Peripheral arterial disease

Peripheral arterial disease (PAD) refers to a condition wherein the blood flow to the legs is diminished due to blockage in the arteries.  It affects about 5% of the U.S. population.  Symptoms and changes related to the disease can be very subtle, making it difficult to diagnose in a timely fashion.

Hardening of the arteries occurs when the inside of the artery wall becomes “sticky.”  As a result of this stickiness, clotting cells (platelets) and inflammatory cells attach to this area of the blood vessel.  Eventually fatty deposits and cholesterol build up on the inside of the wall and this thickening can block the blood flow.

The big question is why the arteries become sticky in the first place.  Risk factors for developing hardening of the arteries (atherosclerosis) include cigarette smoking, high blood pressure, high cholesterol, and diabetes.  We do know that reducing these risks will lessen the chance of getting arterial problems.  Also, arterial disease becomes more common as we age.  Blockage in the legs can be an important clue that other major blood vessels of the body are affected as well, including the arteries of the heart, kidneys, and brain.  

The symptoms of PAD are due to the impeded blood flow and the diminished oxygen delivery to the affected body tissues.  Therefore, individuals with blocked arteries in the legs will develop pain in the calves or thighs as they walk a certain distance.  The pain goes away when they rest.  This is called claudication and it is the classic sign of PAD.  

Other signs and symptoms of the disease also reflect this lack of proper blood flow through the arteries to the legs.  Loss of hair on the legs, poor nail growth (brittle nails), dry and scaly skin, redness of the feet and soles, and pale-appearing legs when the legs are raised up can all be signs of PAD.

The diagnosis of peripheral artery disease may be obvious if all of the above signs and symptoms are present.  However, if symptoms are intermittent or mild in nature, other testing may need to be performed to identify the problem.  These tests include checking blood pressures in the legs (ankle-brachial index); ultrasound testing to examine the blood flow in the arteries; and dye testing that directly visualizes the blood flow (arteriography).

Treatment of PAD reflects the risk factors I mentioned above.  Smoking cessation is the first step.  This is the single biggest risk factor for PAD and needs to be eliminated in order to properly deal with this disease.  Progressive exercise helps to stimulate circulation and blood flow to the extremities.  These two steps are most likely to affect the greatest improvement in early PAD.  Other important modifications include controlling the blood pressure, cholesterol, and blood sugar, if these are high.  

Medicines that prevent the platelets from sticking to the vessel walls may be recommended by your physician.  These include aspirin and some prescription medications such as dipyridamole, Pletal, and Plavix.  In severe cases of PAD, the arteries may be obstructed to such a degree that surgery is needed to either open the blocked vessel or bypass the vessel altogether.    

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.

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