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Peripheral Artery Disease

By Angela Young

Peripheral vascular disease (PVD) includes all diseases that are all caused by a large artery obstruction in the arms or legs. Also commonly known as peripheral artery disease (PAD) and peripheral artery occlusive disease (PAOD), PVD can be a result of an embolism, a thrombus formation, atherosclerosis or inflammatory processes leading to stenosis.

In the 55 and over age group the prevalence of PVD is as high as 10% to 25% with 70% to 80% of those people having no symptoms of the disease. Even with the prevalence and implications of cardiovascular risk only approximately 25% of patients actually undergo treatment. The risk and incidence of PVD both increase with age and it is essential to make a proper diagnosis because those suffering from this disease have a four to five times risk to have a stroke or heart attack.

Peripheral Artery Disease Symptoms

Some early symptoms of PVD include numbness, pain, weakness or cramping in the muscles as a result of decreased blood flow. Additionally, sores, ulcers and wounds will either be slow to heal or not heal at all.

Someone suffering from PVT would likely have a discernable change in color or temperature of one limb when compared to the other. They will also have lesser nail and hair growth on both the affected limb and digits.

Peripheral Artery Disease Causes

There are many causes of PVD. The most easily preventable of these is smoking. Cigarette smoking creates change in the lining of the blood vessels which is a precursor to developing atherosclerosis.

People suffering from diabetes mellitus have been shown to have between two and four times higher risk of complications. The correlation here is so strong that a diabetic that smokes runs a 30% amputation risk with 5 years.

High total cholesterol levels as well as high LDL cholesterol levels have also been associated with an acceleration of the disease. Hypertension also increases the risk of developing PVD, as well as if the patient is male, African American, over 50 years old, or has a personal history of heart attack, stroke or vascular disease.

Peripheral Artery Disease Diagnosis

The first test administered upon suspicion of PVD is the ankle brachial pressure index, which tracks the fall in blood pressure in the leg’s arteries.

If these results come back abnormal, the next step is to perform a Doppler ultrasound exam to identify the severity of the atherosclerosis at the femoral artery.

Angioplasty is another imaging option, inserting a catheter into the femoral artery and guiding it to the artery under observation and then injecting a radiodense contrast agent to take an X-ray.

Peripheral Artery Disease Treatment

The therapy for PVD varies based on the severity of the disease. Some conservative measures for treatment in less severe cases include smoking cessation and regular exercise. Taking aspirin is also known to slow the effects of the disease as well as address some other cardiovascular risks the patient may have. Treadmill exercise has been correlated with very positive outcomes in the treatment of PVD.

In more severe cases, angioplasty can be performed on individual lesions in major arteries like the femoral artery. In some cases bypass grafting is used avoid a stenosed area of the artery. In this case, the saphenous vein is generally used although Gore-Tex can also be used veins are of lesser quality.

Plaque excision is another effective therapy, and even more rarely sympathectomy, or removing the nerves responsible for arterial contraction, is used. In severe cases where gangrene is present, amputation is the final option.

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