According to "The 5-Minute Clinical Consult" textbook, 8 to 12 million people are affected by peripheral artery disease (PAD) or occlusive disease of the legs. Patients are predominately male and over the age of forty. There is a mortality rate of 30 percent over 5 years in patients with symptoms. According to "The 5-Minute Clinical Consult" text, 2 to 5 percent of patients with PAD will eventually require amputation of the affected limb. Smoking, diabetes, obesity, high blood pressure, high cholesterol and high homocysteine levels are risk factors. Treatment for PAD includes medication, exercise, angioplasty and vascular bypass.
Medication and Exercise
Antiplatelet therapy is the first line of therapy in PAD. Antiplatelet therapy is a form of anticoagulation which affects the ability of the platelets to form a clot. PAD is the result of atherosclerotic plaques and blood clots blocking the arteries in the leg. With the use of antiplatelet medication such as Plavix or clopidogrel, ticlopidine or Ticlid or low dose aspirin, the platelets are less likely to stick to atherosclerotic plaques in the arteries.
Walking is used to increase the endurance of the leg muscles. PAD diminishes blood flow to the legs. Diminished blood flow means decreased oxygen to the muscles in the legs, creating what is commonly called claudication. Patients with PAD complain of calf pain or claudication when walking only a few blocks. The combination of antiplatelet therapy and slowly increasing the endurance of the muscles can decrease claudication symptoms. The American Heart Association states that regular exercise can reduce leg pain symptoms in 4 to 8 weeks.
Angioplasty
Patients with debilitating claudication or those who have pain at rest are candidates for angioplasty. The angioplasty balloon is threaded into a groin artery until it reaches the occlusion. At that point the balloon is inflated and compresses the atherosclerotic plaque against the artery wall thereby re-opening the lumen of the artery.
Vascular Bypass
Vascular bypass is done for patients with severe leg pain at rest or those who have tissue loss. The surgeon may use synthetic grafts that are tubular shaped and pliable or he may choose to harvest a vein from the inside of the leg for the bypass graft. The surgeon will locate an area where there is good blood flow in an artery, attach the graft and then find an area below the occlusion to attach the other end of the graft. This restores blood flow to the area below the occlusion and can eliminate pain.
References
- "The 5-Minute Clinical Consult 2010". 18th Ed. Frank J. Domino, MD Editor. 2009
- The American Heart Association: PAD Treatment and Medications
