Peripheral arterial disease (PAD) is when your arteries begin to narrow. It's a common problem that affects 9% of the population, but will only cause symptoms or problems in a quarter of those people.
How it develops
Arteries carry blood away from the heart and supply essential nutrients and oxygen to every part of your body. Normally the artery is a hollow tube and the inside has a smooth surface for the blood to travel over. When the blood is travelling through the artieries it can leave behind deposits, known as plaque, which stick to the inside of the artery. This is known as atherosclerosis. Gradually, over many years, these deposits can build-up and cause the inside of the artery to narrow. This is often called 'furring up of your arteries', though health care professionals call this 'occlusive disease'.
Peripheral arterial disease (PAD) is the name given to occlusive dissease that occurs in the peripheral or outer arteries of the body, such as the legs. However, if you have been diagnosed with PAD, it is likely that the same process will be happening in the arteries which supply your brain and heart; leaving you at higher risk of suffering a heart attack or stroke.
What are the causes of peripheral arterial disease?
Diet and Weight
Vascular disease can also be a hereditary condition. If you have a history of vascular disease in your family, you may want to discuss this with your health care practitioner.
One of the first symptoms of peripheral arterial disease that you may experience is an ache or cramp in your leg muscles when you're walking. Most commonly this occurs in the calf muscle, but can also occur in the thigh or buttock muscles. This symptom is called intermittant claudication.
In some people, the disease progresses and the amount of blood able to go down the leg is not enough to supply the nutrients and oxygen to their feet. In cases like this, the individual will get pain in their feet even when they're not moving. This is known as rest pain and is a symptom of critical limb ischaemia. Without nutrients and oxygen getting down into the foot, the skin is unable to function properly and can break down into an ulcer. If an individual has rest pain or skin breakdown they are at risk of losing their foot or leg by amputation.
Tests to assess if you have peripheral arterial disease
Ankle Brachial Pressure Index (ABPI): This is a menthod of assessing the blood supply to your feet by comparing your blood pressure in both of your arms. If you have atherosclerosis of your leg artieries, there's likely to be a lower blood pressure in your feet.
Treadmill Exercise Test: This test combines the ankle brachial pressure index with a treadmill test. The ABPI is performed before and after you walk on a treadmill. If you have atherosclerosis of your leg arteries, there is likely to be a lower blood pressure in your feet after the exercise. This is a good test to confirm the diagnosis of peripheral arterial disease.
Duplex Ultrasound: Duplex ultrasound is a non-invasive investigation that uses a probe and jelly on the skin to look inside your leg and gives a picture of the anatomy of your arteries. This will show any atherosclerosis in the arteries, and whether this is causing a narrowing or blockage.
Treatments for peripheral arterial disease
Exercise is very important for vascular health
Conservative Management: Most people with peripheral arterial disease are treated this way. It involves:
Managing your risk factors, including high blood pressure, stop smoking, diabetes, diet
Anti-platelet medication, aspirin or clopidogrel (prevents blood clots forming on the atherosclerosis inside your arteries)
Peripheral vasodilators occasionally help (medication to relax your blood vessels and allow blood to flow more easily)
Taking regular exercise - very important, your leg gets fitter and you can get further. Help yourself.
Statins (drugs used to lower cholesterol levels)
For some people with severe vascular disease, invasive therapy such as balloon angioplasty or stent insertion may be considered.
Bypass Graft: This is a surgical operation that involves attaching a graft (hollow tube that is able to carry blood) above the area of narrow or occluded artery and attaching it to an area below the diseased artery. This provides a new path for the blood to travel to and improves the blood supply to the leg and foot. This treatment is usually only used for patients with severe disease and critical limb ischaemia.
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