October 2013

Peripheral Arterial Disease: Symptoms, Diagnosis, and Treatment

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Peripheral arterial disease (P.A.D.) affects more than 8 million Americans. This disease is characterized by the build-up of plaque within the blood flow channels of the arteries. Plaque can harden and narrow the arteries causing decreased blood flow to the muscles and organs that the artery is supplying. It is commonly seen in the legs but can also affect arteries of the arms, kidneys, brain and heart. When arterial plaque builds up in the heart arteries, it is called coronary artery disease.

SYMPTOMS

THE ARTERIES OF THE LEGS ARE OFTEN AFFECTED BY P.A.D. AND THIS MAY BE THE AREA WHERE SYMPTOMS SHOW UP FIRST. LEG PAIN, ESPECIALLY WITH WALKING, IS OFTEN THE FIRST SIGN. THIS SYMPTOM, KNOWN AS CLAUDICATION, COMMONLY OCCURS AS CALF PAIN THAT WORSENS WITH WALKING AND IS RELIEVED BY REST. OTHER ARTERIES, SUCH AS THOSE TO THE BRAIN AND HEART, CAN ALSO BE AFFECTED. PATIENTS WITH ARTERIAL DISEASE IN THEIR LEGS MAY BE AT HIGHER RISK FOR HEART ATTACK AND STROKE. SINCE ADVANCED ARTERIAL DISEASE IN THE LEGS CAN PROGRESS TO PAIN AT REST, ULCERS OF THE LEGS, FEET, OR TOES AND EVEN GANGRENE, IT IS IMPORTANT TO BE EXAMINED BY A SPECIALIST.

HOW DO YOU DIAGNOSE P.A.D.?
An office-based non-invasive Doppler examination along with a physical exam by an experienced vascular specialist can often discern the signs of P.A.D. Additionally, ultrasound examination of the legs can be helpful in determining the general area where the disease is present. Other radiologic examinations such as CT or MRI can also be used to evaluate the arteries leading into the legs and to pinpoint the area of narrowing within the arteries.

CAUSES
The build-up of plaque within arteries can be caused by several known risk factors. Although family history of arterial disease can play a role in P.A.D., other treatable or preventable factors can also contribute. Smoking, high cholesterol, high blood pressure, diabetes and lack of exercise can increase the likelihood of developing P.A.D. Control of these risk factors can reduce the incidence and severity of the disease.

CAN P.A.D. BE TREATED?
P.A.D is treated in several ways. For mild P.A.D., risk factor modification such as strict blood pressure control and smoking cessation are often used, along with a walking program to increase the distance that patients can walk without pain. For certain patients, medication may also be prescribed to help increase walking distance.

For moderate to severe P.A.D., arteriography may be recommended, including contrast (dye) injection into the arteries and possible expansion of the arteries using a balloon (angioplasty) or stent. This is performed by a vascular specialist using advanced equipment and techniques and can be performed as an outpatient procedure through a single needle stick.

Surgery may be recommended for more advanced P.A.D. This can include leg bypass beyond the blockage or a removal of particularly bulky plaque in certain locations.
If you suspect that you may suffer from peripheral arterial disease, it is important to be examined by a vascular specialist.

For more information, call Savannah Vascular & Cardiac Institute at (912) 352-8346 or visit online at savannahvascular.com

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