PAD

Peripheral artery disease or peripheral arterial disease (PAD) is a disease of circulatory system that involves narrowing of arteries, which causes reduced blood flow to the limbs. 

People with PAD do not receive enough blood flow to their extremities, usually the legs, which may cause pain, particularly when walking. 

A very common disease, peripheral artery disease is more likely to be a sign of underlying conditions, such as atherosclerosis. 

It is often treated with significant lifestyle changes like quitting tobacco, eating a healthy diet, and regular exercise.

While most people with peripheral artery disease (PAD) do not complain about symptoms, some may experience claudication or pain in the legs when walking. 

Claudication may also involve muscle pain, leg or arm cramps, and calf pain. The severity of the symptoms may vary from mild to very painful. Severe claudication may result in walking difficulty or hinder you from doing other physical activities.

Other symptoms of peripheral artery disease include:

• Weakness or numbness of the legs
• Coldness in the lower leg
• Sores on the legs, feet, or toes that won’t heal
• Color of the legs have changed
• Hair loss on the feet and legs
• Slow-growing toenails
• A weak pulse (or no pulse) in the legs or feet
• In men, erectile dysfunction may occur

Peripheral artery disease (PAD) is often caused by atherosclerosis, the fatty deposits that build up in the artery walls. Atherosclerosis reduces blood flow.

While atherosclerosis usually affects the heart, but in some cases when arteries are involved, peripheral artery disease takes place. 

Less common causes of PAD include inflammation of the blood vessels, limb injury, radiation exposure, and unusual anatomy of the ligaments or muscles.

In order to diagnose peripheral artery disease (PAD), the doctor must do the following:

• Physical examination: Signs and symptoms of PAD may be present during a physical exam. Your doctor may check your arteries using a stethoscope, and look for other signs, such as a weak pulse or a poorly-healing wound.
• ABI or ankle-brachial index: This is a common procedure done to diagnose PAD. This involves comparing the blood pressure in  the ankle with the blood pressure in the arm.
• Ultrasound: A Doppler ultrasound may be used to help determine if there are blocked or narrowed arteries. This technique is also used to evaluate blood flow.
• Angiography: This procedure involves injecting a dye into the blood vessels and using imaging techniques like X-ray, MRA (magnetic resonance angiography) or CTA (computerized tomography angiography) to trace the flow of contrast.
• Catheter angiography: Although a more invasive procedure, this type of angiography can be used as a simultaneous procedure for diagnosis and treatment.
• Blood tests: Several blood tests can help measure your blood cholesterol and triglycerides.

Peripheral artery disease (PAD) treatment generally has two goals:

• manage the symptoms,
• stop atherosclerosis from progressing. 

Lifestyle changes, such as quitting smoking, eating a healthy diet, and exercising regularly are sometimes enough to reverse the disease. 

In case lifestyle changes do not work, your doctor may prescribe medications or even suggest surgery.

Medications

Certain medications may be given to alleviate the symptoms and reverse the other underlying diseases. 

Medications that are commonly prescribed to people with PAD include cholesterol-lowering drugs, medications for high blood pressure, medications to control blood sugar, prevent blood clots and other symptom-relief medications. 

Angioplasty and surgery

In some cases, peripheral artery disease may be treated with angioplasty and surgery. 

• Angioplasty. Angioplasty involves inserting a catheter through a blood vessel to the affected artery. The tip of the catheter has a small balloon, which will be inflated to help reopen the blocked artery and increase blood flow.
• Bypass surgery. This surgical procedure involves creating a graft bypass  which will allow the blood to bypass or flow around the blocked artery.

Thrombolytic therapy

A clot-dissolving drug may be injected into the artery, making the clot dissolve or break up.

There are several factors that increase your risk for peripheral artery disease (PAD). These include:

• Smoking
• Obesity
• Diabetes
• High cholesterol
• High blood pressure
• Old age
• Family history
• High levels of homocysteine 

Complications of peripheral artery disease include:

• Critical limb ischemia. It is a condition characterized by open sores that do not heal and often result in infection of the feet or legs. 
• In some cases, critical limb ischemia may cause tissue death or gangrene that may require amputation of the affected limb.
• Stroke and heart attack. Atherosclerosis, the main cause of PAD, may cause fat build up in the arteries, thus resulting in stroke or heart attack.