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Ruling out Other Disorders with Similar SymptomsA number of other tests may be ordered to rule out disorders with similar symptoms. Avoid saturated fats (found mostly in animal products) and trans fatty acids (found in hydrogenated fats and many commercial baked products and fast-foods). The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. It occurs when arteries in the limbs (most often the legs) become narrowed by cholesterol-rich material called plaque.
Genetic factors that cause specific lipid and cholesterol abnormalities may increase the risk for PAD.Artery inflammation and damage. Low levels of vitamin D have been linked to an increased risk of PAD and many older Americans are deficient in this vitamin. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Because PAD interferes with circulation, advanced cases increase the risk for gangrene and amputation.
Such inflammation can cause significant damage in blood vessels, and is highly associated with PAD.Age.
Symptoms include numbness, pain, coolness, pale color, lack of pulse in the artery, and weakness. Deficiencies in the B vitamins folate and B12 have been linked with elevated levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease and PAD. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites.
PAD occurs more frequently in people over age 50 and affects 12 - 20% of Americans age 65 years and older.Ethnicity. However, while vitamin supplementation lowers homocysteine levels, it has no effect on heart disease outcomes. Treatment options include clot-busting drugs delivered to the blockage or procedures to remove the clot.Poor Physical and Mental FunctioningPeripheral artery disease can significantly impair daily physical functioning.
Vitamin E has also not been shown to help with symptoms.Herbs and SupplementsGenerally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Any duplication or distribution of the information contained herein is strictly prohibited.
They are twice as likely to develop PAD as Caucasians.DiagnosisPAD is greatly underdiagnosed. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. Even worse, intermittent claudication increases the risk for falling, usually because of unsteadiness, regardless of the severity of PAD. There have been a number of reported cases of serious and even lethal side effects from herbal products. Aspirin for the prevention of cardiovascular events in patients with peripheral artery disease: a meta-analysis of randomized trials. People should be checked for peripheral artery disease if they have leg pain during walking, or ulcers on their legs.Physical ExaminationThe doctor should check for high blood pressure, heart abnormalities, blockage(s) in the artery in the neck, and abdominal aneurysms. Always check with your health care provider before using any herbal remedies or dietary supplements.Gingko biloba is an herbal remedy reported to have blood-thinning properties. The doctor should also examine the skin of the legs and feet for color changes, ulcers, infection, or injuries, and check the pulse of the arteries in the leg.Ankle-Brachial IndexIntermittent claudication caused by peripheral artery disease is typically diagnosed using a calculation called the ankle-brachial index. However, studies have shown it does not provide any benefit for patients with PAD or intermittent claudication. The build-up of plaque causes the arteries to become narrow and hard, obstructing blood flow. Although the risks for gingko appear to be low, there is an increased risk for bleeding at high doses and harmful interaction with high doses of anti-clotting medications. Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review. Poor glycemic control is associated with vascular and circulation complications such as PAD. This is particularly important because patients with PAD often use these types of medications.
It is the force that blood exerts on the artery walls as the heart contracts to pump out the blood. Commercial gingko preparations have also been reported to contain colchicine, a chemical that can be harmful in pregnant women and people with kidney or liver problems.MedicationsTreatments for PAD help manage leg pain and improve function, as well as reduce the risk for heart attack and stroke. Drugs used for improving leg pain and function are generally those that either prevent blood clots (typically antiplatelet drugs) or improve blood flow.Aspirin and Other Antiplatelet DrugsAntiplatelet drugs such as aspirin reduce the risk for blood clots. The signal emitted from the strongest artery is recorded as the cuffs are inflated and deflated. This is the ankle's systolic pressure.The doctor divides the systolic pressure in the ankle by the systolic pressure in the arm.
For the most part, this recommendation is made to prevent future death from heart attack or stroke. About a third to a half of patients with PAD have this symptom.Symptoms may be felt as pain, achiness, cramping, a sense of fatigue, or nonspecific discomfort that occurs with exercise. Clopidogrel (Plavix, generic) is recommended as an alternative.Dipyridamole (Persantine, generic) may help prevent complications of PAD when taken along with aspirin.
Unhealthy cholesterol levels are major contributors to atherosclerosis, the common factor in PAD and heart disease.
If results fall in the borderline range, and the patient has specific risk factors for artery disease, the patient takes a treadmill test and another ABI measurement.
Aspirin for prevention of cardiovascular events in a general population screened for a low ankle brachial index: a randomized controlled trial. At first, symptoms may only initially develop when walking uphill, walking faster, or walking longer distances.Because the most frequently affected artery in intermittent claudication is the popliteal artery, symptoms are most common in the calf muscles.
A statin drug may is the most common type of medication used to help lower LDL cholesterol and improve lipid profiles. A number of studies have reported that the drug helps improve walking distance and quality of life. It continues below the knee where it branches off and carries blood to the muscles in the calf and foot.
These measurements indicate very severe blockage in the leg arteries and a risk for gangrene.
Physical activity during daily life and mortality in patients with peripheral arterial disease. Talk to your doctor about any leg or thigh pain you have.Leg pain occurs in one leg in 40% of patients and in both legs in 60% of patients. Patients should take precautions to avoid foot injuries, which can increase the risk for non-healing wounds and gangrene.Doppler Ultrasound ImagingDoppler ultrasound imaging is commonly the first imaging test of the arteries performed and also may be used in follow-up of patients. These drugs block the effects of the angiotensin-renin-aldosterone system, which is associated with many harmful effects on the heart and blood vessels. Patients may also have fatigue or pain in the thighs and buttocks.Advanced Peripheral Artery Disease (Ischemic Rest Pain)In advanced cases, the arteries are so blocked that even rest does not help. It is able to provide an anatomic view of the arteries and report on velocity and flow characteristics. They are important drugs for patients with PAD and diabetes who also have high blood pressure.
It is expensive, however, and currently recommended only for patients with moderate-to-severe intermittent claudication who do not respond to aspirin or less costly treatments. It is non-invasive and is usually performed in an outpatient setting.Invasive Angiography, Magnetic Resonance Angiography (MRA), and Computed Tomography Angiography (CTA)Before considering invasive procedures to treat peripheral artery disease, the surgeon needs a better understanding of which arteries are involved, how severe the blockage is, and the state of the blood vessels surrounding the blockage.
Common side effects include headache, swelling in the limbs, and stomach problems such as diarrhea and flatulence (gas). Exercise rehabilitation in peripheral artery disease: functional impact and mechanisms of benefits.

This type of angiogram uses dye, which is injected through a catheter that is inserted in the groin.Magnetic resonance angiography (MRA) is a type of magnetic resonance imaging (MRI).
Quitting smoking may not make leg pain go away, at least not in the short term, but it certainly may keep blockages from getting worse.
Similar drugs have had serious side effects in patients with heart failure, so these patients should avoid cilostazol.Pentoxifylline. Continued smoking is associated with the majority of patients who progress from milder forms of PAD to critical limb ischemia involving severe pain, skin ulcers, and possible amputation. Pentoxifylline (Trental, generic) reduces the sticky properties of blood, improving its flow. The MRA uses a magnetic field and radiofrequency waves instead of radiation to provide pictures of arteries and blood vessels. Patients are given gadolinium (a contrast material) through an IV to improve the image quality. In many medical centers, MRA is considered almost or as accurate as invasive angiography and will frequently be the only test required.A newer technology called computed tomography angiography (CTA) uses x-rays to visualize blood flow in arteries throughout the body.
People who maintain an active lifestyle have a much lower risk of developing heart disease than do sedentary people.
Smoking is the number one risk factor for PAD, and smoking even a few cigarettes a day can interfere with PAD treatment. And, according to the American Heart Association, patients with PAD who are physically active have death rates that are a third of those who are less physically active.Exercise Training to Improve Blood Flow in the Legs. Some studies have reported a small effect on walking ability; another found the drug significantly improved walking distance. Treadmill exercise and resistance training in patients with peripheral arterial disease with and without intermittent claudication: a randomized controlled trial. Smoking increases the risk for PAD by 2 - 25 times, with the danger being higher when other risk factors are present. While it involves radiation exposure, it can be used in patients who have contraindications to magnetic resonance imaging.Treadmill TestA patient is often given a treadmill test if the ankle-brachial index is questionable. Exercise training improves blood flow in the legs and, in some cases, can work as well as medications and surgical procedures in increasing pain-free walking distance.
Other research has found that the drug does not work any better than a dummy pill (placebo). Patients with claudication have a 50 - 60% reduction in peak performance, which is comparable to that in patients with heart failure.
The most common side effects include headache, nausea, heartburn, flatulence (gas), dizziness, blurred vision, and flushing.Thrombolytics (Clot-Busters)Alteplase (Activase), also called t-PA, and reteplase (Retavase) are thrombolytic drugs.
Progression to a more critical state of illness is likely for patients who continue to smoke. The treadmill test is also useful for determining the severity of the pain while walking and assessing the effectiveness of treatments.Waveform AnalysisA test called a wave form analysis may be used to confirm an abnormal API or pressure reading.
Such drugs are commonly called "clot-busters." They break up existing clots, and may be used in cases of acute vascular occlusion (the sudden development of a blood clot). Diagnostic performance of computed tomography angiography in peripheral arterial disease: a systematic review and meta-analysis.
The patient lies on their back for at least 10 minutes in a warm room (so that the blood vessels will not narrow). General guidelines for a heart-healthy diet include:Choose fiber-rich food (such as whole grains, legumes, and nuts) as the main source of carbohydrates, along with a high intake of fresh fruits and vegetables. People with type 2 diabetes have 3 - 4 times the normal risk for PAD and intermittent claudication.
Researchers are investigating whether thrombolytics are an effective alternative to surgery in severe cases of PAD. The doctor passes a handheld scanner over the leg, which picks up sound waves coming from the arteries.
In severe cases, the drugs can be delivered directly into the artery.Other Drugs Used to Treat Intermittent ClaudicationACE Inhibitors. People with type 2 diabetes also tend to develop PAD at an earlier age and have more severe cases. These signals are recorded, and the wave forms are traced to detect abnormal blood flow.Tests for Detecting Heart DiseasePatients with suspected PAD should have an electrocardiogram (ECG, EKG) and other tests that can detect heart problems.
Patients with both diabetes and PAD are at high risk for complications in the feet and ankles.
The electrocardiogram (ECG, EKG) is used extensively in the diagnosis of heart disease, from congenital heart disease in infants to myocardial infarction and myocarditis in adults.
The ACE inhibitor ramipril (Altace, generic) is often recommended for patients with symptomatic peripheral artery disease, primarily to reduce the risk of cardiovascular events.SurgeryIn severe cases, surgery may be needed to open blocked blood vessels. Heart disease and stroke statistics--2012 update: a report from the American Heart Association. These include open bypass procedures, which connect an artery before the location of the obstruction to an artery below the obstruction, or minimally invasive endovascular techniques such as angioplasty and stenting. Soluble fiber is found in foods such as oat bran, barley, nuts, seeds, beans, lentils, peas, and some fruits and vegetables.
The location of the lesions and how many other risk factors and illnesses patients have often determine which procedure is chosen.Surgery is generally performed for claudication that has become disabling despite full medical and exercise therapy. Insoluble fiber appears to speed the passage of foods through the stomach and intestines and adds bulk to the stool.
Surgery may also be necessary for patients with rest pain, and to save a limb when a patient develops critical limb ischemia and is in danger of amputation.Leg Bypass SurgeryFor many years, leg bypass surgery was the main type of surgery used for extensive PAD. Grafts can be made from synthetic material (artificial vein) or from a vein taken from a different location in the patient's leg (natural vein). High blood pressure, especially when combined with other cardiovascular risk factors, increases the chances for PAD. One of the best sources of fiber comes from legumes, the group of food containing dried peas and beans. Possible bypass connections between arteries include aorta to iliac arteries, aorta to femoral arteries, and bypass between the femoral artery and popliteal, tibial, and peroneal arteries.Artificial veins tend to pose a much higher risk for blood clots, and the consequences of re-blockage are must more severe than when the natural vein recloses.
Epub 2011 Oct 6.Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT,Creager MA, Franklin BA, et al. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries. To keep the artificial vein open, oral anti-clotting drugs such as aspirin or warfarin may be used. The object of the procedure is to open the blocked blood vessels that are causing intermittent claudication.
Angioplasty is being increasingly used in place of leg bypass surgery, especially in patients who have other medical conditions.The PTA procedure requires only a local anesthetic.
The effects are not permanent, but the procedure can be repeated without any greater risk than with the original one.Anticoagulants (such as warfarin or heparin) and antiplatelets (such as aspirin) may be used to prevent blood clots occurring during surgery.
Thrombolytic drugs may be used before, during, or after angioplasty if a blood clot is present.Balloon Angioplasty. A thin tube is inserted through an artery in the groin and passed through the blocked artery.
Reblockage of the blood vessels from blood clotting, even long after surgery, is an important complication.
To help prevent this complication, and repeat surgery, a tiny expandable metal mesh tube (stent) is often used along with angioplasty. However, even with stents, some patients experience new blockages within a year of surgery. Some angioplasties are performed with a drug-eluting stent, which is coated with the drug paclitaxel to help prevent artery blockages.Drug-eluting stents may not be recommended for patients who had recent heart surgery, or women who are nursing or pregnant.

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