(s) and in the buttocks, thighs, calves, and feet.

• Pain in the toe tips even at rest position.

• Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all.
• Gangrene (tissue death)- black color change of skin and tissue.

• Infected wounds

• A pale or bluish color to the skin.
• A lower temperature in one leg compared to the other leg.
• Poor nail growth on the toes and decreased hair growth on the legs.
• Erectile dysfunction.

Ankle-Brachial Index(TBI) and Toe Brachial Index(TBI)

• Comparing blood pressure in the hands and legs.

Doppler Ultrasound

• Provides an early screen regarding the presence of reduced blood flow.

Magnetic Resonance Angiogram (MRI Scan)

• The standard test is to obtain information regarding the disease.
• Can be done in patients with reduced kidney function.

Angiogram

• The invasive tests used in patients with doubtful CT/MRI findings Simultaneous therapy can be done.

Pulse Volume recording

• Measuring the pressure-based waveforms in the legs.

Treadmill Test

• In claudicants, helps to document the distance walked.

TREATMENT

• Treatment is based on your signs and symptoms, risk factors, and the results of physical exams and tests.
• Overall goals- improving mobility and quality of life, reducing symptoms of claudication, reducing infection, healing wounds, reducing the risk of heart attack, kidney failure, and stroke.
• The target of treatment in Claudicants- improve walking distance and quality of life.
• The target of treatment in individuals with wounds/gangrene- remove dead tissue, heal the wound and preserve healthy tissue.

Healthy Lifestyle Changes

• Physical activity
• Quitting smoking
• Heart-healthy eating

• Bypass Grafting Surgery- open surgery.

• The patient’s own vein or synthetic tube will be used for the bypass.

• Angioplasty and Stent Placement- minimally invasive.

• Early recovery compared to open surgery.

• New devices provide good long-term outcomes.

• Hybrid procedure- Surgery + Angioplasty/Stent.
• Uses the best options of both modalities.

• If you have P.A.D., you may feel pain in your calf or thigh muscles after walking. Try to push as far as you can tolerate the pain and then take a break and allow the pain to ease before walking again. Over time, this may increase the distance that you can walk without pain.
• Check your feet and toes regularly for sores or possible infections. Wear comfortable shoes that fit well. Maintain good foot hygiene and have professional medical treatment for corns, bunions, or calluses.