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  Home > News Press Release > ASK THE DOCTOR QUESTION AND ANSWER - PERIPHERAL ARTERIAL DISEASE (PAD)
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News Press Release

ASK THE DOCTOR QUESTION AND ANSWER - PERIPHERAL ARTERIAL DISEASE (PAD)
Dated of posted : 2011-01-03

 

Question:
What is Peripheral Arterial Disease?
 
Answer:
Peripheral arterial disease PAD (peripheral vascular disease PVD) refers to diseases of blood vessels outside the heart and brain. It's often a narrowing of blood vessels that carry blood throughout the body (the brain, legs, arms, intestines and kidneys). There are two types of these circulation disorders:
              Functional peripheral arterial diseases don't have an obvious cause. They don't involve defects in blood vessels' structure.
               They're usually short-term effects related to "spasm" that may come and go. Raynaud's disease is an example.
               It can be triggered by cold temperatures, emotional stress, working with vibrating machinery or smoking.
              Organic peripheral arterial diseases are caused by structural changes in the blood vessels, such as inflammation and
                tissue damage. Artherosclerosis is an example. It's caused by fatty buildups in arteries that block normal blood flow.
 
These blockages restrict blood circulation, mainly in arteries leading to the brain, kidneys, intestines, arms, legs and feet. In its early stages a common symptom is cramping or fatigue in the legs and buttocks during activity. Such cramping is relieved when the person rests or stands still. This is called "intermittent claudication." People with PAD also have fatty buildup in the arteries of the heart and brain. Because of this association, most people with PAD have a higher risk of death from heart attack and stroke.
 
Peripheral arterial disease is a very common condition in the United States. It is also very common in The Bahamas.
              It occurs mostly in people older than 50 years. Peripheral arterial disease is a leading cause of disability among people
               older than 50 years and in those with diabetes.
              About 10 million people in the United States have peripheral arterial disease, which translates to about 5% of people
               older than 50 years. The amount of persons in the Bahamas is unknown but because there is a high percent of people
               with diabetes and hypertension there is likely lots of persons with PAD.
              The number of people with the condition is expected to grow as the population ages.
              Men are more likely than women to have peripheral vascular disease.
              Peripheral vascular disease is more common in smokers, and the combination of diabetes and smoking almost always
               results in more severe disease.
 
Symptoms of severe PAD include:
              Leg pain that doesn't go away when you stop exercising.
              Foot or toe wounds that won't heal or heal very slowly.
              Gangrene
              Coolness or coldness of your lower leg or foot particularly compared to the other leg or to the rest of your body.
 
About half of people with peripheral vascular disease do not have symptoms. Of those who do, another half do not tell their health care providers.
              Many people seem to think that this is a normal part of aging, and that nothing can be done or that the only
               alternative is surgery.  Today, however, surgery is only one of several effective treatments available
               for peripheral vascular disease.
              Treating peripheral arterial disease medically is the best way to prevent worsening of the condition or developing
               complications. This is especially true for patients with hypertension or diabetes, those with high fats or lipids
               in the blood, and those who smoke.
 
Diagnosing PAD
PAD diagnosis begins with a physical examination. Your doctor will check for weak pulses in the legs or other affected body parts. For the legs, the ankle-brachial index (ABI) test is usually done. It’s a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing. This inexpensive test takes only a few minutes and can be performed by your healthcare professional as part of a routine exam. Normally, the ankle pressure is at least 90 percent of the arm pressure, but with severe narrowing it may be less than 50 percent.  For other areas of the body one may need to have an ultrasound or CT scan done to detect blood vessel abnormalities. Your doctor usually decides this.
 
Most people with PAD can be treated with lifestyle changes, medications or both. The best way to prevent peripheral vascular disease is to reduce your risk factors. You cannot do anything about some of the risk factors, such as age and family history.
 
Other risk factors are under your control:
              Do not smoke.
              Eat nutritious, low-fat foods; avoid foods high in cholesterol.
              Maintain a healthy weight.
              Engage in moderately strenuous physical activity for at least 30 minutes a day. At least walk briskly for 20-30 minutes daily.
              Control high blood pressure. 
              Lower high cholesterol (especially LDL cholesterol or the “bad cholesterol”) and high triglyceride levels, and raise
               HDL or “the good cholesterol.” If exercise fails to lower your cholesterol, certain medications can be taken to decrease
               the bad cholesterol.
              If you have diabetes, control your blood sugar level and take extra good care of your feet. Ask your doctor what your
               HbA1C is. It is a measure of how well your blood sugar is controlled; it should be less than 7.0. If it is
               greater than 8.0, it is not controlled, and your risk of blood vessel complications (eyes, heart, brain, kidneys, legs)
               increases.
 
PAD may require drug treatment, too. These medicines may
              help improve walking distance (cilostazol).
              prevent blood particles from becoming sticky (antiplatelet drugs like aspirin).
              lower blood cholesterol (statins).
 
In a minority of patients, lifestyle modifications alone are not sufficient. In these cases, surgery or angioplasty may be necessary.  Angioplasty is a non-surgical procedure that can be used to dilate (widen) narrowed or blocked peripheral arteries. A thin tube called a catheter with a deflated balloon on its tip is passed into the narrowed artery segment. The balloon is then inflated, compressing the plaque and dilating the narrowed artery so that blood can flow more easily. Then the balloon is deflated and the catheter is withdrawn.
 
In some instances a stent — a cylindrical, wire mesh tube — can be placed in the narrowed artery with a catheter to help keep it open.
 
If the narrowing involves a long portion of an artery, surgery may be necessary. A vein from another part of the body or a synthetic blood vessel is used. It's attached above and below the blocked area to detour or bypass blood around the blocked spot.
 
PAD often goes undiagnosed. This can be dangerous because PAD can lead to painful symptoms, loss of a leg and/or increased risk of heart attacks and strokes.
 
Because people with PAD have this increased risk for heart attack and stroke, the American Heart Association and other vascular disease advocates encourage people at risk to discuss PAD with their healthcare professional to ensure early diagnosis and treatment. Develop a heart-healthy lifestyle and cooperate with your healthcare professionals.
 
Dr. Delton Farquharson
General and Vascular Surgeon
Bahamas Surgical Associates Center
Tel: (242) 328-5420
 
 

 



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