10 Things You Need To Know About Peripheral Arterial Disease
Underestimated and often neglected, Peripheral Arterial Disease (PAD) has been called a ‘Cinderella’ disease, yet it affects more than 200 million people worldwide, with almost 20% of people aged over 60, and up to 5% of those under 50, having some degree of the disease. In most cases there are no symptoms. Early detection is key to lessen the severe impact that Peripheral Arterial Disease can have on your physical and mental wellbeing.
Just as hard water builds up in your home water pipes, reducing their flow, so your arteries can become narrowed or obstructed through build-up of fatty deposits, and later, blood clots. In Peripheral Arterial Disease (PAD), the arteries in the legs are affected, depriving your limbs of blood and its life-sustaining oxygen and nutrients.
Most commonly, PAD has no symptoms and so is underdiagnosed, perhaps because we may not walk far or fast enough to induce symptoms – or because smaller arteries may have enlarged to help carry blood around the blockage.
An aching or burning cramp-like pain in the legs, induced by exercise and relieved by rest, is the most common symptom and is known as intermittent claudication. Consult your doctor if you have these signs of poor circulation.
When blood supply is seriously reduced in the leg and foot, ulcers and gangrene can develop. If the limb suddenly becomes perishingly cold, persistently painful, pulseless and even paralysed, it’s an acute emergency. In the worst case scenario, amputation is the only answer.
At least half of all cases of PAD are caused by smoking, with heavy smokers having six times the chance of developing the disease. People with diabetes have a similarly increased risk of developing PAD; diabetic complications such as poor circulation and altered feeling in the feet can make ulcers even more likely, and increase pain levels.
Just as your eyes are ‘the windows to your soul’, your legs can shine a light on your heart health. Damage to vessels in your legs could be a sign that arteries elsewhere in the body are in trouble, being also occluded or furred up. Heart attacks and strokes are both diseases of the blood vessels and they are up to three times more likely in people with PAD.
The National Institute for Health and Care Excellence propose that all people with lifestyle-limiting PAD should be encouraged to exercise to the point of maximal pain, and attend a weekly exercise programme involving two hours of supervised exercise for three months, to improve their walking distance. Where this is not easy or available, neuromuscular electrical stimulation may be an effective adjunct*.
High blood cholesterol and high blood pressure both increase the risk of PAD: medications to reduce these can help, as can lifestyle changes. Drugs to prevent blood clots and to open up the arteries are also often prescribed.
Persistent poor circulation can be restored through surgery. Blockages can be bypassed using a vessel from the chest, arm or leg; occlusions are opened using tiny balloons and stents (wire mesh scaffolds).
A type of stem cell, taken from a person’s own fat and grown in the laboratory, can release chemicals that trigger new blood vessel growth. Scientists are trying to translate this into a novel treatment for PAD.
PAD can mimic other common conditions of the leg and foot such as hip arthritis, gout, nerve compression and deep vein thrombosis. For correct diagnosis, the pattern and position of your pain and the presence or absence of pulses are key; blood pressures in your arm and ankle and blood flow measurements are also taken.
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