Peripheral Artery Disease Flashcards
Definition/Description
Peripheral arterial disease (PAD) is known as a condition where by the blood flow in the limb arteries are obstructed [1]. Commonly, the legs are the Peripheral Arterial Disease.gifmost affected [1]. These arteries are obstructed due to plaque deposits that restrict blood flow through the peripheries [2]. Although blood flow may be also restricted by deep vein thrombosis, which may be a blood clot that occurs in the periphery of the limbs [2]. Most patients are asymptomatic, but may experience intermittent claudication (pain on walking). Common symptoms of PAD include pain during walking and rest, skin ulcers,
cramping, aching, clubbing of the finger or toenails, cold skin, blue tinged skin, and slow blood refill [3]. Thus there is a lack of blood flow to remove anaerobic metabolites that cause a pain sensation when built up [2]. Critical limb ischaemia occurs when the blood flow reduction is so severe that it causes pain on rest or loss of tissue (ulceration or gangrene).
Cigarette smoking increases the chance of having PAD by seven-fold [12]. Due to a change in the fibrin formation, endothelial cells, blood rheology, and lipoproteins decrease antioxidants in the blood
Risk factors
Diabetes, similarly to smoking causes abnormalities in endothelial cells and their function. The cells are unable to regulate the function and structure of the arterial walls[15]. Diabetes Mellitus leads to a two-to fourfold increase in risk of cardiovascular events [3]. The TASC II guidelines report that those with diabetes have a similar relative risk of developing PAD to those that smoke. [10] A prospective cohort study found that poor diabetes management was associated with an increased risk of PAD. [16]
Age - The risk of PAD increases as the population approaches the age of 50. It has been reported that PAD affects 0.9% of 40-49 year olds and increases to 14.5% of 70 year olds and above [3].Studies also have shown that men are the target population of PAD [3].
Gender - TASC II guidelines conclude that men are affected at a younger age than women. However, overall there is no clear distinction in risk.
Hypertension - In a study conducted by Lewington et al. illustrated that for each 20-mmHg increase in systolic blood pressure or 10 mmHG in diastolic for people age 40-70 doubled the risk of cardiovascular disease and PAD [3].
Dyslipidemia - Developing PAD by 10% for every 10-mg/dL rise in total cholesterol[3].
Symptoms
Most patients with PAD are asymptomatic. Claudication is the most reported symptom. It is an aching or burning sensation in the muscles of the leg that it reliably reproduced after a set walking distance and is relieved with rest. It is not exacerbated by position or present at rest. The site of pain can often help in providing an indication to the site of the disease. Occlusion or stenosis of the aorta commonly causes bilateral buttock, thigh, and calf claudication. Occlusion of the common iliac, common femoral, and superficial femoral arteries causes unilateral buttock, thigh, and calf claudication.
For a diagnosis of acute limb ischemia a patient must present with a sudden onset of the Six P’s (Pain, Pallor, Pulseless, Parasthesia, Paralysis, ‘Perishingly cold, Sudden onset of claudication.
