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Peripheral Artery Disease

Peripheral Artery Disease

Peripheral Arterial Disease is caused due to blockage of arteries supplying Blood to the lower limbs (legs). These Blood vessels are affected by Atherosclerosis causing formation of plaques in the arteries, which decrease the lumen of the artery and its ability to supply blood to areas farther away. Peripheral arterial Disease is a complication of Diabetes and contribute to the development and aggravation of Diabetic Foot.

Intermittent Claudication- Symptoms of Peripheral Arterial Disease.

Even at rest Muscles require blood to provide them with Oxygen and nutrients for their growth and repair. But as a person walks the requirements of blood carrying Oxygen and nutrients to the muscles of legs increase. If the lumen of the arteries is decreased and the Arteries cannot expand in size to allow more Blood to flow, the muscles cannot contract efficiently and get tired... causing symptoms of 'Claudication' which include

Sense of tiredness or fatigue in muscles

cramp like sensation in muscles of feet

These symptoms are transient they begin after walking some distance and disappear after resting for a short while (as muscles replenish their suplies). This is called intermittent Claudication and is the main symptom of Peripheral Arterial Disease (PAD). The Walking Distance after which these symptoms occur is called 'Claudication Distance'. But these symptoms occur only very late in the course of disease. Our body can adapt to a great extent by growing new blood vessels and making detours around the blocked vessels or increasing supply through other existing vessels. But as the process of Atherosclerosis continues and affects most of the blood vessels, Peripheral Arterial Disease progresses and leads to insufficient blood suply even at rest.

Asymptomatic Peripheral Arterial Disease

Some Studies conducted in the United States have shown that upto 50% of persons with Diabetes have Peripheral arterial disease but without any symptoms of Claudication.

Implications of Peripheral Arterial Disease

The most important implication of this is the fact that Peripheral arterial disease is caused due to Atherosclerosis which is a generalized process affecting the Arteries of the whole Body - not only legs, the same process of plaque formation and blockage is going on in vessels supplying blood to Heart, Brain, Intestines and Kidneys etc..but the extent of the damage could be different. Such people would be more prone to Drastic complications like Heart Attack, Stroke etc.

How to Detect and Diagnose peripheral Arterial Disease

Peripheral Arterial Disease can fortunately be Diagnosed even at an early stage and be instrumental in preventing impending complications not only in the Feet but of Heart ( Heart Attack, Angina) Stroke , Renal failure ... as well. Ankle Brachial Index Measurement with a Doppler is a simple test which hardly takes 10-15 minutes to Diagnose the presence of Peripheral Arterial Disease. Systolic Blood Pressure is measured very accurately with the help of a portable Doppler machine in the Arms and Legs, An index is calculated by dividing the highest pressure values in the feet ( ankle) by those of the arms. Normal values are between 0.9 - 1.2, if the value is below 0.9 this indicates the presence of Peripheral Arterial disease  of varying intensity depending on the Ankle Brachial Index value, values exceeding 1.2 indicate hardening of blood vessels due to calcification , which also is harmful and may predispose the person to various complications mentioned above.

Who may be affected by Peripheral Arterial Disease

Diabetics, Smokers, people with High Blood Pressure and Cholesterol are more likely to suffer from Peripheral Arterial Disease.

Treatment of PAD

At initial stages some medicines may be helpful in dilating the blood vessels and increasing Blood flow to legs. Paradoxically - walking may be very helpful for patients with Peripheral Artery Disease, as working muscles need more blood, vasodilating substances are produced by the muscles which widen the blood vessels and allow more blood to flow. When medicines and exercise  are not helpful , stenting of the blood vessels may be required, Stents are spring like metallic devices which are placed inside the arteries and the expand and  increase the lumen of the artery. If this also fails grafting of Blood vessels taken from other places in the body like the arms may be the only solution. required.


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