Peripheral Artery Disease (PAD) occurs when the arteries are blocked by atherosclerosis or hardening of the arteries. Atherosclerosis occurs when cholesterol plaques block arteries (Grossman & Porth, 2014). PAD causes a narrowing of the arterial lumen that leads to impaired blood flow to the lower extremities (Ferri, 2018). It mostly occurs in the lower extremities and is sometimes referred to as arteriosclerosis obliterans (Grossman & Porth, 2014).
Peripheral Artery Disease (PAD) occurs in men and women equally and affects 8.5 million people in the United States [Division for Heart Disease and Stroke Prevention (DHDSP), 2016]. African Americans have a higher risk of PAD. Other risk factors include tobacco use, hypertension, atherosclerosis, diabetes, high cholesterol, and those that are over the age of sixty (DHDSP, 2016).
Peripheral Arterial Disease may present in a variety of ways depending on the individual patient. About half of all patients with PAD have no symptoms (DHDSP, 2016). The most common symptoms that patients may complain of are cramping, aching, weakness, and numbness in the affected area (DHDSP, 2016). Many of these symptoms are brought on by exercise and get better at rest. There may be diminished pulses and the lower extremities may feel colder to the touch than that of the rest of the body. One may hear bruits over the distal aorta, iliac, or femoral arteries on the exam (Ferri, 2018). It may present with skin discoloration and/or hair loss, brittle nails, and muscle atrophy in the affected limb (Ferri, 2018). Other patients may come in with complaints of a sore or ulcer that will not heal (Ferri, 2018). Men can present with impotence, which can occur if the vessels leading to the penis are affected (Ferri, 2018).
Peripheral Arterial Disease is diagnosed with a thorough health history, careful physical exam, and by measuring the ankle-brachial index (ABI). This is done by dividing the highest ankle blood pressure by the highest arm blood pressure. An ABI value of less than one is abnormal (Ferri, 2018). To determine the extent of the disorder and areas of blockage, a treadmill test, Doppler ultrasound, angiography, and magnetic resonance angiography (MRA) may be done.
Treatment regimens include smoking cessation, maintain control of hypertension, diabetes, and high cholesterol (DHDSP, 2016). Aspirin is used to help prevent the development of serious complications from PAD, which can increase the risk of heart attack or stroke. Physical activity and exercise are important for improving symptoms of PAD (DHDSP, 2016). Severe cases may need to be treated with angioplasty, percutaneous atherectomy, bypass, or amputation (Ferri, 2018).
Patients should be taught to eat a healthy diet and minimize salt intake as well as walk 30 to 60 minutes per day (Ferri, 2018). Patients with severe cases or comorbidities may need to be started in a supervised exercise program, or cardiac rehab (Ferri, 2018). Diabetics should be instructed to follow the American Diabetes Association diet and to be very mindful of maintaining blood sugar levels. Patients that smoke should be instructed about the risk of smoking with PAD and encouraged to quit.
Division for Heart Disease and Stroke Prevention. (2016). Peripheral arterial disease. Retrieved January 2018, from Centers for Disease Control and Prevention: https://www.cdc.gov/DHDSP/data_statistics/fact_sheets/fs_PAD.htm
Ferri, F. (2018). Ferri’s Clinical Advisor 2018: 5 Books in 1 (Ferri’s Medical Solutions). Philadelphia, PA: Elsevier.
Grossman, S. C., & Porth, C. M. (2014). Porth’s Pathophysiology: Concepts of Altered Health States(Ninth Edition). Philadelphia, PA: Lippincott Williams & Wilkins.