Peripheral arterial disease
If you have not heard of peripheral artery disease, or PAD, you are not alone. Health organizations have made headway in raising awareness that heart disease is the No. 1 cause of death worldwide. PAD — despite being part of cardiovascular disease — is not as well-known.
There is limited evidence on the prevalence of PAD; however, about 15% to 20% of the UK population aged 55 to 75 years have evidence of lower extremity PAD on objective testing. But it also affects younger people who have additional risk factors, such as diabetes, smoking, obesity and high blood pressure. Peripheral artery disease involves cholesterol buildup in arteries or blood vessels of the legs.
Peripheral artery disease involves the lower limbs, but it has its basis in atherosclerosis — a vascular disease where cholesterol plaque builds up in artery walls. This narrows the arteries, restricting circulation and possibly resulting in plaque breaking loose and forming a blood clot. Most patients with PAD will have vascular disease in more than one defined area, increasing the chances of serious complications.
Symptoms
As arteries leading to the legs develop significant cholesterol buildup that restricts blood flow, symptoms of PAD may appear. Some symptoms, such as lower leg cramps when walking, may be mild, severe or somewhere in between, but worsen as the disease progresses. Other symptoms may involve changes in the legs, such as coldness in one leg but not the other; shiny skin on the legs; slow growth of toenails and leg hair; sores on toes, feet or legs that do not heal; and no pulse or a weak pulse in legs. People may think some of these symptoms are just signs of aging, so it is important to speak to your gp if you have these symptoms.
Diagnosis and treatment
Diagnosing peripheral artery disease starts by checking circulation to the feet.
Doctors can ask patients what sort of activities they can comfortably do to identify problems. And blood tests to check for diabetes and measure cholesterol also should be up to date.
Diagnostic tests, such as the ankle-brachial index test that compares blood pressure in a patient's ankle to that in their arm before and after exercise, can identify circulation issues in the legs. This test is a noninvasive way to identify the presence and severity of peripheral artery disease.
This test can be done by your family doctor.
Angiograms use imaging technologies to home in on blockages and can be done with CTs or MRI. Catheter angiograms allow for treatment to open the arteries at the same time. When initiated early enough, revascularization in lower limbs restores blood flow and prevents the need for amputation. Losing mobility can affect a person's ability to work, making it more difficult to stay active and independent.
Apart from cholesterol medications, such as statins or the role of aspirin, there are other medications to help reduce that future risk.
Due to late diagnosis approximately one-third of patients will die within five years of a peripheral artery disease diagnosis, and 20% will experience a heart attack or stroke. So it is really important to see a doctor when you have any of the earlier prescribed symptoms.
