PERIPHERAL ARTERIAL DISEASE
Peripheral arterial disease (PAD), also called peripheral vascular disease (PVD), is a prevalent condition characterized by the accumulation of fatty deposits in the arteries, which limits blood flow to the leg muscles.
Many individuals with PAD do not exhibit symptoms. However, some experience a painful cramp in their legs while walking, which typically subsides after a few minutes of rest—a condition known to doctors as "intermittent claudication." The pain can vary from mild to severe and generally diminishes within a few minutes of resting the legs. Both legs are frequently affected simultaneously, although the pain may be more pronounced in one leg.
Other symptoms of PAD can include:
Hair loss on legs and feet
Numbness or weakness in the legs
Brittle, slow-growing toenails
Ulcers (open sores) on the feet and legs, which do not heal
Changing skin colour on the legs, such as turning paler than usual or blue shiny skin
Erectile dysfunction in men
Shrinking (wasting) of leg muscles
The symptoms of PAD often develop slowly, over time. If they develop quickly, or get suddenly worse, it could be a sign of a serious problem requiring immediate treatment.
Consult your GP if you experience recurring leg pain when exercising. PAD is usually diagnosed through a physical examination by a GP, and by comparing the blood pressure in the arm and the ankle. A difference between the 2 may indicate PAD and is called the ankle brachial pressure index (ABPI).
Causes of PAD:
There are certain things that can increase the chances of developing PAD. These include:
- Smoking
- Diabetes
- High blood pressure (hypertension)
- High cholesterol
- Age - growing older
Diagnosis of Peripheral Artery Disease:
PAD is diagnosed by the doctor by measuring Ankle Brachial Pressure Index
While lying on the back, the blood pressure in the upper arms and ankles is measured using a cuff and a Doppler probe. A Doppler probe uses sound waves to determine the blood flow in the arteries. In a healthy person, the blood pressure in both parts of the body should be the same, and the ABPI value will be equal to 1. However, in a person with PAD, the ankle blood pressure will be lower because of a reduction in blood supply. This would make the result of the ABPI less than 1.
Complications of peripheral arterial disease
PAD is not immediately life-threatening, but the process of atherosclerosis that causes it can lead to serious and potentially fatal problems.
Coronary heart disease (CHD): The blockages in the arteries in the legs can also affect other areas of your body, such as the arteries supplying the heart and brain.
This means that having PAD makes one more likely to develop another form of cardiovascular disease (CVD), such as:
- Coronary heart disease
- Stroke
- Heart attack
- Angina
Critical limb ischaemia (CLI)
If the blood flow to the legs becomes severely restricted, critical limb ischaemia (CLI) can develop. CLI is an extremely serious complication and requires hospital admission to save the limb.
Treatment of PAD:
Treatment is very important, because having PAD is a sign that the blood vessels are unhealthy.PAD is mainly treated through lifestyle changes, controlling chronic conditions and medications, as needed.
Lifestyle changes include:
- Quit smoking
- Exercise
- Eat a healthy diet
- Lose weight (if obese or overweight)
Control of chronic conditions:
Diabetes: Having poorly controlled diabetes makes PAD symptoms worse and raise the chances of developing other forms of CVD. It is important to manage diabetes properly, which may involve lifestyle changes. These can include having a healthy, balanced diet and taking medicines to lower the blood sugar level.
High Cholesterol: If blood tests show that the levels of LDL cholesterol ("bad cholesterol") are high, Statins will be prescribed by the doctor.
Hypertension: High Blood Pressure is controlled by antihypertensive medications and controlling salt in the diet.
Atherosclerosis: One of the biggest potential dangers of atherosclerosis is a piece of fatty deposit (plaque) breaking off from the artery wall. This can cause a blood clot to develop at the site of the broken plaque. If a blood clot develops inside an artery that supplies the heart with blood (a coronary artery), it can trigger a heart attack. Similarly, if a blood clot develops inside any of the blood vessels going to the brain, it can trigger a stroke.
Since patients with PAD are prone to these conditions, blood thinners are prescribed. This medicine works by stopping platelets (a type of blood cell) from sticking together so the blood is less likely to clot.
Peripheral Arterial disease is a silent condition that develops slowly. It is an indicator of poor health and inadequate control of underlying medical conditions. Over a period of time, people with PAD may lose the function of their legs, or develop heart attack or stroke. However, being aware about this condition and seeking medical advice from your doctor can help prevent PAD and its complications.
Dr. M Najeeb, MBBS, MSc, MRCGP (UK)
Diabetologist & General Physician
City Clinic Khaitan
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