Peripheral Artery Disease Treatment in Delhi, India

Peripheral artery disease (PAD) is a condition characterised by narrowing arteries or blood vessels that reduce blood flow to your limbs (arms and legs). It is a disease of blood vessels (arteries) located away from the heart and brain.

In most cases, a buildup of plaque (fatty deposits or cholesterol) in the arteries of your arms or legs causes this disease. Narrowed arteries decrease the blood supply to your limbs, causing the allied symptoms. You can treat this condition with the help of medications and some lifestyle changes.

Associated Anatomy of Peripheral Artery Disease

Arteries or blood vessels that carry blood away from the heart and brain (arteries of arms and legs).

Alternate Names of Peripheral Artery Disease

arteriosclerosis obliterans

Types of Peripheral Artery Disease

We have two common types of peripheral vascular disease (PVD): functional and organic PVD

Functional PVD

Your blood vessels narrow in response to factors such as brain signals or temperature changes.

Organic PVD

Changes in the structure of blood vessels due to inflammation, tissue damage or plaque deposition.

Peripheral Artery Disease Causes

The primary cause of peripheral artery disease is atherosclerosis, narrowing arteries due to the buildup of cholesterol or other substances inside the artery walls. Some other reasons include:

• Blood clots in arteries
• High cholesterol levels
• Blood vessel inflammation
• Injury to your limbs
• Unusual anatomy of muscles or ligaments
• Radiation exposure

Peripheral Artery Disease Symptoms

Almost half the people with PAD do not experience any symptoms. Pain in the legs is the most common symptom; this pain characteristically subsides with rest and increases with activity (claudication). However, some possible symptoms include:

• Pain in thigh or calf muscles while walking or climbing stairs
• Painful hips
• Weakness in legs
• The lower leg or feet may feel cold
• Hair loss on feet and legs
• Numbness in legs
• Delayed healing of sores, infections or ulcers on legs and feet
• Pale, reddish or bluish skin
• Brittle toenails
• Difficulty in finding the pulse in the leg or feet
• Erectile dysfunction in men

Peripheral Artery Disease Diagnosis

The differential diagnosis of PAD comprises:

• Chronic Exertional Compartment Syndrome
• Chronic Venous Insufficiency
• Degenerative Disk Disease
• Osteoarthritis (hip, knee, ankle)
• Spinal Stenosis (i.e. pseudo claudication)
• Thromboangiitis Obliterans
• Varicose Vein Surgery
• Medial Tibial Stress Syndrome
• Nerve Entrapment
• Nerve Root Compression
• Peripheral Neuropathy (diabetes mellitus, alcohol abuse)
• Deep Venous Thrombosis
• Popliteal Artery Entrapment
• Vasculitis
• Venous Insufficiency

Typical tests for diagnosing PAD

You can diagnose PAD in several ways. If the doctor suspects the disease, the doctor will initially check the patient’s legs.

• Ankle-brachial index (ABI)- It is the most common test conducted for PAD, which compares the blood pressure variation between your ankle and arms.&
• Angiography- Detects the blockage in the artery with the help of X-rays by injecting a contrast agent into the artery.
• Blood tests- To check cholesterol, homocysteine and C-reactive protein levels.
• Doppler and ultrasound (Duplex) imaging.
• Ultrasound scan.
• Computed tomographic angiography (CT).
• Magnetic resonance angiography (MRA).

Stages of Peripheral Artery Disease

Depending on the severity of PAD, there are two classification systems:

Fontaine classification

• Stage I- No symptoms
• Stage II a- Mild claudication (pain on walking or using arms) >200 m of walking distance
• Stage II b- Intermittent (moderate to severe) claudication <200 m of walking distance
• Stage III- Rest pain
• Stage IV- Avascular Necrosis/gangrene

Rutherford classification

• Stage 0- Asymptomatic
• Stage 1- Mild claudication
• Stage 2- Moderate claudication
• Stage 3- Severe claudication
• Stage 4- Rest pain
• Stage 5- Ischemic ulceration, which does not exceed the digits of the foot
• Stage 6- Severe ischemic ulcers or gangrene

Peripheral Artery Disease Treatment

PAD treatment aims at reducing the risk of stroke or heart attack and improving quality of life by alleviating your pain on walking. Possible treatment options include:

• Doctors may prescribe aspirin or similar antiplatelet medicines to prevent PAD and allied atherosclerosis complications
• Medications to reduce your cholesterol and blood pressure
• Surgical treatments such as balloon angioplasty, stents or atherectomy
• Surgery to bypass blocked arteries
• Changes in lifestyle that can stop the worsening of PAD
• Daily exercise
• Following a balanced diet
• Decreasing stress levels
• Quitting smoking tobacco
  
  

Risk Factors of Peripheral Artery Disease

Some risk factors that can lead to peripheral artery disease are:

• High blood pressure and cholesterol
• Family history of heart disease
• Excess levels of homocysteine or C-reactive protein
• Atherosclerosis
• Diabetes
• Smoking
• Obesity
• Increase in age

Peripheral Artery Disease Prevention

The following measures can help you prevent PAD:

• Managing your diabetes, blood pressure, and cholesterol levels
• Getting plenty of physical activity or exercise
• Following a nutritious diet
• Avoiding consuming tobacco
• Maintaining your weight

Possible Complications of Peripheral Artery Disease

The restricted blood flow caused by the narrowing of arteries may result in complications such as critical limb ischemia, which occurs when sores, injury or infection of your feet or legs fail to heal, progress and cause tissue death, occasionally requiring amputation; stroke and heart attack, when atherosclerosis or plaque form in arteries that may even affect arteries supplying blood to your heart and brain, which may result in a heart attack; severe pain that limits mobility; non-healing wounds; life-threatening infections; impotence and death.

Epidemiology of Peripheral Artery Disease

• More than 200 million people suffer from PAD globally.
• Incidence of PAD is relatively uncommon in younger people, and its prevalence is high in the age group of 60 to 80, with >20% cases in >80-year-old individuals.
• It is more likely to affect men than women (ratio of 2:1).
• Smokers have a 2.5 times risk of getting PAD.
• Incidence of PAD is 50% greater in African Americans as compared to Americans.

Expected Prognosis of Peripheral Artery Disease

The prognosis of PAD largely depends on its severity, as measured by an ABI, your overall health and the amount of plaque formed in your body. PAD with large vessels is associated with an increased risk of ischemia, coronary disease or morbidity. Its outcome is much better when PAD is diagnosed in the early stages. With lifestyle changes, you can have an active and healthy life. Although the plaque buildup may aggravate PAD and can sometimes be painful, there are ways to slow it down.

Pathophysiology of Peripheral Artery Disease

PAD is usually caused by the plaque buildup in the arteries of your legs and arms, which are meant to carry oxygen and nutrient-rich blood from the heart to your limbs. The smooth lining of arteries usually prevents blood from clotting and supports steady blood flow. However, in PAD, plaque formed by (fat, cholesterol or other substances) eventually narrows your arteries, restricting the blood flow to organs and tissues, causing further complications.

Natural Progression of Peripheral Artery Disease

PAD is usually associated with plaque deposits in your arteries. Often these deposits are hard on the outside and soft on the inside. The hard surface can crack or tear, causing platelets to gather and form a clot, which further narrows the arteries. The lack of blood supply to tissues and organs can deprive them of oxygen and nourishment, resulting in organ damage or death (gangrene). However, the progression depends on several factors and varies with every person.

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