Peripheral artery disease

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Peripheral artery disease
Synonyms	Peripheral artery occlusive disease, peripheral vascular disease (PVD)
Pronounce	N/A
Specialty	N/A
Symptoms	Leg pain when walking, skin ulcers, cold skin
Complications	Heart attack, stroke, critical limb ischemia
Onset	Typically over age 50
Duration	Long term
Types	N/A
Causes	Atherosclerosis, smoking, diabetes mellitus, high blood pressure, high cholesterol
Risks	Smoking, diabetes, obesity, hypertension, hyperlipidemia
Diagnosis	Ankle-brachial index, ultrasound, angiography
Differential diagnosis	Spinal stenosis, deep vein thrombosis, arthritis
Prevention	Smoking cessation, exercise, healthy diet
Treatment	Lifestyle changes, medications, angioplasty, surgery
Medication	Statins, antiplatelet drugs, cilostazol
Prognosis	N/A
Frequency	202 million (2010)
Deaths	41,000 (2010)

Necrosis due to peripheral artery disease

Diagram of peripheral arterial disease

Atherosclerosis

Ankle-brachial index test for PAD

3D animation of vascular bypass grafting

Peripheral Artery Disease (PAD), also known as peripheral arterial disease, is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. When someone has PAD, their extremities — usually the legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (claudication). PAD is often a sign of a buildup of fatty deposits in the arteries (atherosclerosis). Atherosclerosis causes narrowing of the arteries that can reduce blood flow in the legs and, sometimes, the arms. PAD is similar to coronary artery disease (CAD) and carotid artery disease, where the arteries that supply the heart and brain, respectively, are also affected.

Causes

The primary cause of Peripheral Artery Disease is atherosclerosis. Other factors that can increase the risk of PAD include:

• Smoking
• Diabetes
• Obesity (a body mass index over 30)
• High blood pressure
• High cholesterol
• Increasing age, especially after reaching 50 years of age
• A family history of PAD, heart disease, or stroke
• High levels of homocysteine, a protein component that helps build and maintain tissue

Symptoms

Many people with PAD have mild or no symptoms. Some may have leg pain when walking (claudication). Claudication symptoms include muscle pain or cramping in the legs or arms that starts during exercise and ends with rest. The severity of claudication varies widely, from mild discomfort to debilitating pain. Severe PAD can lead to foot or toe wounds that won't heal or heal very slowly, gangrene, and possibly amputation.

Diagnosis

Peripheral Artery Disease is diagnosed based on medical history, physical examination, and test results. The Ankle-Brachial Index (ABI) is a simple, non-invasive test used to diagnose PAD. It compares the blood pressure in the ankle with the blood pressure in the arm. Other diagnostic tests include ultrasound, angiography, and Magnetic Resonance Angiography (MRA).

Treatment

Treatment for PAD focuses on managing symptoms and stopping the progression of atherosclerosis throughout the body to reduce the risk of heart attack and stroke. Lifestyle changes, medications, and in some cases, surgery are options.

Lifestyle Changes

• Quitting smoking
• Exercising regularly
• Eating a healthy diet

Medications

• Cholesterol-lowering medications
• High blood pressure medications
• Medications to control blood sugar
• Medications to prevent blood clots

Surgery

In severe cases, procedures such as angioplasty, stent placement, or bypass surgery may be necessary to open blocked arteries.

Prevention

Preventing PAD involves making the same lifestyle changes that can help treat it, including quitting smoking, exercising regularly, and eating a healthy diet.

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