Canada Vascular

Peripheral Artery Occlusive Disease (PAOD)

Background

How Can PAD Be Diagnosed?

Treatment Options

How Can I Get Screened & Treated for PAD?

Common Questions & Answers

Bibliography

 

 


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).

Claudication


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 diseaseAortoiliac 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?

Leg Artery DiseaseYour 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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