CIRCULATORY DISORDERS(Peripheral Arterial Disease)

Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is a common circulatory problem in which narrowed arteries reduce the blood flow to the limbs.

When one develops Peripheral Arterial Disease, the extremities — usually the legs — don't get enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking — a condition called Intermittent Claudication.

CAUSES

PAD is usually caused by a gradual buildup of plaque within the arteries ( atherosclerosis ). Other causes include blood clots or embolisms, congenital heart disease, inflammation of the blood vessels (vasculitis), and aortic dissection.

PAD can be hereditary. More commonly, you may get PAD if you are overweight or obese , or have high blood pressure , diabetes , or high cholesterol . Unhealthy lifestyle choices such as smoking, eating a high-fat diet, and not exercising enough frequently lead to PAD.

RISK FACTORS

* Diabetes

* Cigarette smoking

* High blood pressure (or family history)

* Coronary heart disease (or family history)

* Stroke (or family history)

* High cholesterol (or family history)

* Age over 50

* High homocysteine level in blood

* Gender: Male

* Family history of PAD

SYMPTOMS

Symptoms of PAD are related to the organ or part of the body deprived of adequate circulation. This includes:

* Claudication–pain, fatigue, cramping or tingling in the leg(s) brought on by exercise that goes away when resting

* Numbness of the legs or feet at rest

* Cold legs or feet

* Loss of hair on the legs and/or feet

* Paleness or blueness of the legs

* Weak or absent pulse in the leg

* Sores, ulcer, or infection of the feet and legs that heal slowly

* Erectile dysfunction

* Swelling in lower extremities

DIAGNOSIS

* Checking the strength of the pulse in the leg arteries

* Listening for a whooshing sound in a leg artery or the abdomen using a stethoscope

* Ultrasound and doppler analysis of the arteries, especially the carotid arteries in the neck which supply the brain with blood

* Checking blood pressure at various points in the leg and comparing it to the normal arm blood pressure

* Blood tests for blood lipids, homocysteine

* Treadmill test

* Electrocardiogram (ECG, EKG) –a test that records the heart's activity by measuring electrical currents through the heart muscle

* Angiography of the arteries in the legs (x-rays of blood vessels that have been injected with a dye)

* MRI –a test that uses magnetic waves to make pictures of the blood vessels.

TREATMENT

Early treatment can slow or stop the advancement of the disease. Treatment options include the following:

LIFESTYLE CHANGES

* Smoking cessation

* Diabetes control

* Blood pressure control

* Increased physical activity (eg, walking program)

* Weight loss if overweight

* Low-saturated fat, low-cholesterol diet

* Attentive foot care (very important for people with diabetes)

- Shoes that fit properly

- Proper treatment of all foot injuries–healing is slowed when circulation is poor, and the risk of infection is higher

MEDICATIONS

* Anti Platelet agents such as Aspirin and Clopidogrel to thin the blood

* Medicines to reduce leg pain

* Medicines to help improve walking distance ( Cilostazol )

* Cholesterol-lowering agents (statins)

* Medicines to enlarge or dilate the affected artery(ies).

INVASIVE PROCEDURES

* Balloon Angioplasty – a balloon is inflated in the artery to stretch it

* Stent Implant – a wire mesh tube is placed in the artery; the stent expands and stays in place, keeping the artery open

* Laser treatment

* Atherectomy

SURGERY

Surgery to open up narrowed arteries is performed in severe cases.

* Endarterectomy – the lining of the artery is removed.

* Bypass surgery – a vein from another part of the body or a synthetic graft replaces the vessel.

Source:www.h4heart.com