Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD) is a medical condition characterized by the narrowing or blockage of the blood vessels outside of the heart, typically in the legs, but also in the arms, kidneys, and other organs.

Causes and Risk Factors

• Atherosclerosis: The buildup of plaque in the arteries, which can lead to narrowing or blockage of the blood vessels.
• High blood pressure: Uncontrolled high blood pressure can damage the blood vessels and increase the risk of PAD.
• Smoking: Smoking damages the blood vessels and increases the risk of PAD.
• Diabetes: People with diabetes are at higher risk of developing PAD due to high blood sugar levels damaging the blood vessels.
• High cholesterol: High levels of low-density lipoprotein (LDL) cholesterol can increase the risk of PAD.
• Obesity: Being overweight or obese can increase the risk of PAD.
• Age: The risk of PAD increases with age, especially after the age of 50.
• Family history: Having a family history of PAD or other cardiovascular diseases can increase the risk.

Symptoms

• Pain or cramping in the legs or arms during exercise or activity, which is relieved by rest (intermittent claudication).
• Persistent pain in the legs or feet at rest.
• Numbness or weakness in the legs or feet.
• Coldness or paleness of the skin in the affected area.
• Slow or non-healing wounds on the legs or feet.
• Erectile dysfunction in men.

Diagnosis

• Medical history and physical examination: A doctor will ask about symptoms, medical history, and perform a physical examination to check for signs of PAD.
• Ankle-brachial index (ABI): A test that compares the blood pressure in the ankles with the blood pressure in the arms to diagnose PAD.
• Doppler ultrasound: A non-invasive test that uses sound waves to evaluate blood flow in the arteries.
• Angiography: An imaging test that uses X-rays and a contrast agent to visualize the blood vessels and diagnose blockages.
• Computed tomography (CT) angiography or magnetic resonance (MR) angiography: Imaging tests that use CT or MR technology to visualize the blood vessels and diagnose blockages.

Treatment

• Lifestyle modifications:
  • Quitting smoking.
  • Exercising regularly, such as walking.
  • Eating a healthy diet low in saturated fats and cholesterol.
  • Maintaining a healthy weight.
  • Managing stress.
• Medications:
  • Antiplatelet agents to prevent blood clots.
  • Statins to lower cholesterol levels.
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) to control high blood pressure.
  • Cilostazol to improve walking distance and reduce symptoms.
• Minimally invasive procedures:
  • Angioplasty: A procedure that uses a balloon to widen the narrowed artery.
  • Stenting: A procedure that uses a small mesh tube to keep the artery open.
  • Atherectomy: A procedure that uses a catheter to remove plaque from the artery.
• Surgery:
  • Bypass surgery: A surgical procedure that creates a detour around the blocked artery using a graft.
  • Endarterectomy: A surgical procedure that removes plaque and damaged tissue from the artery.

Complications

• Critical limb ischemia (CLI): A severe blockage of the blood vessels that can lead to gangrene, amputation, or death.
• Heart attack and stroke: PAD increases the risk of heart attack and stroke due to the buildup of plaque in the arteries.
• Kidney disease: PAD can increase the risk of kidney disease and kidney failure.
• Erectile dysfunction: PAD can cause erectile dysfunction in men due to reduced blood flow to the penis.