Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) is a common circulatory problem where the blood vessels outside of the heart and brain (typically in the legs) become narrowed or blocked due to a build-up of atherosclerotic plaque. This leads to reduced blood flow, which can cause pain, mobility issues, and in severe cases, tissue damage or gangrene. The lower extremities are the most commonly involved vasculature in the PAD category.

🔹 Risk Factors

• Atherosclerosis (the most common cause)
• Smoking (strongest modifiable risk factor)
• Diabetes mellitus
• Hypertension
• Hyperlipidemia
• Age > 50, especially for those with multiple risk factors
• Family history of PAD or cardiovascular disease
• Sedentary lifestyle
• Chronic kidney disease

🔸 Symptoms of PAD

Symptoms can vary from mild to severe and often depend on the location and extent of the blockage. Key signs include:

1. Intermittent claudication:
• Pain, cramping, or fatigue in the legs (usually in the calf or thigh) during physical activity, especially walking.
• Pain is relieved by rest but recurs with exertion.
2. Rest pain (in severe cases):
• Pain in the feet or toes while at rest, often worsened when lying down and relieved by hanging the legs over the side of the bed.
3. Non-healing wounds or ulcers on the feet, ankles, or legs.
4. Cold or pale legs.
5. Hair loss on the legs or feet.
6. Weak or absent pulses in the legs or feet.
7. Shiny skin on the legs.

🔹 Diagnosis

1. Ankle-Brachial Index (ABI):
• A simple test comparing blood pressure in the ankle to the arm. An ABI of <0.90 is diagnostic of PAD.
2. Ultrasound/Doppler:
• Used to assess blood flow and detect areas of narrowing or blockages.
3. CT Angiography (CTA) or MR Angiography (MRA):
• For detailed visualization of blood vessels to identify blockages or stenosis.
4. Angiography:
• Invasive procedure using contrast dye to evaluate arterial blockages, typically used when planning for interventions like surgery or stenting.

🔸 Treatment Options

1. Lifestyle Modifications:

• Smoking cessation (most important step for preventing further progression).
• Exercise therapy: Supervised walking programs improve walking distance and reduce symptoms.
• Dietary changes: Focus on a heart-healthy diet to manage cholesterol and blood sugar.

2. Medications:

• Antiplatelet agents (e.g., aspirin, clopidogrel) to reduce the risk of blood clot formation.
• Statins to manage cholesterol and reduce plaque buildup.
• ACE inhibitors or ARBs to control blood pressure and improve blood flow.
• Cilostazol: A vasodilator that may improve symptoms of claudication.
• Semaglutide [SGLT Inhibitor]: New data from STRIDE trial shows improvement in walking distance and reduces the number of interventions.
• Xarelto 2.5 mg orally twice a day improves survival and reduces the risk of lower extremity amputations

3. Endovascular Procedures:

• Angioplasty and stenting: Minimally invasive procedure where a balloon is used to open narrowed arteries, and a stent may be placed to keep the artery open.
• Atherectomy: Removal of plaque buildup from the artery.
• Stenting: Placing a metal scaffold to improve the vessel lumen to achieve significant improvement in blood flow.

4. Surgical Interventions:

• Bypass surgery: A graft is used to reroute blood flow around a blocked artery.
• Endarterectomy: Surgical removal of plaque from the artery wall.

5. Amputation (in severe, non-recoverable cases):

• Required when the limb becomes nonviable due to infection or severe ischemia.

🔹 Prevention

• Control risk factors (smoking, diabetes, hypertension, cholesterol).
• Regular screening for people over 50, especially those with risk factors.
• Daily foot care: Check for wounds or signs of infection in people with diabetes or PAD.
• Regular physical activity: Walking and leg exercises improve circulation and reduce PAD symptoms.