Peripheral

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					    Peripheral Arterial Disease
              (PAD)
What is peripheral arterial disease (PAD)? PAD is a condition in which the
arteries become narrowed by plaque limiting the blood flow to the limbs, sometimes
becoming completely blocked.




               Normal Arterial Blood Flow                 Plaque Formation




IMPORTANT FACTS ABOUT PAD:

 8-12 million in the United States have PAD. It is common, but often under-
  recognized. As many as 20-30 million people may be at risk.

 If you have PAD, you are 5 times more likely to have a heart attack.



WHAT ARE THE SYMPTOMS OF PAD?

 Claudication - Pain, aching or fatigue in the calf, thigh or buttock
  occurring after walking; consistently relieved with rest. If
  claudication progresses to rest pain, may indicate severe
  disease.
 Cool temperature of the leg or foot
 Loss of hair on lower legs and feet
 Slow healing ulcers on legs and feet
 Reddish-blue color of the leg when sitting
WHAT ARE THE RISK FACTORS FOR PAD?
    Smoking
    Diabetes
    Coronary artery disease
    High blood pressure
    High cholesterol
    Age
    Obesity
    Male
    Family history of peripheral arterial disease

HOW IS PAD DIAGNOSED?

 Ankle-brachial Index (ABI): This is a painless test that
  measures and compares the blood pressure in the arms
  and ankles. If there is difference between the results,
  results are read as abnormal. If abnormal, more tests may
  be needed to check for blockages.

 CT angiogram: Contrast dye is given through an IV in
  your arm. You lay under the camera and images are taken
  of the blood vessels. The contrast dye highlights the blood
  vessels.

 Ultrasound: A painless test in which a probe is moved up
  and down the skin over the blood vessels. Sound waves
  reflect off blood cells as they flow through the blood vessel to form a picture.

 Magnetic Resonance Angiography: A non-invasive test in which you lay under a
  camera and pictures are taken. Powerful magnets are used to create a field to
  examine blood flow through the blood vessels.

 Arteriogram: Invasive test in which a plastic tube is inserted usually into an artery
  in the groin area. Contrast (dye) is injected into the artery and a type of x-ray takes
  pictures of the flow within the blood vessels. Considered the gold standard of
  checking for blockages.

HOW IS PERIPHERAL ARTERIAL DISEASE TREATED?

 Modify risk factors such as smoking cessation, blood pressure control, weight loss,
  lowered cholesterol level, and blood sugar control.

 Exercise - Increase your walking. This helps build collaterals (formation of new
  small vessels to help supply oxygen to the muscle). Also, conditions the leg
  muscles to work with less oxygen.
 Medicines - Medicines are used to lower blood pressure, lower cholesterol, and to
  lower blood sugar. Others help prevent blood from
  clotting.

 Angioplasty/Stenting or Atherectomy – In this
  procedure a tube is fed through your artery and
  dye is injected to see your vessels. Your femoral
  artery in the groin is usually the site of insertion,
  although the brachial artery in the arms and popliteal artery behind the knee can
  also be used. If a blockage is detected, treatments include balloon inflation to open
  the blockage, implantation of a stent or eliminating the blockage by shaving the
  plaque and removing it in a catheter.

 Surgical revascularization (Bypass) - Surgery where blood flow is re-established
  using a vein taken from the patient’s leg or a synthetic one that is connected to the
  artery above and below the blockage.

OTHER TYPES OF VASCULAR DISEASE:

 Carotid Artery Disease - Plaque builds up in main artery to the brain. If this occurs,
  you are at a higher risk for having a stroke. Many times with this disease a TIA can
  occur (transient ischemic attack, also known as a “mini-stroke”).
                              Symptoms: Confusion, weakness, slurred speech,
                               paralysis, headache, loss of balance, blurred vision.
                              Treatment:
                             1) Controlling risk factors
                             2) Carotid balloon angioplasty/stenting
                             3) Carotid endarterectomy (surgical repair)



 Renal Artery Disease - Plaque builds up in arteries to the kidneys. If it occurs, your
  kidneys may not work as efficiently and
  may cause high blood pressure.
    Treatment:
   1) Control risk factors
   2) Renal balloon angioplasty/stenting



 Abdominal Aortic Aneurysm - A ballooning of the major artery in your abdomen
  area occurring at a weak spot. Blood enters into the wall of the vessel and builds
  pressure causing stretching of the vessel. If pressure is too great, the size of the
  aneurysm will increase and may rupture, which can be life-threatening.
    Symptoms: Most commonly none
    Treatment:
              1) Repair with stenting
              2) Abdominal aortic surgery repair


References for additional information:

http://www.americanhart.org/ Click on diseases/conditions
http://www.vdf.org Click on disease information
http://www.understandingpad.com