How widespread it is may still be
under appreciated, although hundreds of millions of people worldwide are victims
of his disease. Peripheral artery disease is alarmingly prevalent, and longer
life expectancy along with evolving lifestyle (not necessarily for the better)
seem to be exacerbating its rise. Its cardiovascular risk implications (it
frequently lead to heart attacks and strokes) mean that there is a dire need to
assess preventative measures and treatment.
The free, uninterrupted flow of oxygen-rich
blood in our bodies is essential, and this is facilitated by our blood vessels,
of which there are two main groups – arteries and veins. The former carry
nutrients and oxygen to the cells, while the latter bring back cells metabolic
by-products, toxins and carbon dioxide back to the heart for recycling.
Peripheral arteries are those that do not
supply the heart and brain. They are, however, still extremely important.
Disease of the arterial tree can range from short segment narrowing to full
blown occlusion / blockage and can have devastating effects on the area where
the artery is supposed to supply. These are mostly related to diabetes
mellitus, atherosclerosis (blockage), hyperlipidaemia (high blood cholesterol)
or even trauma. Veins however have a different subset of condition ranging from
the unsightly varicose veins on the lower limb to the painful, calf-bursting
feeling of deep vein thrombosis (DVT) and its subsequent effects.
“Atherosclerosis” or blockage by plaque
(fat, cholesterol, calcium and other substances) of these blood vessels,
results in a debilitating condition known as peripheral artery disease (PAD).
While the heart often takes centre stage when it comes to atherosclerosis,
blood vessels in other parts of the body, are equally important, and should be
given adequate focus and attention.
Blood vessels are lined by endothelium, a
thin layer of cells which maintains a toned and smooth interior for good blood
flow. When the endothelium is compromised by causes such as high blood
pressure, smoking or elevated blood cholesterol, atherosclerosis takes place
with the formation of plaque on the arterial walls, thus obstructing blood
flow. Left unremedies, ensuing plaque builds up, and over years, as arterial
clogging worsens, so does resulting incapacitation of limbs and the pelvis
area.
In some, recurring cramps and pain in the
leg while exercising, otherwise known as intermittent claudication, may signify
the beginning of problems. Conditions deteriorate as peripheral arteries
continue to constrict, and the discomfort then spreads to the thighs, hips and
buttocks. Other manifestations thereafter include perpetually cold and numb
feet and toes, the thickening of nails, a bluish tint and shine to the skin,
erectile dysfunction in the men, and the poor healing of sores. As PAD
progresses, pain occurs even at rest, intense enough to disturb sleep.
Serious complications also result from PAD.
Sores and injuries hich do not heal, may turn full-blown into gangrenous tissue
and require the amputation of the affected limb. And atherosclerosis is not
confined to just the peripheral blood vessels but happens as well in the
arteries supplying the heart and the brain as well, eventually leading to a
stroke or heart attack.
SCREENING
Often dismissed as simply a part of aging,
the aforementioned signs and symptoms are actually serious indication to get
screened by a medical professional. Do not wait for pain to occur before taking
action. Preemptive screening is especially advisable for the aged, diabetics, smokers,
the obese and those with hypertension, because of their vulnerability to PAD.
Potential patients are asked about their
symptomatic experiences, as well as their personal and family history. During a
physical examination to determine PAD, pulses in certain areas of the feet,
legs and groin are inspected for weakness or even absence. Whooshing sounds
over arteries heard with a stethoscope, ulcers where blood flow has become
restricted, and lowered blood pressure in affected limbs, are all indicative
too.
More advanced testing includes a Doppler
(ultrasound) test, whereby high-frequency sound waves evaluate blood flow and
where arteries may be blocked or narrowed. But for a more precise picture, an
angiogram is carried out – arteries are injected with dye to clearly watch
blood flow, and how restricted it gets in certain areas.
To complete the investigation, blood tests
are included to measure blood cholesterol and triglyceride levels as well as to
check for diabetes.
PREVENTION
IS BETTER THAN CURE
Lifestyle changes are a must for those at
risk of PAD. First and foremost, it is never too late to quit smoking. Also,
since “we are what we eat,” dietary discipline in the form of higher intake of
fiber-rich foods like whole wheat, oatmeal, bran, brown rice, fruits and vegetables,
is a major step in the right direction.
In addition, the reduction of salt,
unhealthy fats and refined sugar in meals, will help treat or prevent related
ailments like diabetes, high blood pressure, lipid problems and vascular
disease. Physical activity three to four times a week keeps the blood flowing
nicely. Brisk walking at least 20 minutes at a time, cycling and swimming are
great options, but it is wise to first consult with a physician before starting
any exercise programme.
MEDICAL INTERVENTION
Depending on the situation and severity,
doctors will assess if it is necessary to resort to procedures like
angioplasty, bypass surgery or thrombolytic therapy to treat PAD, and will
advise their patients accordingly.
Angioplasty requires a tiny hollow tube
(catheter) to be threaded through the artery to the affected location, when a
small balloon on its tips inflates to reopen the constricted artery as well as
flatten the blockage against the artery wall. Thus stretched, blood stream
through unhindered. Further, a mesh framework (stent) may be added to ensure
the artery stays open. Lately, thetr are balloons and stent coated with
medication that prevent the endothelium from producing scar tissues that could
lead to further blockage.
In bypass surgery, the doctor will graft a
blood vessel from another part of the patient’s body (or a synthetic one) to
allow blood to flow around, that is, to bypass the blocked or narrowed artery.
There is also thrombolytic therapy which may be recommended for blood clots
found blocking an artery, whereby there are injected with a drug to dissolve
them in situ.
