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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Illustration
Illustration
Peripheral Artery Disease
What is peripheral artery disease?
Peripheral artery disease is a type of atherosclerosis, a
hardening and narrowing of the arteries that supply blood
to the arms and legs. In most cases, it affects the legs.
When the problem becomes severe, leg pain develops.
How does it occur?
The narrowing of the inside of the arteries occurs when
deposits of cholesterol and calcium develop over time on the
inner artery walls. These deposits are called plaques. The
plaques may eventually become so thick that they completely
block the flow of blood through the arteries.
Several factors can put you at risk for developing
peripheral artery disease:
- an inherited (genetic) tendency in your family
- diabetes
- high levels of blood fat (for example, cholesterol)
- high blood pressure
- being overweight
- cigarette smoking.
What are the symptoms?
The disease progresses silently, without symptoms, until
the arteries have become significantly narrowed.
The first symptom is usually pain or cramping in the calf
muscles when you walk or exercise your legs. The discomfort
quickly goes away when you rest, and may come back when you
are active again. As the narrowing worsens, the pain
worsens. Pain may be felt in the thighs and buttocks if the
narrowing is in the arteries leading to the thighs. One or
both legs may be affected.
Your feet may seem cooler. If you previously had hair on
the tops of your feet, you may notice some hair loss. Cuts
and scrapes may take longer to heal.
How is it diagnosed?
Your doctor will examine you and ask about your symptoms and
your personal and family medical history. He or she will
check the pulses in your feet, legs, and groin.
To identify the location and degree of arterial narrowing,
you may have an angiogram or Doppler (sound wave) test. In
an angiogram, dye is injected into the arteries. The dye
allows the flow of blood to be observed. Your doctor can
measure the narrowing of the arteries and find any complete
blockages with this test. A Doppler, or ultrasound, test
does not require any injections and may also be used to
locate blockages.
How is it treated?
The first important step of treatment is to manage any risk
factors. For example you might need to:
- Stop smoking.
- If you are diabetic, control your blood sugar.
- Reduce your blood pressure.
- Lower the level of fats in your blood.
Changes in your diet may be necessary. A diet high in
complex carbohydrates (whole grains, pastas), fresh fruits,
vegetables, and fiber, and low in salt, animal fats, and
refined sugar is healthy for nearly everyone. It is
especially important in the treatment of diabetes,
hypertension, lipid (blood fat) disorders, and vascular
disease.
If you are a smoker, you must stop smoking. Smoking
increases the rate of narrowing of the arteries. One of
nicotine's effects is vasoconstriction. Each cigarette
you smoke decreases blood flow as the inhaled nicotine
circulates in your blood.
Your doctor may need to adjust or change the medications you
are taking. Some dosages or drugs restrict blood flow less
than others. Your doctor may prescribe new medication to
try to improve blood flow.
Exercise is vital to improving and maintaining good
circulation in your arteries. Your doctor may recommend an
exercise program for you. However, you may need to have
surgery first.
Your doctor may recommend surgery for significant blockages.
During surgery the blocked area may be removed and replaced
with a piece of your own vein (removed from another part of
your body). The replacement is called a graft. Sometimes
synthetic material instead of a vein is used for the graft.
Abdominal surgery may be necessary to repair blockages in
the arteries that flow into the legs.
In some cases other techniques are available that allow
blockages in the peripheral arteries to be treated through
catheterization and balloon dilatation, thus avoiding
surgery. In catheterization a small tube is inserted in an
artery in the groin; it allows your doctor to see blockages.
The blockages can sometimes be treated by inflating a
balloon at the tip of the catheter to widen the area around
the blockage.
If your disease is extremely severe or other health problems
prevent surgery, amputation of your foot or leg may become
necessary. Amputation is usually necessary if you have so
little blood flow that the skin and other tissues die and
you become susceptible to life-threatening infection.
Amputation is a last resort, but if peripheral vascular
disease is not controlled, it is a possible complication.
How long will the effects last?
Peripheral artery disease is a disease that you will
continue to have and that will get worse unless you receive
treatment.
How can I take care of myself?
- Follow your doctor's instructions on diet, exercise, and
medication.
- If you are a smoker, stop smoking.
- Take care not to injure the affected leg. Injuries
to that leg will heal much more slowly. Proper shoes,
safe terrain, and safe exercise equipment are important.
- See a doctor immediately if your symptoms suddenly
become more severe. The worsened symptoms could
indicate a complete blockage.
What can I do to help prevent peripheral artery disease?
The best way to try to prevent peripheral artery disease
is to maintain all-around fitness. Try to reach and keep a
normal weight, normal blood pressure, and normal levels of
lipids and sugar in your blood. Eat a diet low in fat and
refined sugar, and high in complex carbohydrates and fiber.
Exercise three to four times a week, striving to walk 20 or
more minutes each time, or according to your doctor's
prescription. Cycling and swimming are good alternatives to
walking, but you should consult with your doctor before you
start a more vigorous program.
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