Risks of Peripheral Vascular and Arterial Diseases
Dr. Alvaro Alonso Alvaro Alonso, MD, FSVM
Assistant Professor of Medicine, Tulane University Heart & Vascular Institute
Peripheral vascular disease (PVD) refers to diseases and disorders of the blood vessels outside of the heart, such as those of the brain, gut, kidneys, or limbs. PVD is typically caused by blockage or damage to blood vessels such as veins and arteries.
The heart pumps blood through pipes called arteries to supply all of your organs and limbs. From there, blood returns to the heart in pipes called veins and lymphatic vessels. Each of these pipes or vessels can develop diseases.
PVD can affect the arteries which supply your brain, the arms, the legs or your organs in your abdomen. The aorta, the main artery which supplies all organs and limbs can become weakened, causing an aneurysm. PVD can also affect the veins, causing problems such as venous insufficiency or varicose veins.
Peripheral artery disease
When PVD affects the arteries, we call it peripheral artery disease (PAD). If we focus our attention only on PAD affecting the legs or lower extremities, we realize that it is a very frequent condition: It affects over 12 million people in the United States, and over 220 million people worldwide. The chances of getting PAD increase with age. Almost 1 in 25 persons older than 40, 1 in 7 over 70, and 1 in 4 over 80 have PAD. There are more people with PAD than there are patients with heart failure, stroke or Alzheimer's disease. Patients with lower extremity PAD have a higher chance of dying than patients with a previous stroke, previous heart attack or breast cancer. The cost of PAD is estimated to be $4 billion a year in the US.
While there are many forms of lower extremity PAD, the most frequent cause is cholesterol plaque buildup (atherosclerosis). Risk factors for the development of PAD include smoking, diabetes, high blood pressure, high-cholesterol, obesity and a sedentary lifestyle.
When patients have PAD, blood flow to the legs becomes limited, which can cause pain or numbness when walking, and can potentially lead to skin breakdown or even the threat of losing a limb through amputation. The risk of death is much higher among patients with PAD, even among patients without symptoms. This is simply because patients who have developed more plaque buildup than others have a much higher risk of suffering a future heart attack or a stroke. That's why it is important to detect PAD early and aggressively treat risk factors in addition to leading a healthy lifestyle.
Lower extremity PAD is very easily detected with a test called ABI or ankle-brachial index, which consists of measuring the blood pressure in your arms and legs with the assistance of a special machine. This test is more accurate than many other screening tests used in Medicine (such as PAP smears or mammograms). The American College of Cardiology recommends screening with an ABI for patients with leg pain, non-healing wounds or patients at risk of PAD (e.g., diabetics, patients with history of smoking or patients over the age of 70).
PAD treatments focus on two main aspects: 1) an emphasis in decreasing the risk of heart disease and stroke, and 2) controlling leg symptoms. The first is achieved by very aggressive management of heart disease risk factors (controlling diabetes, blood pressure and cholesterol, quitting smoking, exercising, etc). To control leg symptoms, there are exercise programs (supervised rehabilitation) and medications that can relieve leg pain. Sometimes patients may also require procedures, such as angioplasty, stent placement or even surgery.
More information about PAD, visit: http://www.nhlbi.nih.gov/health/health-topics/topics/pad To make an appointment with a cardiovascular physician with the Tulane University Heart and Vascular Institute, please visit: http://www.tulaneheart.com
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