Peripheral arterial disease (PAD)

Peripheral artery disease is usually caused by atherosclerosis. In atherosclerosis, the accumulation array of arteries and reduced blood flow.
Definition

Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs.

When developing peripheral artery disease (PAD), extremities - usually the legs, not getting enough blood flow to keep up with demand. This causes symptoms, especially leg pain when walking (claudication).

Peripheral artery disease is likely a sign of a more accumulation of fat in the arteries (atherosclerosis). This condition can reduce blood flow to the heart and brain, as well as legs.

Typically, the treatment can successfully peripheral arterial disease quit smoking, exercise and eat a healthy diet.

Symptoms

While many people with peripheral artery disease have mild or no symptoms, some people with leg pain when walking (claudication).

Continuous symptoms include muscle pain or cramping in the legs or arms triggered by activities, such as walking, but disappears after a few minutes of rest. The location of the pain depends on the location of the clogged or narrowed arteries. Painful muscle mass probably the most popular.

The severity of claudication is constantly ranging from mild discomfort to debilitating pain. Continuous severe claudication can make it difficult to walk or other physical activity.

Symptoms of peripheral artery disease include:

Painful cramps in the thighs, hips or leg muscles after activity, such as walking or climbing stairs (claudication).

Leg numbness or weakness.

Cold in the lower leg or foot, especially when compared with the other leg.

Pain in the toes, feet or leg wound would not heal.

The color change of foot.

Hair loss or slower hair growth on the legs.

Slow development of toenails.

Shiny skin on the legs.

No circuit or circuit weakness in the legs or feet.

Erectile dysfunction in men.

If peripheral artery disease progresses, pain can occur even when resting or lying down (ischemic pain at rest). It can be powerful enough to break sleep. Legs hanging over the edge of the bed or walking around the room can temporarily relieve the pain.

Go see a doctor when

If you have leg pain, numbness or other symptoms, do not give them as a normal part of aging. Call your doctor and make an appointment.

Even when no symptoms of peripheral artery disease, may need to be checked if:

Over 70 years of age.

Over 50 years old and have a history of diabetes or smoking.

Under 50 years old but diabetes and the risk of arterial disease, other factors, such as obesity or high blood pressure.

Cause

Peripheral artery disease is usually caused by atherosclerosis. In atherosclerosis, the accumulation array of arteries and reduced blood flow.

Although the heart is often the focus of discussion of atherosclerosis, the disease can and usually does not affect arteries throughout the body. When it occurs in the arteries that supply blood to the arms and legs, it causes peripheral arterial disease.

Less common, PAD can cause inflammation of the blood vessels, damage to the hands and feet, abnormal anatomy of the ligaments or muscles, or exposure to radiation.

Risk Factors

These factors increase the risk of developing peripheral artery disease include:

Smoke.

Diabetes.

Obesity (body mass index 30).

High blood pressure (140/90 millimeters of mercury or higher).

High cholesterol (total cholesterol over 240 mg / dL, or 6.2 millimoles / liter).

Increasing age, especially after age 50.

Family history of peripheral arterial disease, heart disease, or stroke.

Exceed the level of homocysteine, a protein component helps to build and maintain tissue.

People who smoke or have diabetes are at high risk of peripheral artery disease by reducing blood flow.

Complications

If peripheral artery disease is caused by a buildup of plaque in blood vessels (atherosclerosis), there is also the risk of developing:

Details ischemia. This condition begins as sores that do not heal, an injury or infection foot or hand. Ischemic important detail (CLI) occurs when injury or infection progress and can cause cell death (necrosis), sometimes requiring amputation of the affected limb.

Stroke and heart attack. Atherosclerosis is the cause of the signs and symptoms of peripheral arterial disease is not limited denchan. Also from fatty plaques in the arteries that supply the heart and brain.

Tests and diagnosis

A number of tests, doctors can rely on to diagnose peripheral artery disease:

Examination. Your doctor may find signs of PAD in a physical examination, such as absent or weak pulse under a narrow area of ​​the artery, sounds (bruits) in arteries can be heard with a stethoscope evidence of poor wound healing in areas where blood flow is restricted, and reduce blood pressure in affected limb.

Ankle arm index (ABI). This is a test commonly used to diagnose PAD. It compares blood pressure in the ankle with the blood pressure in the arm. To get your blood pressure, your doctor uses a regular blood pressure cuff and a special ultrasound device to evaluate blood pressure and flow. Can walk on the treadmill and read before and immediately after exercise to capture the severity of arterial narrowing in walking time.

Ultrasound. Especially ultrasound, such as Doppler ultrasound can help doctors evaluate blood flow through blood vessels to narrow and define or blocked arteries.

Angiography. By injecting a dye into the blood vessels, this test lets doctors see blood flow through the artery as it happens. Doctors can monitor the flow of the contrast material, using imaging techniques such as X-ray or procedures called magnetic resonance imaging (MRA) or computerized tomography (CTA). Catheter angiography is a more invasive procedure, involves guiding a catheter through an artery in the groin to the affected area and inject dye that way. Although invasive, this type of angiography allows simultaneous diagnosis and treatment - finding an area to narrow the blood vessels and then extend it with an angioplasty procedure, medication management to improve blood flow.

Blood tests. A blood sample can be used to measure triglyceride, cholesterol and diabetes to test.

Treatments and drugs

Treatment for peripheral artery disease has two main objectives. The first is to manage the symptoms, such as leg pain, to be able to resume physical activity. The second is to prevent the progression of atherosclerosis throughout the body to reduce the risk of heart attack and stroke.

Can accomplish these goals with lifestyle changes. If you smoke, quitting smoking is the most important thing you can do to reduce the risk of complications.

If lifestyle changes are not enough, need additional medical treatment. Your doctor may prescribe medication to prevent blood clots, lower blood pressure and cholesterol, reduce pain and other symptoms.

Medications

Cholesterol-lowering medications. Can be used cholesterol-lowering drugs called statins to reduce risk factors for heart attack and stroke. The goal for people with peripheral arterial disease is to reduce low density lipoprotein (LDL), "bad" cholesterol less than 100 mg / deciliter (mg / dL), or 2.6 millimoles / liter (mmol / L). The purpose even lower if there is a major risk factor in addition to heart attacks and strokes, particularly diabetes or smoking continues.

Drug treatment of hypertension. If you have high blood pressure, your doctor may prescribe medication to lower it. The goal of this therapy is to reduce systolic blood pressure to 140 millimeters of mercury (mm Hg) or lower and diastolic blood pressure (bottom number) to 90 mm Hg or lower. If you have diabetes, high blood pressure goal of less than 130/80 mm Hg.

Medications to control blood sugar. If you also have diabetes, it becomes more important to control blood sugar (glucose). Talk to your doctor about target blood sugar levels and the steps to take to achieve these goals.

Medications to prevent blood clots. Because peripheral arterial disease is related to reduced blood flow to the limbs, it is important to reduce the risk of blood clots. A blood clot can completely block blood vessels narrow place and cause tissue death. Your doctor may prescribe daily aspirin therapy or other medication to help prevent blood clots, such as clopidogrel (Plavix).

Symptom relievers. The cilostazol (Pletal) increase blood flow to the limbs, both by preventing blood clots and blood vessels expand. It especially helps the symptoms of claudication, leg pain, for people with peripheral arterial disease. Common side effects of this medicine include headache and diarrhea. Replacement for cilostazol is pentoxifylline (Trental), however, are often less effective. But rare side effects with this drug.

Angioplasty and surgery

In some cases, angioplasty or surgery may be needed to treat peripheral arterial disease, claudication caused constant:

Angioplasty. In this section, a small hollow tube (catheter) is threaded through blood vessels to the affected artery. There, a small ball on top of the tube will rise to reopen the artery and flatten the blockage in the artery wall, while at the same time extending the artery open to increase blood flow. Your doctor may insert a stent into a grid called the artery to keep it open. This is the same procedure used to open heart arteries.

Surgery. Your doctor may need to create a loop using a vessel from another part of the body or a blood vessel made of synthetic fabrics. This technique allows blood to flow around - or bypass the blocked artery narrowing.

Thrombolytic Therapy. If a blood clot blocks an artery, your doctor may inject a drug dissolves blood clots in the arteries of the clot to break it.

Monitoring exercise program

In addition to medication or surgery, your doctor may prescribe an exercise program supervised training to increase the distance you can walk. Regular exercise improves symptoms of PAD using a number of methods, including helping the body use oxygen more efficiently.

Lifestyle and home remedies

Many people can manage the symptoms of peripheral arterial disease and prevent progression of the disease through lifestyle changes, especially to quit smoking. To stabilize or improve PAD:

Stop smoking. Smoking contributes to tighten and damage the arteries and is an important risk factor for the development and worsening of PAD. If you smoke, quitting smoking is the most important thing you can do to reduce the risk of complications.

Exercise. This is an important component. Success in the treatment of PAD is often measured by how far you can walk without pain. Appropriate exercise helps muscles use oxygen more efficiently. Your doctor can help develop a plan appropriate exercise. Can refer you perform recovery program claudication.

Eat a healthy diet. A diet for heart health in saturated fat can help control blood pressure and cholesterol levels, contributing to atherosclerosis. Diets rich in nutrients - like vitamin A, B-6, C and E, folate, fiber; and omega 3 fatty acids - associated with a lower incidence of peripheral arterial disease.

Some cold pills. Cold Remedies containing pseudoephedrine (Advil Cold and Sinus, Aleve, Claritin-D, Sudafed, Tylenol Cold, Zyrtec-D, others) constrict blood vessels and can increase the symptoms of PAD.

Careful foot care

In addition to the above suggestions, take good care of feet. People with peripheral artery disease, particularly those who also have diabetes, are at risk for ulcers on the lower legs and feet healed poorly. Poor blood circulation can delay or prevent appropriate treatment and increase the risk of infection. Follow these tips to care for feet:

Wash feet daily and dry thoroughly moisturize regularly to prevent cracks can lead to infection. Do not moisturize between the toes, however, as this can encourage fungal growth.

Wear properly fitted shoes and thick socks dry.

Promptly treat any fungal infections of the feet.

Be careful when trimming nails.

Avoid going barefoot.

There is a doctor (podiatrist) treat bunions, corn or callus.

Go see a doctor when the first signs of pain or skin damage.

Alternative medicine

The blood-thinning effects of ginkgo may allow those with claudication constantly walking long distances with less pain. However, this herb can cause bleeding when taking high doses, and it can be dangerous if combined with antiplatelet drugs, including aspirin, are often prescribed with PAD. Talk to your doctor before considering using ginkgo to reduce foot pain.

Coping and support

Peripheral artery disease can be very frustrating, especially when the exercise will be painful. Do not be discouraged, however. As exercise continues, will increase the distance you can walk without pain.

May find useful to enhance bedside by 10-15 cm, because retention is often below the level of the heart to reduce pain.

Another tip to reduce symptoms is to avoid cold temperatures as much as possible. If you can not avoid the cold, wear warm clothing.

Some people find it helpful to talk with others who are in similar situations. Support groups can provide encouragement, advice and understanding. Heart Association provides an online forum for the PAD. can also ask your doctor if he knows of any support groups in the area.

Prevention

The best way to prevent claudication is to maintain a healthy lifestyle. This means that:

Quit smoking if you are a smoker.

If you have diabetes, keep your blood sugar in good control.

Exercise regularly. Goal in 30 minutes at least three times a week after receiving doctor OK.

Lower cholesterol and blood pressure levels, if necessary.

Eating foods high in saturated fat.

Maintain a healthy weight.