Peripheral arterial disease (PAD) refers to diseases of the blood vessels outside the heart and brain. In patients with PAD, the arteries that carry blood to the arms, legs, stomach or kidneys become narrowed or clogged, interfering with normal blood flow.
Alternative Names of Vascular Disease are: Peripheral Arterial Disease.
Causes of Vascular Disease
Risk factors that may increase the likelihood of peripheral arterial disease and the risk of heart attack or stroke include:
Other cardiovascular diseases
Elevated levels of homocystine, an amino acid and building block of proteins that occurs naturally in the blood. Studies have found that people with elevated levels of homocystine have higher risk of heart and blood vessel damage.
Signs & Symptoms of Vascular Disease
The symptoms of peripheral arterial disease vary and typically become more severe as the arteries narrow. In the early stages, common symptoms include intermittent claudication (pain, cramping or weakness in the legs, buttocks or arms) that occurs with the patient is active and disappears when activity stops.
As peripheral arterial disease progresses, the symptoms may increase, including:
In severe cases, blackened tissue on the toes, feet or fingers, indicates that the tissue has died (gangrene). Treatment may require amputation. Abdominal and thoracic aortic aneurysms are typically symptomless until they expand, leak or rupture. Severe abdominal and/or back pain may indicate a leak or rupture. A leak or rupture is urgent and patients should seek medical attention immediately. Some patients with carotid artery disease may be asymptomatic (without symptoms) while others may experience transient ischemic attacks (TIA) that produce strokelike symptoms that warn of impending stroke but cause no lasting damage. These symptoms may include numbness or weakness in an arm or leg, slurred speech or blindness in one eye.
Diagnosis of Vascular Disease
A comprehensive diagnosis will help determine the most appropriate treatment for patients with peripheral arterial disease (PAD).
Physical Examination and Blood Tests
Physicians review each patient's medical history and conduct a detailed assessment of risk factors for PAD, heart disease and stroke, including:
Blood tests may be used to confirm cholesterol levels, diabetes, and other indicators of a high risk for hardening of the arteries, such as high levels of homocystine (an amino acid found naturally in the blood that acts as a building block for proteins).
Ankle-Brachial Index (ABI)
This noninvasive test compares the blood pressure between the arms and ankles. An abnormal ratio may indicate decreased circulation.
Ultrasound is a painless, noninvasive procedure that sends high-frequency sound waves into the arteries. As the sound waves bounce back, specialists analyze the images and assess the degree of circulatory impairment.
Computed Tomography Angiography (CTA)
In this noninvasive test, a CT scanner rapidly rotates around the body, taking a series of images that are reconstructed, with the aid of a computer, to produce detailed images of the arteries and surrounding structures.
Magnetic Resonance Angiography (MRA)
MRA uses a powerful magnet and radio waves to produce a detailed, three-dimensional view of the arteries. Narrowed and blocked arteries can be identified in this noninvasive test.
In this procedure, a catheter (thin, flexible tube) is inserted into the artery through a skin puncture, usually in the groin. The catheter is threaded, with X-ray guidance, through the circulatory system to the affected artery. Dye is injected into the artery to give a detailed view of problem areas. If a blockage or narrowing is discovered, it can occasionally be treated with a balloon or stent (a wire mesh tube) inserted into the artery, often during the same procedure.
Treatments of Vascular Disease
Treatment programs for patients with peripheral arterial disease are tailored to each individual and take into account the needs of the patient and family. Treatment depends on factors such as the severity of the symptoms, the degree of arterial narrowing or blockage, and the patient's overall health.
Treatment programs for patients with peripheral arterial disease may include:
Controlling Risk Factors
Peripheral arterial disease is common among smokers and people who have diabetes. It is critical for diabetics to control their blood sugar levels and for smokers to quit smoking. Also critical for patients with PAD, and particularly those with diabetes, is to carefully monitor their feet for cuts or wounds and avoid tight-fitting shoes.
Diet and Exercise
Patients with peripheral arterial disease must reduce the amount of cholesterol-containing (fatty) foods in their diet. Overweight patients must also reduce their daily calorie intake to lose weight. Exercise helps patients lose weight and build a stronger circulatory system, improving blood flow. Although patients with peripheral arterial disease may experience pain during exercise, a program of daily walking for short periods may help maintain or regain function.
Patients with peripheral arterial disease may benefit from medications to reduce the risk of heart attack and stroke. Several types of drugs commonly are prescribed:
Antiplatelet drugs make blood platelets less likely to stick together. Sticky platelets, which are common in damaged blood vessels, may form a blood clot and lead to a stroke or heart attack. Aspirin is the most common, least expensive, antiplatelet drug and typically has the fewest potential side effects.
Anticoagulants prevent blood clots by affecting the proteins in the body's clotting system. They require careful monitoring. Heparin, which is used short term, and warfarin, which is used long term, is both anticoagulants.
By decreasing the amount of cholesterol, especially low-density lipoprotein (LDL), these drugs decrease the primary material that makes up deposits that narrow or plug arteries and create atherosclerosis (hardening of the arteries). Examples of these drugs include niacin, statins, fibrates and bile acid sequestrants.
Calcium Channel Blockers
Calcium channel blockers help dilate arteries and control high blood pressure.
Folate, B-6 and B-12 are vitamins that help to decrease homocystine in the blood. Other dietary supplements, such as L-arginine and omega-3 fatty acids, may also be prescribed.
Endovascular (Within the Blood Vessel) Therapy
In angioplasty and stenting, a balloon is attached to a catheter (a long, thin tube) that is inserted in the groin artery and threaded through the arteries to the narrowed peripheral arteries. The balloon is then inflated to open the narrowed areas. In some cases, a metal stent (a wire mesh tube) is left in place to keep the artery from collapsing. Patients are typically given a mild sedative during the procedure and are usually discharged from the hospital the following day. Most patients are able to resume normal activities immediately.
Surgery is the appropriate option for those patients with severe cases of peripheral arterial disease that interfere with daily activities. There are several surgical treatments.
In endarterectomy, the surgeon cleans out the plaque buildup inside the artery of the affected leg or arm.
Grafting or Bypass
In grafting or bypass, the surgeon replaces the section of blocked artery with a graft (replacement section of vein or artificial blood vessel) or a bypass (a vein or artificial blood vessel that channels blood around the blockage).