Peripheral arterial disease (“PAD,” “peripheral vascular disease,” or “bad circulation”) is a medical condition caused by blockages in the arteries (blood vessels that carry blood from the heart to the rest of the body). The most common cause of this problem is atherosclerosis, the medical term for cholesterol build-up in the blood vessels. This build-up causes blockages that reduce the amount of blood and oxygen delivered to the muscles in the extremities. This problem is very similar to the build-up of cholesterol in the coronary arteries (which supply blood to heart), which can cause chest pain (angina) or heart attacks.
Risk factors: The risk factors for PAD are the same as those for heart attack or stroke. They include cigarette smoking, diabetes, high blood pressure, high cholesterol, and older age (greater than 70 years).
Symptoms: The most common symptom in PAD is called “intermittent claudication,” or leg discomfort brought on by walking. Claudication is a feeling of pain, aching, cramping, tiredness, or burning in the muscles of the legs that typically begins after walking or climbing stairs and goes away after resting for a few minutes. The discomfort can be felt in the calves, thighs, or buttocks. Patients with severe forms of PAD can have discomfort after walking very short distances or may have pain even while at rest. In severe cases, sores (ulcers) or blackened skin (gangrene) can develop on the feet or toes. Less common complaints include erectile dysfunction or pain in the arms. In many cases, patients may have no symptoms at all.
Diagnosis: PAD can be diagnosed by careful medical history and a physical examination focused on the heart and blood vessels. Your doctor may also recommend a special test called an ankle-brachial index (ABI). This simple test involves measuring and comparing the blood pressures in both arms and both feet. Depending on the results, you may need additional tests to confirm the severity and location of the blockages. These may include an ultrasound test, CT scan (computed tomogram), or MRA (magnetic resonance angiogram), all non-invasive tests of the blood vessels. Also, pressures may be measured at several locations along the leg. Finally, your doctor may recommend an angiogram, a procedure where dye is injected directly into the blood vessel while taking x-rays to look for blockages, but this is usually reserved for use along with a planned treatment.
Treatment: There are several treatment options for individuals with symptoms due to PAD. The initial treatment plan includes quitting smoking, starting an exercise program, and possibly taking medications that can improve blood flow to your legs. For some patients with severe PAD, a doctor may recommend a special procedure to restore blood flow, either by placing a stent or by doing bypass surgery. A vascular specialist can help you decide which treatment is most appropriate for you.
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