Conditions
Peripheral Arterial Disease
Peripheral arterial disease (PAD) is a common disease of arteries that affects up to 15% of Americans. The most common etiology of PAD is atherosclerosis. Atherosclerosis is a complex process whereby dynamic fatty plaque is deposited on the inner surface of the arterial wall. Atherosclerosis, and consequently PAD, is generally a progressive disease that obstructs blood flow to the limbs and vital organs and can result in symptoms depending on the site of obstruction. Additionally, fragments of plaque may become dislodged and subsequently block arteries at distant sites. Peripheral arterial disease can produce a spectrum of symptoms.
Many risk factors are associated with PAD. Risk factors for PAD include advancing age, male gender, family history of PAD, tobacco use (especially cigarette smoking), diabetes mellitus, high cholesterol, high blood pressure, and inactivity. Other diseases associated with PAD include stroke and coronary artery disease.
Most patients with PAD exhibit no symptoms. However, the most common symptom of PAD is intermittent claudication, a process in which exercising muscles are deprived of adequate blood and oxygen. Symptoms of intermittent claudication include pain, cramping, aching, or fatigue in the affected muscles, most commonly the calves, but also in the hips and thighs. The symptoms of intermittent claudication are classically relieved by rest. Advanced stages of PAD may cause constant pain, especially in the feet, painful ulcer formation, and gangrene (tissue death).
Peripheral vascular disease can be diagnosed by simultaneously measuring the blood pressures at the arm and leg and calculating the ABI, or ankle brachial index. The ABI indicates the severity of PAD, but may also predict the risk of future heart attack and stroke. Ultrasound, CT, and MRI are non-invasive methods of determining the extent, severity, and location of PAD. Occasionally, traditional angiography (mapping blood vessels with dye) is performed to assist with diagnosis and treatment planning.
Treatment of PAD involves both medical, and occasionally, surgical intervention. Smoking cessation is critical to prevent progression of PAD and to increase the success of treatment. A regular walking program is an integral part of the treatment process and may improve walking ability in approximately half of patients. Control of risk factors, such as treatment of high blood pressure and high cholesterol, is also important. Patients who have persistent symptoms or who have advanced PAD may require further intervention to improve blood flow. Intervention for PAD may include traditional surgical techniques such as bypass, or, more commonly, minimally-invasive treatment such as balloon angioplasty, stent placement, or other novel treatment techniques. Frequently, the surgeon employs both traditional and minimally-invasive techniques
References:
Paul M. Schumacher, MD