Peripheral Artery Disease

What is Peripheral Artery Disease (PAD)

Peripheral artery disease (PAD) is an inflammatory disease that most often affects the arteries of the lower extremities, less often the upper ones, in which the blood vessels are narrowed (atherosclerosis), normal blood flow is disturbed, leading to insufficient blood supply to the tissues of the lower extremities. PAD of the legs differs in three types depending on their location: pelvic (iliac artery), femoral (femoral arteries) and tibia (leg and foot arteries).

Thrombosis of the infrarenal abdominal aorta, known as Leriche syndrome, results in poor circulation in both legs, with pain in the buttocks and hips. In this case, men may develop impotence. Although Leriche syndrome is uncommon peripheral arterial occlusion is quite common. Up to 10% of the american population over the age of 50 suffers from this disease, but only in one third of cases the disease has pronounced symptoms, and in men it occurs four times more often than in women.

Symptoms of PAD

Depending on the type and severity of symptoms, PAD is divided, according to Fontaine, into four stages.

• Stage I: no complaints – the length of the distance traveled by the patient is not limited.
• Stage II: If, as a result of spasm in the peripheral vessels, there is an insufficient supply of oxygen to the muscles, this can lead to so-called intermittent claudication, characterized by pain in the lower extremities that occurs during walking and subside when movement stops. At the same time, people are forced to make stops after a certain time while walking in order to get rid of pain. This stage is also divided into additional stages, depending on the distance that can be traveled by the patient.
• Stage IIa: the length of the distance that can be covered while still remaining painless during walking is more than 200 meters; 
• Stage IIc: the distance traveled by a person without pain is less than 200 meters;
• Stage III: feeling of pain at rest;
• Stage IV: tissue destruction (necrosis) with the appearance of ulcers and wounds due to a large lack of oxygen in the tissues.

Along with pain, a number of other signs of circulatory disorders appear in the lower extremities: pallor of the skin of the extremities and a feeling of coldness in the legs, lack of pulsation in the affected extremities, muscle weakness during exercise, non-healing ulcers and wounds due to narrowing (stenosis) of blood vessels and insufficient oxygen supply to the muscles.

Causes and risk factors for PAD

The main cause of peripheral arterial disease is believed to be mainly atherosclerosis. Much less often, PAD occurs on the basis of trauma, inflammatory diseases, embolism, inflammation of large blood vessels due to circulatory disorders. The main risk factors for the development of atherosclerosis and PAD include: smoking, diabetes mellitus, high blood pressure (arterial hypertension), metabolic disorders due to obesity. Other risk factors also include gender (men suffer from atherosclerosis more often than women), age, heredity, unhealthy diet (for example, excessive intake of fat, meat and insufficient intake of vegetables and fruits), excess weight (obesity), lack of movement and physical loads.

Examination and diagnosis

In order to confirm the diagnosis in case of suspected PAD, the doctor needs to conduct a series of tests: a medical examination, which includes checking the color of the skin of the limbs, circulatory disorders, monitoring the pulse rate, body temperature, listening for the flow of noise, testing sensory and motor skills, clinical studies ( ergometry for determining the distance traveled on a treadmill, Doppler ultrasound, oscillography, color duplex ultrasound, digital angiography, CT angiography (CTA), magnetic resonance angiography (MRA) and laboratory tests to determine the SC of myoglobin and C-reactive protein (CRP).

Treatment

Treatment for PAD should be done according to the stage of the disease. At the first stage, conservative treatment is appropriate – first of all, the elimination of risk factors for cardiovascular diseases. A successful result in this case largely depends on the cooperation of patients with a doctor. The more active their actions (for example, quitting smoking, controlling blood pressure, etc.), the more successfully they will be able to stop the progression of the disease and avoid complications such as heart attack or stroke. In the second stage, along with the adjustment of risk factors, drug treatment and an increase in the level of physical activity for the legs and blood vessels are recommended. As drug therapy, vasoactive substances such as cilostazol and antiplatelet drugs such as clopidogrel are often used. Movement and walking play a decisive role in the treatment. They stimulate the formation and development of collateral circulation, leading to an improvement in the blood supply to the affected lower extremities. In stages II – IV, in addition to drug therapy, revascularization methods of treatment can be used, which means either open surgery or catheter procedure. The latter involves the introduction of a catheter into a narrowed or blocked blood vessel, equipped with a stent, which expands the patency of the artery and helps to restore normal blood circulation. In surgery, shunting operations are often performed: stitching in an additional vessel bypassing the affected artery. In the case of destruction of a large area of ​​tissue (stage IV of the disease), and when revascularization methods of treatment do not bring the desired results, it is usually used    

Disease course and prognosis

The course of the disease depends on many factors and, in particular, on how successfully you can cope with the main cause of vasoconstriction – atherosclerosis. To a large extent, this depends on the patient himself, on how actively and consistently he himself will deal with risk factors. This is, first of all, quitting smoking and controlling possible diabetes mellitus with the help of drugs. Despite the fact that atherosclerosis cannot be completely cured, the process of the disease can still be slowed down or even stopped.

Note:

PAD often overlaps with other cardiovascular diseases, such as coronary artery disease or cerebro-arterial obliterating endarteritis. In this regard, the physician is advised not only to examine the patient for PAD, but also to be aware of the patient’s heart and central nervous system problems.