Treating Peripheral Arterial Disease
Contents
Introduction
Peripheral Arterial Disease (PAD) is a disease of the arteries, the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels that carry blood from the heart to the rest of the body. It usually develops when fatty deposits (plaques) build up on the walls of the arteries (this is called atherosclerosisDisease leading to fatty deposits in the inner walls of the arteries, which reduce and may eventually obstruct blood flow.), causing the arteries to become narrowed. This in turn restricts the flow of blood to the muscles in the limbs. The disease typically affects the legs, causing pain on walking, although often there will be no symptoms and sufferers are frequently unaware that they have it. It is however important to detect and treat the disease as it increases the risk of heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. or strokeAny sudden neurological problem caused by a bleed or a clot in a blood vessel. and PAD is classed as equivalent to coronaryRelating to the arteries supplying the heart itself. heart disease (CHD). It is a common problem in older people with around 1 in 10 people aged between 60 and 70 suffering from PAD, and this rises to 2 in 10 over the age of 70. It is more common in men than women.
Diagnosing Peripheral Arterial Disease
Despite the fact that PAD is so prevalent it is often not diagnosed and even when a diagnosisThe process of determining which condition a patient may have. is made appropriate treatment goals are often not set. This is a missed opportunity to effectively treat a high risk population. The relatively simple ankle –brachial pressure index test (ABPIAn abbreviation for ankle brachial pressure index) can be used to detect PAD and this is something that can easily be done in the GP surgery. It is a test that measures blood pressureThe pressure of blood within the arteries. at the ankle and in the arms and compares the ratio of the two. Lower blood pressure in the legs compared with the arms is an indication of blocked arteries.
Treatment
We now have evidence that shows that lowering lipid levels with the use of statinsA class of drugs that inhibit cholesterol formation in the liver. reduces the risk of heart attack and stokes in people suffering from PAD. In addition, there is some evidence that suggests that this treatment also improves symptoms and preserves kidneyOne of two bean-shaped organs that are located on either side of the body, below the ribcage. The main role of the kidneys is to filter out waste products from the blood. function. We also have emerging evidence showing that taking statins a few weeks before surgery also helps to reduce any associated risks. Other vascularRelating to blood vessels. risk factors also need to be addressed including type-2 diabetesA disorder caused by insufficient or absent production of the hormone insulin by the pancreas, or because the tissues are resistant to the effects. and high blood pressure, both of which are common among people with PAD. Furthermore, PAD is very strongly associated with smoking. People with PAD also benefit from taking antiplatelet medication such as aspirinOne of the most used medicines..
As far back as 1994 the vascular surgery and vascular disease prevention teams at the Royal Free Hospital set up a weekly outpatient clinic that addresses the medical aspects of treating PAD and it would be encouraging to see this model being followed.
Dr Dimitri Mikhailidis
