Peripheral Artery Disease (PAD)

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1- Introduction

2- Physiological  Overview

3- Symptoms 

4- Treatment 

Introduction

Peripheral Arterial Disease (PAD) refers to atherosclerotic disease of arteries that perfuse the limbs, especially the lower extremities. The risk factors for PAD are the same as those for atherosclerotic disease, and it is especially prevalent in individuals with diabetes.

Physiological Overview

  • In most individuals, gradually increasing obstruction to arterial blood flow to the legs caused by atherosclerosis in the iliofemoral vessels results in pain with ambulation called intermittent claudication. If a thrombus forms over the atherosclerotic lesion, perfusion can cease acutely with severe pain, loss of pulses, and skin color changes in the affected extremity.

Symptoms

  • Claudication: Pain or cramping in the legs or hips while walking or climbing stairs, which typically disappears with rest.
  • Leg Numbness or Weakness: Persistent or intermittent feelings of numbness or weakness in the legs.
  • Coldness in Lower Leg or Foot: Noticeably colder lower leg or foot compared to the other side.
  • Sores on Toes, Feet, or Legs: Sores that won’t heal or heal very slowly.
  • Change in Leg Color: Legs may appear pale or have a bluish tint.
  • Hair Loss or Slower Hair Growth: Decreased hair growth on the feet and legs.
  • Slower Toenail Growth: Toenails may grow more slowly than usual.
  • Shiny Skin: Skin on the legs may become shiny.
  • Weak Pulse: Weak or absent pulse in the legs or feet.
  • Erectile Dysfunction in Men: Particularly if the man has diabetes.

Treatment

Lifestyle Changes

  1. Exercise: Regular physical activity, especially walking programs, can improve symptoms and increase walking distance.
  2. Smoking Cessation: Stopping smoking is crucial as it significantly worsens PAD.
  3. Diet: Eating a heart-healthy diet low in saturated fats, trans fats, cholesterol, and sodium.

Medications

  1. Antiplatelet Agents: Such as aspirin or clopidogrel to reduce the risk of heart attack and stroke.
  2. Cholesterol-Lowering Medications: Statins to manage high cholesterol levels.
  3. Medications to Manage Blood Pressure: Such as ACE inhibitors or beta-blockers.
  4. Medications to Control Blood Sugar: For individuals with diabetes, to maintain optimal blood glucose levels.
  5. Cilostazol and Pentoxifylline: To improve walking distance and reduce symptoms of claudication.

Surgical and Interventional Procedures

  1. Angioplasty and Stent Placement: A catheter with a balloon is used to open up blocked or narrowed arteries, often with a stent placed to keep the artery open.
  2. Atherectomy: Removal of plaque from the artery.
  3. Bypass Surgery: Creating a graft bypass using a vessel from another part of the body or a synthetic vessel to redirect blood flow around a blocked artery.
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