Peripheral Arterial Disease

What are Peripheral Arterial Disease?

Peripheral Arterial Disease (PAD) is a condition in which there is a build-up of plaque inside the major arteries in the body, particularly affecting those arteries that carry blood to your head, major organs, arms and legs. The plaque consists of an accumulation of cholesterol, calcium and fat. This causes the arteries to narrow as well as lose their suppleness and elasticity and become hardened. This process of arterial hardening and narrowing is called atherosclerosis. Atherosclerosis reduces the amount of oxygen-rich blood that is circulated to your vital organs and other parts of the body. The plaque can often become inflamed, unstable and may rupture causing a blood clot to form in that area, resulting in major reduction of the downstream circulation. The is often the underlying mechanisms for major conditions such as heart attacks, strokes and critical/sudden reduction in blood supply to the legs. Atherosclerosis of the heart arteries (Coronary Artery Disease) is classified separately from Peripheral Arterial Disease but the underlying process is the same for both problems.

Risk factors

There are several risk factors that can lead to PAD. These include, but are not limited to:

Symptoms

Many people who have underlying PAD don’t exhibit any symptoms or mistake their symptoms as being due to some other cause (eg. Arthritis etc). The most common symptoms involve the lower limbs where people may experience:

Symptoms

Many people who have underlying PAD don’t exhibit any symptoms or mistake their symptoms as being due to some other cause (eg. Arthritis etc). The most common symptoms involve the lower limbs where people may experience:

Diagnosis

The diagnosis is based on a review of your symptoms and physical examination by the doctor or vascular specialist. The examination usually consists of checking the pulses around the body, including the arms, neck, abdomen and legs. The quality and presence of pulses will often, but not always, act as a good guide as to whether there is any significant underlying peripheral vascular disease. In addition, a stethoscope may be used to listen for any bruits, (noise cause by turbulent blood flow that results for an underlying narrowing or stenosis in the artery).

In addition, the colour of your hands and feet and other subtle signs (hair growth on the legs, quality and health of nails etc) offer useful information to aid with the diagnosis. The blood pressure in both arms is often checked and can be compared and contrasted against the blood pressure in the leg, around the level of the ankle, a bedside test known as an Ankle Brachial pressure Index (ABPI or ABI). If the PAD is moderate to severe and requires intervention to help alleviate the symptoms, further tests such as CT scans, MRI scans and Ultrasounds may be required to help plan surgical intervention.

Ankle-Brachial Pressure Index

Treatment

The first line of treatment for those diagnosed with mild PAD or claudication is lifestyle changes and simple medication. Smoking cessation, a regular structured exercise/walking program, dietary regulation to help manage high blood pressure, diabetes and weight loss (if overweight) are the most important lifestyle changes that are required to combat.

Simple medication is usually, especially Aspirin and a cholesterol tablet. The Aspirin helps reduce the ‘stickiness’ and ‘thickness’ of blood by altering the function of platelets while the cholesterol tablet functions not just to reduce the cholesterol level but also a number of other functions, including stabilising any existing plaque and reducing inflammation in the arteries. Medication for blood pressure and diabetes may be considered on a case-by-case basis if required. If intervention is being considered for PAD, these include options such as Angioplasty and/or stenting, bypass surgery or endarterectomy.

Treatment

The first line of treatment for those diagnosed with mild PAD or claudication is lifestyle changes and simple medication. Smoking cessation, a regular structured exercise/walking program, dietary regulation to help manage high blood pressure, diabetes and weight loss (if overweight) are the most important lifestyle changes that are required to combat.

Simple medication is usually, especially Aspirin and a cholesterol tablet. The Aspirin helps reduce the ‘stickiness’ and ‘thickness’ of blood by altering the function of platelets while the cholesterol tablet functions not just to reduce the cholesterol level but also a number of other functions, including stabilising any existing plaque and reducing inflammation in the arteries. Medication for blood pressure and diabetes may be considered on a case-by-case basis if required. If intervention is being considered for PAD, these include options such as Angioplasty and/or stenting, bypass surgery or endarterectomy.

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