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Speciality

Peripheral Vascular Disease (PAD)

What is PAD?
PAD is a blood circulation disorder that causes the blood vessels outside of your heart and brain to narrow, block, or spasm. In PAD or Vascular Disease not enough blood flows to the legs. This is usually caused due to the build-up of plaque (fatty deposits) along the walls of the blood vessels (this is a condition called atherosclerosis); causing the passageway to shrink in size, thereby reducing the amount of blood that can flow through it.

The risk factors for getting PAD are similar to the risk factors for coronary heart disease. They are:
    • Smoking cigarettes or consumption of other forms of tobacco (inhale and chew)
    • Abnormally high level of cholesterol (hypercholesterolemia)
    • Abnormally low level of high-density lipoprotein (HDL, the good cholesterol)
    • High blood pressure (hypertension)
    • Diabetes
    • Family history of cardiovascular disease
    • Obesity
    • Physical inactivity
    • Kidney disease

Symptoms

The most common symptom of PAD is pain or cramping in the legs (intermittent claudication) or buttocks that starts when you exercise and goes when you rest. Often the pain is described as a deep ache, especially in the calf muscle. The pain may extend to the foot or up toward the thigh and buttock. Sometimes, there is just numbness in the leg or a sense that one leg gets tired when you walk. A foot or toes also may feel cold or numb. If the arteries are severely narrowed, you could experience leg pain at rest, when you are not exercising. If blood flow stops completely (usually because a blood clot forms in the narrowed vessel), parts of the leg may become pale or turn blue, feel stone cold to the touch and eventually develop gangrene

Diagnosis

Techniques used to diagnose PAD include a medical history, physical examination, Doppler ultrasound, computerized tomographic angiography (CTA) and magnetic resonance arteriography (MRA).

Probably the most useful, although underutilized, diagnostic tool for detecting PAD in the outpatient setting is the Ankle Brachial Index or ABI test. This simple, painless test compares the blood pressure in the legs to the blood pressure in the arms to help accurately measure the degree of blood flow in the lower extremities.

Underdiagnosed and undertreated

In contrast to coronary and cerebral artery disease, PVD is vastly underdiagnosed despite its abysmal mortality rates. It is estimated that less than 30% of PVD patients are diagnosed, mainly due to the fact that over 50% are asymptomatic - leg pain may be present in only 10% of patients. Lack of awareness and appreciation of PVD is a major contributing factor to the under diagnosis of this serious disease

Prevention

You can help to prevent peripheral arterial disease by modifying your risk factors:
    • Don’t smoke. This a major risk factor that you can control.
    • Maintain a healthy weight. Obesity, especially a concentration of body fat around the waist, has been linked to unhealthy
      blood levels of cholesterol and other fats, which can build up inside your arteries.
    • Eat a healthy diet. Your diet should be loaded with vegetables and fruits, and it should be low in saturated fats.
    • Exercise regularly. Ideally, you should exercise 45 minutes or more every day.
    • Lower your blood pressure. Medications may be necessary if maintaining a healthy lifestyle is not enough.

Treatment

    • Modifying risk factors. Quitting smoking can reduce the symptoms of intermittent claudication
    • Exercise programmes
    • Medications
    • Revascularization procedures. The goal of revascularization is to improve circulation, either by opening narrowed arteries or
      by bypassing the narrowed section of the artery. These procedures include surgical and non-surgical techniques and are
      used in people who have severe or progressive symptoms, or whose leg pain occurs at rest. The most common non-
      surgical procedure is percutaneous transluminal angioplasty, also called balloon angioplasty. In this procedure, a catheter is
      inserted into the narrowed artery and a small balloon at the tip is inflated to open the narrowed vessel. Often, a metallic
      implant called a stent is used as a scaffold to support the wall of the artery after it is opened with the balloon. In some
      people, the narrowed vessel must be bypassed surgically using either a section of vein taken from the leg or a synthetic
      graft.

When to call a Professional

Call your doctor if you consistently suffer from cramps, aching, numbness or disproportionate fatigue in your leg muscles or buttocks when you exercise. Call immediately if you have these symptoms at rest or when any part of your leg or foot suddenly turns numb, cold, pale or a bluish colour.