PERIPHERAL ARTERIAL DISEASE (PAD)

Image Credit: National Heart, Lung and Blood Institute

“Our greatest happiness does not depend on the condition of life in which chance has placed us, but is always the result of a good conscience, good health, occupation, and freedom in all just pursuits.”
– Thomas Jefferson

What Is Peripheral Arterial Disease? 

 The health of our circulatory system is one of the key contributors to our health. Peripheral artery disease (P.A.D.), is a disease that results from an accumulation of plaque in the arteries that carry blood to various parts of the bodies such as the head, organs and extremities. The plaque that accumulates in the arteries is as a result of accumulation of various substances in the blood including fat, cholesterol and calcium. 

With an accumulation of plaque in the arteries, the arteries will eventually harden and narrow. With a restriction in the arteries, there will be a limited flow of oxygen rich blood to critical portions of the body. These include various organs, the heart, the stomach arms and legs. The legs are the areas that are predominantly affected by Peripheral Artery Disease. With a lack of oxygen rich blood to the legs, there is often pain called claudication that is experienced by patients. PAD in the body is an indication of downstream ailments, if left untreated. These include strokes and heart attacks due to the circulatory effects on the brain and on the heart. 

The blocked blood flow to the legs can often cause pain and numbness. The pain is often experienced during instances of activity. Many persons with PAD do have the ability to walk for very long distances without having to stop due to painful legs. Gangrene, or tissue death is one of the side effects of limited blood flow to an area. 

Leg pain in patients is often experienced during activities such as walking or climbing stairs. If you’re experiencing these symptoms with shortness of breath, take the time to have a physical examination of your body, conducted by a specialist. If necessary, you will be referred to a cardiovascular specialist, who will be able to determine the root cause of your condition. 

The link between Smoking and PAD 

Scientific studies have indicated a direct correlation between smoking and PAD. The risk of PAD increases with the habit of smoking. The first step to curing the condition is to ensure that you stop smoking. As a treatable condition, PAD is  a condition that can be managed. With treatment, the risk of complications will be reduced significantly. Via a series of changes in lifestyle, incorporated with the appropriate prescribed medicines and surgical procedures PAD will be easily managed. 

Signs & Symptoms

Most people have no symptoms during the early stages of PAD. Often, by the time symptoms are noticed, the arteries are already significantly blocked.

Common symptoms of PAD include:

  • Leg pain (cramping) that occurs while walking (intermittent claudication)
  • Leg pain (cramping) that occurs while lying down (rest pain)
  • Leg numbness or weakness
  • Cold legs or feet
  • Sores that will not heal on toes, feet or legs
  • A change in leg color
  • Loss of hair on the feet and legs
  • Changes in toenail color and thickness 

If any of these symptoms are present, it is important to discuss them with a foot and ankle surgeon. Left untreated, PAD can lead to debilitating and limb-threatening consequences.

Source: [1]

PAD Risk Factors

Because only half of those with PAD actually experience symptoms, it is important that people with known risk factors be screened or tested for PAD.

The risk factors include:

  • Being over age 50
  • Smoking (currently or previously)
  • Diabetes
  • High blood pressure
  • High cholesterol
  • Personal or family history of PAD, heart disease, heart attack or stroke
  • Sedentary lifestyle (infrequent or no exercise)

Source:[1] 

How Is PAD diagnosed?

There are a series of activities that the Orthopaedic surgeon will incorporate into your PAD diagnosis. This involves an initial comprehensive medical history analysis. Physical examination in the lower extremity will analyze the pulse rate, skin health and foot condition. Based on the appropriate decision matrix, if risk factors for PAD are indicated from the initial examination, the concluding tests will then be performed. These tests include the ankle-brachial index (ABI) test, which compares ankle and arm blood pressures for any distinct differentials. Vascular specialists are incorporated where necessary. 

How Is PAD Treated? 

The treatment of PAD involves a variety of lifestyle changes, the utilization of medication and where necessary the incorporation of surgery to clear the vascular system of blockages. Smoking cessation, the inclusion of exercise and a balanced diet are key to improving your health. Medications that will improve circulation are often administered. These medications will regulate the internal body chemistry in order to control blood pressure, cholesterol and blood glucose levels. Surgical procedures such as endovascular procedures and leg bypass surgeries are often incorporated into the treatment plan. 

The key to good PAD management involves ensuring that the entire system of treatments is optimized according to the patients needs. With all of these changes implemented, the risk of heart attack and stroke and claudication will be reduced. Via an appropriate feedback loop, the patient will have an improvement in their mobility and quality of life. With each set of physical examinations, and the existing signs and symptoms, the various risk factors will be controlled. 

Surgical Treatments of Peripheral Artery Disease

Bypass Grafting

PAD creates restrictions in the blood flow through the circulatory system. Bypass grafting surgery is a procedure that is usually conducted by the orthopaedic surgeon in order to restore blood flow to limbs. Utilizing a blood vessel from another part of the body or a synthetic vessel, a graft will be created. The bypass graft is used to create a bridged flow of blood that goes around the blocked artery. It is a countermeasure that will increase blood flow to an affected limb. The root cause of PAD will have to be addressed by lifestyle changes. 

Angioplasty and Stent Placement

An angioplasty is a procedure that restores blood flow through a narrowed or blocked artery. Catheters are utilized during this procedure in order to expand the artery. The catheter is a thin inflatable tube that will displace the plaque towards the outer edges of the artery wall. Once the restriction is eliminated, the blood flow to the area is restored. The catheter is removed after the angioplasty. In order to sustain the widened artery, a stent is placed to reinforce the procedure. Medicinal coatings on the stent, help to treat and prevent blockages.

Atherectomy

Another treatment that can improve PAD is the removal of the actual plaque from the artery. Utilizing a catheter, a small cutting device is installed into the blocked artery. The plaque is then shaved away. Laser treatment of plaque is also an option. 

PAD & Orthopaedic conditions

As a condition that affects the extremities, there is a noticeable increase in foot deformities with PAD. Cases of hammertoes, bunions, bony prominences and dermatologic conditions are often increased in patients with PAD. With limited blood flow to the legs and feet, the presence of cuts, blisters and sores must be treated with extreme care. Neuropathy is also a condition that results in PAD patients and causes ulcers. If care is not taken, the patient’s leg can ultimately be amputated. For this reason, preventative care will be important to sustain the health of the patient. 

Avoiding PAD Complications

There are a few things that you can do to ensure that you are keeping your PAD under control. With diet and exercise, and regular foot examinations, you will be able to stay in good health. Wash your feet daily, and dry them well. The application of lotions will keep the skin nice and soft. Patients with PAD should not go barefoot, even indoors, in order to keep their feet protected. Prevention is better than cure. 

Reference: 

[1] FootHealthFacts: https://www.foothealthfacts.org/conditions/peripheral-arterial-disease-(p-a-d-)

Like this article?

Share on facebook
Share on Facebook
Share on twitter
Share on Twitter
Share on linkedin
Share on Linkdin
Share on pinterest
Share on Pinterest

Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

Leave a comment

Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

Copyright © 2020 orthopaedic-surgeon.com.au