What is Peripheral Artery Disease (PAD)?
The arteries (with the exception of the pulmonary arteries) are the conductors that carry blood rich in oxygen from the heart to the rest of the body to nourish it. The interior of the arterial lumen is smooth to allow for trouble -free blood flow. Over time, however, their inner wall can become thick and abnormal by deposits of materials such as cholesterol, calcium, damaged cells and fibrous tissue. This is mainly the case where the arteries branch. These deposits are the so -called atherosclerotic plaque . This disease is known to all atherosclerosis .
Over time, enough plaque gradually accumulates which creates stenosis or blockages in the vessels, thus reducing blood flow and thus the supply of oxygen to the tissues. This condition mainly concerned with the arteries of the lower extremities is called peripheral obstructive arterial disease (RDP) or peripheral vascular disease (PAN) .
Usually the disease progresses slowly and it takes a long time to worsen the symptoms when they occur because the body develops sideways in its attempt to maintain good tissue hematopoiesis.
Sometimes, however, an atherosclerotic plaque can be compared and undergoing partial rupture from bleeding inside. This results in the immediate coaching of new clots on it resulting in a rapid deterioration of stenosis or even complete obstruction leading to the rise of symptoms and critical ischemia.
What are the risk factors of peripheral obstruction artery disease?
The main risk factors for the RDP coincide with those who cause, increase and maintain atherosclerosis. Smoking is the main one of them who not only causes and aggravates the atherosclerotic plaque, but also reduces the prognosis of any surgical effort if it continues post -operatively . Additional risk factors are diabetes , arterial hypertension , high cholesterol , obesity , increased uric acid and family history of RDP , ischemic stroke or infarction . It should also be noted that the RDP affects older people (usually over 60 years). In western societies, about one in four to five people over 70 years old with RDP with men developing the disease more often than women.
It is obvious that smoking cessation, regular control and corresponding treatment of diabetes, blood pressure, cholesterol and uric acid, as well as a healthy lifestyle with a balanced diet and physical activity, significantly prevent the development and development of the disease.
What are the symptoms of peripheral obstruction artery disease?
The RDP can remain asymptomatic for a long time. The first symptom it usually shows is the so -called intermittent lameness. In other words, it is a pain that occurs after certain walking measures in the buttocks, thighs, calf or legs depending on the stenosis/blockage and forces the patient to stop. After a short break a few minutes the pain disappears and the patient can continue walking again until the next few minutes of rest. For this characteristic, this disease is also called " showcase disease" , because the sufferers who walked the markets were trying to hide their "disability" by stopping the showcases to stare at them.
When the disease progresses then the pain occurs after a few steps or even at rest in the gamba and foot/ toe area, mainly during the night hours. It is not too often that the patient hangs his foot out of bed so that he can mitigate the pain and sleep.
At the final stage of the RDP there are food disorders in the lower extremities resulting in chronic ulcers and gangrene . In these cases the chance of the patient to lose part of the lower extremity is quite high.
Particular references to patients with RDP in whom diabetes coexist . Here the prognosis of the disease is worse and its evolution is faster. One of the reasons is that patients with chronic diabetes, in addition to the lesions of microcirculation of the vessels, also have degenerative peripheral nerve lesions, resulting in a decrease to a lack of aesthetics of the limbs and pain sensation (peripheral neuropathy) . In an advanced RDP, when external pressure from narrow shoes or after microtranses is exerted, the lack of hematopoiesis causes chronic ulcers or even gangrene with a high risk of infection that are difficult to cure even after a re -mark. The above description, along with certain complex structural lesions on the bones of the foot, are the clinical picture of the diabetic foot .
How is peripheral obstructive arterial disease diagnosed?
Taking a very good history - as in all diseases - is vital to the diagnosis of the RDP. This is because often pain in the lower extremities is attributed to musculoskeletal or neurological pain (sciatica) and the patient does not immediately seek the physician. It is then important to investigate and control the risk factors and to properly directed the patient not only to the RDP but also for the risk of carotid and/or coronary heart disease.
Following is the necessary clinical examination with lower extremity inspection, palpation of pulse and measurement of the hammer pressure indicator that is nothing more than the measurement of systolic pressure at the lower extremity, depending on the "great" pressure we measure in our hand, and its comparison. Ideally, their prices should be the same or have a slight difference. This measurement is calm and if necessary after gait test as the pain limit.
If the above tests lead to the suspicion of PDA, the next stage is a Triplex ultrasound (Triplex) in which abnormalities can be highlighted in the structure and range of the vessels as well as measuring the blood flow speeds within them giving us a very reliable image.
If the clinical picture and the above tests make it necessary to plan a treatment then the next step is a axial, magnetic or digital angiography , depending on the ultrasonic finding. In all, it is necessary to administer contrasting (the sketch of magnetic angiography is not nephrotoxic as in the other two). The digital angiography that is invasive as it is usually punctured by the femoral artery and administration of contrast through it, offers the advantage beyond the diagnosis and immediate treatment, if possible with a balloon or stent.
What is the treatment of peripheral obstruction artery disease?
The treatment of the RDP is diverse and can be purely endovascular (balloons, stents), purely open surgery (endartectomy, bypass) or combine both methods so it is called a hybrid approach (see treatment).