PERIPHERAL ARTERY DISEASE
What is a Peripheral Artery Disease?
Peripheral Artery Disease is a disorder of the circulatory system in the body’s limbs. It occurs when the body’s arteries narrow from arteriosclerosis or “hardening of the arteries.” Plaque, the result of arteriosclerosis, builds up in the artery resulting in a narrower path for blood flow, which equates to inadequate blood and oxygen flow through the body. People who suffer from Peripheral Artery Disease often have problems with their legs. The leg’s muscles have to work harder to support the body with less oxygen and blood flow.
What causes Peripheral Artery Disease?
Peripheral Artery Disease is caused by the build-up of plaque as a result of arteriosclerosis. The buildup of plaque on the wall of the artery causes a reduction in blood flow. When arteriosclerosis occurs in the arteries that supply blood to the limbs (especially the legs and feet) it refers to peripheral artery disease. Peripheral Artery Disease most commonly affects men over 50 years of age. Men and women who have or have had the following are at a higher risk of the disorder.
- Body Mass Index over 30 (obesity)
- Coronary Artery Disease
- Family history of Peripheral Artery Disease
- High cholesterol or high blood pressure
It is important to note, that people who smoke or who are diabetic have a greater chance of developing Peripheral Artery Disease. Both of these factors lead to reduced blood flow.
What are the symptoms of Peripheral Artery Disease?
The severity of symptoms ranges from person to person. Early onset of Peripheral Artery Disease may not cause any symptoms. However, those with more severe cases complain of pain in the lower extremities, thighs, legs and feet. Generally, this pain begins during exercise and then goes away within a few minutes of rest but as the disorder advances this pain may be present during inactivity. The most common symptoms include:
- Cramps in the hip, thigh, calf or foot
- Weakness or numbness in the leg
- Coldness in the leg
- Color change in the skin on the leg
- Weak pulse in the leg or foot
- Sores on the leg or foot that do not heal
How is Peripheral Artery Disease diagnosed?
Exempla Rocky Mountain Cardiovascular Associates identifies Peripheral Artery Disease with some of the following tests:
- Diagnostic Tests
- Peripheral Angiography
- CT Angiography
- Ankle Brachial Index/ pulse volume recordings and segmental pressures
How is Peripheral Artery Disease treated?
Treatments for Peripheral Artery Disease are two-fold. The first is to manage symptoms and the second is to slow down or stop the progression of the disorder. If you smoke, the single most important thing you can do is to quit. Lifestyle treatments include:
- Quitting smoking
- Exercising and modifying your diet in an effort to lose weight (or decrease your body mass index)
- Alternating exercise and rest. Over time, circulation may improve as new blood vessels form
- Take care of your feet, especially if you are diabetic – wear shoes that fit properly and make sure to treat all cuts and scrapes right away
Medication treatments include:
- High-blood pressure medicine
- Cholesterol lowering medicine
- Medicine to control blood sugar
- Medicine to prevent blood clots like Aspirin or clopidogrel (Plavix)
- Medicine to provide symptom-relief like cilostazol (Pletal), which increases blood flow to the limbs by enlarging the artery
Cardiac Catheterization Lab treatments include:
- Stent placement
Smoking is a major risk for several diseases including heart disease, stroke, and several cancers. Even low-tar cigarettes and light smoking can increase the risk of heart disease substantially. There are now several alternative approaches to helping people stop smoking. These include nicotine-replacement patches and gum as well as oral medication.
If you are able to stop smoking, your risk of a heart attack or stroke decreases within a few weeks. The risk goes down to that of a nonsmoker within about 2 years. In addition, a lot of patients comment that they feel healthier and have more energy after they've stopped smoking.
Hypothyroidism can increase blood cholesterol levels and that contributes to heart disease; however, if the hypothyroidism is being treated with a thyroid hormone, then the cholesterol returns to normal.
Birth control pills can cause a small increase in the risk of thrombosis and heart attack. That occurs mainly in people who have been on the pill for more than 10 years and who smoke cigarettes.
There is an increase in the risk of heart attack if a first-degree relative (parent or sibling) has had a heart attack or stroke. That is mainly seen when the relative has had a heart attack before the age of 45 if they are male, 55 if they are female. Obviously, you cannot change your family history, but a positive history should suggest the need to improve all the other risk factors like stopping smoking and decreasing cholesterol.
Heart disease is potentially reversible by attending to risk factors like cholesterol, blood pressure, and smoking. Several studies have shown, for example, that aggressive lowering of blood cholesterol with LDL levels below 100 can open up blocked coronary arteries at least partially. Perhaps I should explain that LDL cholesterol is the "bad" cholesterol component.
I would suggest a diet that is balanced among all the main food groups, with fat content making up no more than 30 percent of calories and most of that fat being unsaturated. I would not advise patients to eat a diet that is restricted in carbohydrates or fruits and vegetables, because this may adversely affect vitamin intake and blood cholesterol.