Peripheral Arterial Disease (PAD) is caused by diminished blood flow to your legs. It is caused by diseased arteries, that could cause narrowing or blocking of the blood flow. The most common cause of occlusion of the arteries is buildup of fatty deposits (Atherosclerosis).
The major complaint of patients with peripheral artery disease is called Intermittent Claudication. Claudication is pain in your calf muscles after you have walked a certain distance, usually a few blocks. It goes away after you rest for a few minutes.
The pain on claudication is caused because your narrowed artery does not allow enough blood flow to your calf muscle when you are doing exercise. When you rest, the scarce flow is enough for the resting muscle, and the pain goes away, but the blood flow needs to increase for the working muscle and the narrowed artery might not let enough blood go through. This is the equivalent of angina, for your heart muscle.
Cardiovascular disease as we have stated in previous columns is the disease that results from diseased arteries due to arteriosclerosis. It is a systemic condition, and affects arteries of your brain (giving symptoms of Transient Ischemic Attack [TIA]) that we discussed in a previous column; arteries of your heart (Angina); arteries of the kidneys (giving symptoms of kidney shutdown, or renal failure), and arteries of your legs (Intermittent Claudication).
The risk factors for PAD and Cardiovascular Disease are high blood pressure, high cholesterol, Diabetes, cigarette smoking, and old age.
Smoking is the worst risk factor for Intermittent Claudication, and is more commonly seen in men than women.
Arteriosclerosis obliterans is a condition that causes atherosclerosis of the lower abdominal aorta, the arteries of the groin area and the arteries that supply the lower legs. It is more common in persons older than 50 years old, but up to 19 percent present in patients between 30 and 49. Men are affected more than women 5:1 to 10:1.
If you have symptoms of intermittent claudication, you need to visit your doctor. He will check the pulses on your legs and he might order a test called Arterial Brachial Index test (ABI test).
This test compares blood pressure in your arms and your legs (above the ankle) using an ultrasound probe. Normally the blood pressure in the legs should be the same or slightly increased.
A drop of the blood pressure in the legs might indicate narrowing of the artery. Normally the ratio of blood pressure on the ankles compared to the arms should be between 0.9 to 1.2.
PAD and claudication are often treated with diet and exercise. If you have diabetes or high cholesterol, they need to be controlled up to the levels recommended for cardiovascular diseases.
If you smoke, you need to quit smoking. Your blood pressure also should be at the levels recommended, less than 130/80.
A walking program is very helpful. You should walk from three to five times per week, from 45 to 30 minutes each outing. Walk until the pain is too uncomfortable to continue.
Stop and rest until the pain goes away. Then start walking again. If you did not exercise before, you have to start slowly, and then gradually increase the time you spend exercising. You might see improvement within two months.
But if these therapies do not work, you might need more invasive treatments, like angioplasty or surgery.
Once again, it is always better to prevent the narrowing of your arteries by CONTROLLING YOUR RISK FACTORS!
