Introduction to Peripheral Arterial Disease

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Peripheral artery disease (PAD) is a condition in which one or more of the arteries that supply blood to the legs, arms, head, or abdomen are blocked or partially blocked, usually due to atherosclerosis . If the blood flow to the extremities is no longer sufficient to meet the need, a person with PAD may develop symptoms.

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Symptoms

The most common symptom of PAD is lameness. Lameness is pain, cramping, or discomfort that can range from simply annoying to quite severe, occurring in the affected limb. Lameness usually occurs during exercise and resolves after rest.

Because PAD most commonly affects the legs, lameness is most commonly seen as pain in the legs when walking. Depending on where the artery in the leg is blocked, lameness can affect the foot, calf, thigh, or buttocks. People with PAD in one of the arteries that supply blood to the upper extremities may experience lameness in the arm or shoulder; and some may even experience neurological symptoms during arm exercise, a condition called subclavian steal syndrome .

Sometimes PAD causes persistent lameness even at rest. Lameness at rest often means that the arterial blockage is relatively severe and that the affected limb does not receive enough blood flow even at rest.

Because lameness is not always typical, i.e. pain with exercise with relief at rest, a diagnosis of PAD should be considered whenever a person over 50 years of age who has risk factors for atherosclerosis experiences unexplained pain. on the arms or legs.

Very severe PAD can lead to ulceration and even gangrene of the affected limb.

Causes

In the vast majority of cases, PAD is caused by atherosclerosis. This means that the same risk factors that cause coronary heart disease (CHD) , especially high cholesterol, smoking, hypertension, and diabetes, also cause PAD. In fact, since PAD and CAD are caused by the same disease, when PAD is diagnosed, this often means that CAD is also present.

Less commonly, PAD can be seen in people without atherosclerosis. For example, PAD can be caused by trauma to the extremities, exposure to radiation, and certain medications (ergotamine preparations) used to treat migraines.

Diagnostics

PAD can be diagnosed with non-invasive tests. In some cases, PAD can be detected on physical examination, when there is a decrease in heart rate in the affected limb. However, more often, one of several specific tests is required to diagnose PAD.

PAD in the legs can be diagnosed using the ankle-brachial index, or ABI, in which the blood pressure in the ankle and upper arm is measured and compared. A low ABI indicates low blood pressure in the leg artery, indicating the presence of PAD.

Plethysmography is another technique used to diagnose PAD. This test pumps air into a series of cuffs along the leg and measures the pulse pressure in the artery below each cuff. A blockage somewhere in the artery will lower the pulse pressure outside of the blockage area.

"Duplex ultrasound" is a special ultrasound test that evaluates blood flow at various levels in an artery. A sudden drop in blood flow suggests a partial blockage in the droplet area.

If your healthcare provider suspects PAD, one or more of these non-invasive tests is usually enough to make a diagnosis. The ABI is the most widely used test today.

Watch out

While mild to moderate PAD can be treated with medication and lifestyle changes, more severe cases often require bypass surgery or angioplasty to remove the obstruction.

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