Gradual accumulation of fatty material (atheroma) within the wall of the artery causes hardening and narrowing of the arteries, a condition known as atherosclerosis. This results in less nutrition to the body parts that are supplied by the affected arteries. The manifestation depends on which arteries are affected. For example, when the arteries supplying blood to the heart are affected, angina or heart attack may result. When the arteries supplying blood to the legs are affected, peripheral artery disease ensues. Interested readers can find more information about them at Pulse Vascular.
How common is the disease?
It becomes more common as one gets older, and by 70 years of age, about 20 percent of the population has peripheral artery disease. Interestingly, nearly 75% of those with the disease do not experience symptoms in the early stages. Diagnosis is critical, as people with peripheral artery disease also have a six-to-seven times higher risk of heart attack or stroke.
What are the symptoms of peripheral artery disease?
Pain in the calf muscles, thighs or buttocks on walking or exercise is the predominant symptom. Slowing down allows the pain to wear off. As the disease progresses the pain may become continuous. The skin of the leg becomes shiny and may develop change in colour. Sometimes, ulcers may develop in the feet or toes. Gangrene of the leg may develop with further progression of the disease.
What causes peripheral artery disease?
Smokers have 20 times higher risk of peripheral artery disease than non-smokers. High fat diet, lack of physical activity, high blood pressure and diabetes hasten the development of the disease.
How is the condition diagnosed?
The typical history together with a clinical examination is helpful to make a diagnosis. The ratio of blood pressure measured at ankle to that at arm, termed as Ankle Brachial Index (ABI) is very useful as a screening test to identify those with peripheral artery disease. Further testing such as doppler ultrasound scan and angiogram of the leg arteries may be required to find out where the narrowing of the artery is and how severe it is.
What treatments are available?
Smoking should be given up immediately. Low fat diet, losing weight and regular physical activity are encouraged. Those with high blood pressure and diabetes should ensure that their illness is well controlled. Care of the feet is an important aspect of management. Feet should be inspected regularly for any skin changes, washed and properly dried everyday and well-fitting shoes should be worn. Medicines are generally not of much use in reducing symptoms, although cilostazol and pentoxifylline are thought to improve walking distance. Aspirin and cholesterol-lowering drugs are usually given.
If symptoms are interfering with normal activities, intervention should be considered. The narrowed artery could be opened up with an inflatable balloon passed down through an artery in the groin under local anaesthesia, the procedure is known as peripheral angioplasty. A cylindrical wire mesh tube, called stent is placed in the narrowed segment of the artery to keep the diseased artery open. The procedure is painless and needs only a couple of days of hospital stay.
In some cases surgical operation to bypass the blockage may be the only option. This is a major operation under general anaesthetic requiring longer stay in the hospital. The graft used for bypass may be an artificial one or one of the patient’s veins may be used for this purpose. Amputation of the leg is the last resort and seldom becomes necessary if medical advice is followed and proper precaution is taken from the beginning