Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is a growing public health issue affecting 202 million people worldwide.1 It is an obstruction of the blood flow in the peripheral arteries, most commonly to the lower limbs and feet.
PAD can result from the slow accumulation of plaque over time (a process known as atherosclerosis) or the sudden formation of a blood clot which leads to arterial narrowing or blockage of a vessel.1

1. Fowlkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, Norman PE, Sampson UKA, Williams LJ, Mensah GA, Criqui MH. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013; 381: 1329-1340.
Risk factors:

  • Age
  • Smoking
  • Diabetes
  • Poor diet
  • Genetics
  • High blood pressure
  • High LDL (“bad” cholesterol) and low HDL (“good” cholesterol)
  • Sedentary lifestyle

Symptoms: Not always noticeable, especially in early stages.

  • Burning or aching in feet and toes.
  • Hip, leg or calf pain or cramp (called “claudication”) when walking
  • Numbness, weakness, heaviness.
  • Coldness in your lower leg or foot.
  • Loss of hair in the leg area
  • Change in the color of your legs

Critical Limb Ischemia (CLI) is the extreme state of this condition. It is a severe blockage in the arteries of the legs or feet, which significantly reduces blood flow. If this condition is left untreated, patients may face the risk of limb amputation.

Diagnosis: If PAD is suspected, your doctor will usually recommend the following tests:

  • Physical Exam
  • Ankle-Brachial Index (ABI): ABI test compares the blood pressure in your ankle with the blood pressure in your arm.
  • Ultrasound: Special ultrasound imaging techniques such as Doppler ultrasound or duplex scanning can help evaluate blood flow through your blood vessels and identify blocked or narrowed arteries.
  • Angiogram: an X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in an artery or a vein
  • Blood Tests

Treatment: Options are available for treating PAD, surgery and non-surgical treatments include:

  • Vascular Surgery – implantation of a new vessel (either a natural vein portion or synthetic tube) that allows blood to bypass the obstruction.
  • Amputation – removal of a limb, or part of a limb, that is in a condition of threatening the patient’s life or is causing suffering and pain.
  • Stenting – a small tubular mesh that is inserted into the diseased coronary artery to reestablish the blood flow. The scaffold remains inside the artery forever.
  • Atherectomy – minimally-invasive method of removing plaque to re-open arteries while cutting and removing plaque.
  • Balloon angioplasty or PTA (Percutaneous Transluminal Angioplasty) is a minimally-invasive method of increasing lumen diameter that has become the standard of care for most peripheral lesions. Angioplasty balloons have remained a consistent and necessary part of PTA procedures; even with alternatives to simple balloon dilatation available, such as atherectomy and laser devices. Balloon dilatation is an expected component of treatment often used in conjunction with other approaches. Furthermore, outcomes with standard balloon angioplasty remain the most accepted comparator for judging the success of peripheral vascular technologies.

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