Peripheral Artery Disease is frequently discussed in the popular press. The articles usually have frightening connotations but often with very little explanation.
In common usage the term applies to the obstruction of blood flow by plaques of cholesterol and calcium that form on the inside layers of arteries supplying the legs. The causative factors are the usual culprits - genetic predisposition, diabetes, high blood pressure and elevated cholesterol. However, the most impressive and most preventable culprit is cigarette smoking. The condition is much more common in men than women.
This problem usually presents in one of two ways. The first is when a person experiences pain in his/her thighs or calves when he/she walk or climb hills. Over a period of time the persons notices that his/her walking distance is decreased by pains that occur after shorter intervals and after walking shorter distances. A poorly understood detail is that patients who stop after the onset of walking pain can wait for the pain to stop and then walk an even longer distance before the pain stops them a second time. It is like a car that can drive better after warming the engine; except that people are not engines and it has been difficult to explain how a blocked human circulation warms up.
The diagnosis can be ascertained with ultrasound techniques that visualize the arteries and measure the blood flow in them. The arteries lie very close to the skin and are easily visualized with ultrasound. This minimizes the number of times that angiograms with contrast injections and Xrays are used. There are additional techniques of measuring the blood pressure in different segments of the leg and the oxygen levels in the toes when diagnostically complex cases have to be evaluated.
Physicians’ options include a small number of medications, surgery bypassing the blockages or placing stents into the blocked arteries. In general, surgery and stent placement is purposely postponed until the walking distance is reduced to one block. Exceptions leading to earlier surgery are made when a less severe degree of claudication makes life unbearable for the patient. Success is marked by the ability of the patient to increase the distance he/she walks before being stopped by pain. A very advanced form of this problem occurs when people have purplish feet and foot pain even at rest. This represents a very distressing and urgent situation that requires urgent attention.
The second type of presentation is more ominous. It occurs when a skin ulcer refuses to heal even with optimal local care. A similar situation occurs when a black area of gangrene forms on the foot. In these situations, the blood flow must be improved for healing to start. This can involve angioplasty and stents to the arteries or bypasses from healthier arteries around the obstruction to part of the artery closer to the wound.
After the endangered area has had its blood flow optimized, the local care of the wound and related infections is crucial. To be brutally frank there is a race against time. If the ulcer does not heal or if the gangrenous area does not recede the patient is faced with a deteriorating situation which will eventually lead to amputations. This is what makes peripheral arterial disease such a threatening situation.
The real opportunity, when faced with an illness this threatening, is to practice prevention. In order to prevent the arteries from becoming blocked in the first place, the risk factors like smoking have to be eliminated and like diabetes have to be controlled. For patients who already have obstructed arteries prevention consists of exercise to naturally maintain blood flow. Uninterrupted attention to foot care to prevent ulcers and infections from forming is essential. Lastly when all the preventive measures fail and an ulcer or a foot infection forms prompt presentation for medical care gives the physician the maximum amount of time to turn the course of events in the patient’s favor.
Blocked leg arteries represent a dangerous situation for the patient and often predict that arteries to other parts of the body are also blocked. Nevertheless, each year treatment options grow and with determined therapy the outcomes continue to improve.
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