• 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 hands.
• Less common than Lower Limb Disease due to the arms’ closer proximity to the heart, and the fact that most patients are asymptomatic.

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.
• Thoracic Outlet syndrome.
• Raynauds syndrome.
• Idiopathic(unknown).
• Eventually, a section of plaque can rupture (break open), causing a blood clot to form at the site.

TYPES

• Acute- Sudden block of the blood vessels causing an immediate threat to the hand.
• High risk of amputation.
• Needs urgent treatment.
• Chronic- Gradual decrease in blood flow.
• Needs treatment of the underlying cause.

ASSOCIATED HEALTH ISSUES

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

• Weak or absent pulses in the hands.
• Intermittent Claudication symptoms when using the arms and forearms for work may include pain, numbness, aching, or heaviness in the muscles. Symptoms also may include cramping in the affected side.
• Pain in the fingertips even at rest.
• Sores or wounds on the fingers 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 hand compared to the other hand.

• Doppler Ultrasound.
• Stress position tests.
• X-rays of the neck to see bony abnormalities.
• Computerized Tomographic Angiogram (CT Scan).
• Magnetic Resonance Angiogram (MRI Scan)
• Angiogram

• Treatment is based on your signs and symptoms, risk factors, and the results of physical exams and tests.
• Overall goals- improving symptoms 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 pain-free period.
• 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

TREATMENT OPTIONS

Bypass Grafting/Embolectomy Surgery- open surgery.