Peripheral
Artery Occlusive Disease (PAD) & Claudication
Background
Peripheral Arterial Disease
What is Claudication?
What is Aortoiliac Occlusive disease?
What is Leg Artery Disease?
Peripheral Arterial Disease
Peripheral arterial disease (PAD), also known as peripheral
vascular disease (PVD), is a very common condition affecting
12-20 percent of Canadians age 65 and older. PAD develops most
commonly as a result of atherosclerosis, or "hardening
of the arteries," which occurs when cholesterol and scar
tissue build up, forming a substance called plaque inside the
arteries that narrows and clogs the arteries. This is a very
serious condition. The clogged arteries cause decreased blood
flow to the legs, which can result in pain when walking, and
eventually gangrene and amputation.
Because atherosclerosis is a systemic disease, people with
PAD are likely to have blocked arteries in other areas of the
body. Thus, people with PAD are at increased risk for heart
disease, aortic aneurysms and stroke. PAD is also a marker
for diabetes, hypertension and other conditions. This is a
major public health issue and the Society of Interventional
Radiology recommends greater screening efforts through the
use of the ankle brachial index (ABI) test. This simple, painless
test compares the blood pressure in the legs to the blood pressure
in the arms to determine how well the blood is flowing and
if further tests are needed. Each September, during Peripheral
Vascular Disease Month, Interventional Radiologists participate
in Legs For Life, a nationwide screening program sponsored
by the Society of Interventional Radiology.
Symptoms
The most common symptom of PAD is called claudication, which
is leg pain that occurs when walking or exercising and disappears
when the person stops the activity.
- Other symptoms of PAD include: numbness and tingling in
the lower legs and feet; coldness in the lower legs and feet;
and ulcers or sores on the legs or feet that don't heal.
- Many people simply live with their pain, assuming it is
a normal part of aging, rather than reporting it to their
doctor.
Prevalence
- Peripheral Arterial Disease (PAD) is a disease of the
arteries that affects 1 million Canadians.
- PAD can happen to anyone, regardless of age, but it is
most common in men and women over age 50.
- PAD affects 12-20 percent of Canadians age 65 and older.
What is Claudication?
Claudication is pain or a tired or weak feeling that occurs
in your legs, usually during activity such as walking. The
symptoms typically begin when you start to exercise, and go
away a short time after you rest.
Your arteries carry blood rich with oxygen and nutrients
from your heart to the rest of your body. When the arteries
that carry blood to your legs become narrowed or blocked, your
leg muscles may not receive enough of the blood and oxygen
they need to support physical activity. Physicians call this
lack of oxygen ischemia. Initially, your legs may receive enough
blood while you are at rest so that you do not experience any
discomfort without activity.
However, your muscles need more oxygen when you exercise,
so if the arteries in your legs are narrowed to the point that
too little blood reaches your muscles, you may feel leg pain
when you walk. Claudication, which physicians also call intermittent
claudication because it happens off and on, is a serious warning
symptom because people who have it are also at increased risk
for heart attack and stroke.
Your arteries are normally smooth and unobstructed on the
inside but, as you age, they can become blocked through a process
called atherosclerosis, also called “hardening of the arteries.”
As you age, a sticky substance called plaque can build up in
the walls of your arteries. Plaque is made up of cholesterol,
calcium, and fibrous tissue. As more plaque builds up, your
arteries can narrow and stiffen. Eventually, enough plaque
builds up to reduce blood flow to your leg arteries. Physicians
call this condition peripheral arterial disease (PAD).
What are the symptoms?
Claudication is discomfort or pain in your legs that happens
when you walk and goes away when you rest. You may not always
feel pain; instead you may feel a tightness, heaviness, cramping,
or weakness in one or both of your legs. Claudication often
occurs more quickly if you walk uphill or up a flight of stairs.
Over time, you may feel claudication at shorter walking distances,
as the degree of artery blockage worsens.
What causes claudication?
Claudication is a symptom of PAD, which is caused by atherosclerosis.
Risk factors for atherosclerosis include:
- Smoking;
- High cholesterol levels in the blood;
- High blood pressure;
- Obesity; and
- Having a family history of heart or vascular disease.
What is Aortoiliac Occlusive disease?
Aortoiliac
occlusive disease occurs when your iliac arteries become narrowed
or blocked. The aorta, your body's main artery, splits into
branches at about the level of your belly button. These branches
are called the iliac arteries. The iliac arteries go through
your pelvis into your legs, where they divide into many smaller
arteries that run down to your toes. Aortoiliac disease is
considered a type of peripheral arterial disease (PAD), because
it affects arteries that carry blood away from your heart to
your limbs.
Your arteries are normally smooth and unobstructed on the
inside, but as you age, a sticky substance called plaque can
build up in the walls of your arteries. Plaque is made up of
cholesterol, calcium, and fibrous tissue. As more plaque builds
up, it causes your arteries to narrow and stiffen. This process
is called atherosclerosis, or hardening of the arteries. Eventually,
enough plaque builds up to interfere with blood flow in your
iliac arteries or leg arteries. Physicians call this aortoiliac
occlusive disease.
When your iliac arteries narrow or become blocked, your legs
may not receive the blood and oxygen they need. This lack of
oxygen is called ischemia and it can cause pain. In severe
cases, sores or gangrene can develop, which can result in you
losing a limb. However, these developments are uncommon unless
the process is not treated and is allowed to progress.
What are the symptoms?
Early in the disease, you may feel pain, cramping, or fatigue
in your lower body when you walk or exercise. The pain with
walking usually occurs in your buttocks, thighs, and legs.
This symptom is called intermittent claudication because it
stops when you rest. As the disease worsens, you may find that
pain occurs when you walk for shorter distances. Ultimately,
as the disease progresses, you may feel pain, usually in your
toes or feet, even when you are resting.
Some men who have aortoiliac occlusive disease also experience
erectile dysfunction, the inability to have or maintain an
erection.
Aortoiliac disease may worsen if it is not treated. Signs
that it has advanced include:
- Severe pain, coldness, and numbness in a limb
- Sores on your toes, heels, or lower legs
- Dry, scaly, cracked skin on your foot. Major cracks, or
fissures, may become infected if left untreated
- Weakened muscles in your legs
- Gangrene (tissue death), which may require amputation
If you experience any of these advanced symptoms, it usually
means that your leg arteries are blocked in more than one place.
Your physician may need to treat more than one site to prevent
gangrene or limb loss.
What causes Aortoiliac Occlusive disease?
Atherosclerosis, or hardening of the arteries, causes most
cases of aortoiliac occlusive disease.
Risk factors for hardening of the arteries include:
- Smoking
- High cholesterol
- High blood pressure
- Obesity
- Having a family history of heart disease
In rare cases, a condition known as Takayasu’s arteritis
may cause blockages in your aorta and its branches. Takayasu’s
arteritis usually affects young Asian women between the ages
of 10 and 30.
What is Leg Artery Disease?
Your
arteries carry blood rich in oxygen and nutrients from your
heart to the rest of your body. When the arteries in your legs
become blocked, your legs do not receive enough blood or oxygen
and you may have a condition called leg artery disease. Leg
artery disease can cause discomfort or pain when you walk.
The pain can occur in your hips, buttocks, thighs, knees, shins,
or upper feet. Leg artery disease is considered a type of peripheral
arterial disease because it affects arteries that carry blood
away from your heart to your limbs. You are more likely to
develop leg artery disease as you age. One in 3 people age
70 or older has leg artery disease. Smoking or having diabetes
increases your chances of developing the disease sooner.
The aorta is the largest artery in your body, and it carries
blood away from your heart. Just beneath your belly button
in your abdomen, the aorta splits into the two iliac arteries,
which carry blood into each leg. When the iliac arteries reach
your groin, they split again to become the femoral arteries.
Many smaller arteries branch from your femoral arteries to
take blood down to your toes.
Your arteries are normally smooth and unobstructed on the
inside but, as you age, they can become blocked through a process
called atherosclerosis, which means hardening of the arteries.
As you age, a sticky substance called plaque can build up in
the walls of your arteries. Plaque is made up of cholesterol,
calcium, and fibrous tissue. As more plaque builds up, your
arteries narrow and stiffen. Eventually, enough plaque builds
up to reduce blood flow to your leg arteries. When this happens,
your leg does not receive the oxygen it needs. Physicians call
this leg artery disease. You may feel well and still have leg
artery disease or similar blockages in other arteries to the
heart or brain. It is important to treat this disease not only
because it may place you at a greater risk for limb loss but
also for having a heart attack or stroke.
What are the symptoms?
You may not feel any symptoms from leg artery disease at
first. The most common symptom is intermittent claudication
(IC). IC is discomfort or pain in your legs that happens when
you walk and goes away when you rest. You may not always feel
pain; instead you may feel a tightness, heaviness, cramping,
or weakness in your leg. IC often occurs more quickly if you
walk uphill or up a flight of stairs. Over time, you may begin
to feel IC at shorter walking distances. Only about 50 percent
of the people with leg artery disease have blockages severe
enough to experience IC.
Critical limb ischemia is a symptom that you may experience
if you have advanced leg artery disease. This occurs when your
legs do not get enough oxygen when you are resting. With critical
limb ischemia, you may experience pain in your feet or in your
toes even when you are not walking.
In severe leg artery disease, you may develop painful sores
on your toes or feet. If the circulation in your leg does not
improve, these ulcers can start as dry, gray, or black sores,
and become dead tissue (called gangrene).
What causes leg artery disease?
Atherosclerosis causes leg artery disease. As you get older,
your risk of developing leg artery disease increases. People
older than age 50 have an increased risk of developing the
disease, and men have a greater risk than women. Other factors
that increase your chances of developing the disease include:
- Smoking;
- Diabetes
- High blood pressure
- High cholesterol or triglycerides
- High levels of homocysteine, an amino acid in your blood
- Weighing over 30 percent more than your ideal weight
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