Peripheral Artery Disease (PAD)
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Peripheral vascular disease affects approximately 10 million people. Of these, our current efforts only reach 1.25 million. Many of the remaining patients are symptomatic but yet go untreated thinking that leg pain and decreased mobility is a natural part of aging.
Depending on which arteries are affected and the extent of disease, the signs and symptoms of peripheral artery disease can differ greatly. The majority of patients with symptomatic disease present with complaints of reproducible leg pain associated with walking a certain distance. This is referred to as claudication. From there, some patients progress to ischemia, ulceration and gangrene.
Risk factors associated with the development of peripheral vascular disease include: smoking history, cardiac disease, diabetes, high blood pressure, high cholesterol and a sedentary lifestyle.
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Central to the diagnosis of peripheral vascular disease is a detailed history and physical examination. Subsequent to this, special non-invasive or invasive test may be ordered. Of these, the Ankle-Brachial Index (ABI) is the least expensive and serves as a reliable indicator of limb perfusion. It is also the simplest and can be done in the office setting.
Treatment options usually depend on the severity and extent of disease. Mild forms are most often treated with medications and a dedication to implementing lifestyle changes. This involves smoking cessation, a routine exercise regimen and a low fat diet. For those with progressive or advanced disease, treatment can involve either percutaneous endovascular interventions or surgical revascularization.
While surgery involves bypassing the blocked artery or excising the plaque, percutaneous interventions involve dilating the narrowed artery with a balloon. In certain situations, a stent may be used to treat a residual stenosis and maintain the artery open.
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