Peripheral Artery DiseaseTuesday, June 30, 2009
What Is Peripheral Arterial Disease (PAD)?
Peripheral arterial disease, commonly referred to as PAD, is a kind of atherosclerosis, or hardening of the arteries. PAD affects your cardiovascular health and can hamper your ability to walk well. It can also increase your chances of suffering a stroke or heart attack. In people with diabetes, PAD most often affects arteries in the thigh or lower leg, although other arterial areas can include the brain, kidney, and intestines.
Atherosclerosis can lead to PAD. Smoking, high cholesterol, and high blood pressure all contribute to the fat deposits (plaque) that build up in the arteries. As plaque increases, the arteries narrow and harden, making it difficult for oxygen to move freely.
Other risk factors include diabetes, inadequate exercise, and a high-fat diet low in vitamins C and E.
Many people experience no symptoms with PAD. Others develop an ache, cramping, tiredness, or pain in their calf after walking, called claudication.
If you have very poor circulation in your leg, you might also experience pain in your feet and toes - even when you`re not doing anything. The pain can worsen when you raise your legs.
Your first course of treatment should focus on reducing the risk of heart attack or stroke. Lifestyle changes such as smoking cessation, exercising, and eating a healthful diet - along with good control of diabetes, blood pressure, and cholesterol - can greatly reduce the progression of the disease and reduce the risk of stroke or heart attack.
If pain from the disease interferes with daily life, you may need angioplasty (either alone or with a stent) and/or bypass surgery.
Angioplasty widens the blocked artery by inserting a balloon-tipped, hollow tube into the area, then blowing up the balloon, causing the artery to stretch and widen a bit. Stents (tube-shaped devices) help keep an artery open.
Bypass surgery uses a vein from another part of your body to bypass the blockage in the affected artery. In cases of progressive deterioration, you may need arterial grafts, which remove the blockage and repair the artery using a piece of artery from elsewhere in the body.
Another treatment option involves drug therapy. Antiplatelet drugs, such as aspirin or clopidogrel, help prevent the formation of clots. Statins help lower "bad" cholesterol as well as total cholesterol. Blood pressure medication, particularly ACE drugs such as ramipril, are also often prescribed.
The treatment methods above help reduce the risk of heart attack and stroke, but do not reduce the pain associated with PAD. To treat the pain, your doctor may prescribe cilostazol or pentoxifylline, each of which increases blood flow to the limbs by preventing blood clots and widening the blood vessels. They may help increase the distance you can walk without pain.
What Are the Complications of PAD?
PAD dramatically increases your risk for stroke or heart attack. In addition, it increases the risk of amputation of the foot or leg. Also, because PAD results from inadequate blood supply to part of the body, wounds in the affected area may not heal as well as they should. This can lead to ulcers, which can be painful unless neuropathy (nerve damage) also exists.
- Stop smoking.
- Keep blood sugar levels and blood pressure in the normal range.
- Eat a diet that helps keep blood fats close to normal. Avoid saturated fat and tropical oils, such as palm or coconut oil.
- Get enough vitamin B-6, B-12, and folic acid in your diet to help control homocysteine levels (high levels can cause damage to your arteries).
- Talk with your healthcare provider about taking an aspirin every day.
- Manage your stress with biofeedback, meditation or whatever works for you to avoid stress-related high blood pressure.
Reviewed by Clara Schneider MS, RD, RN, CDE, LDN - 05/13