Peripheral arterial occlusion
Merk Manual: Peripheral arterial occlusion
American Heart Association
Wikipedia.com, Peripheral Atery Occlusive Disease, was used as basis for this article; edited for content.
WebMD.com, Peripheral Aterial Disease of the Legs
Fast Click to Complications
Foot & Skin Problems
High Blood Pressure
Seizures & Coma
Peripheral Artery Disease
Diabetes Treatment & Management
Main Treatment Menu
Diabetes Type 1
Monitoring Your Blood Glucose
Pancreas Islet Cell Transplant
Pancreas (Organ) Transplant
Herbals & Natural
Lifestyle Approaches to Diabetes Management
John A. Seneff
Numb Toes and Aching Souls: This is, in
a nutshell, the best current work on the subject of neuropathy for lay people.
It explains the problem, goes through the rational for treatment, and discusses
the treatments one by one. In addition to the use of PO medication, it covers vitamin therapy, physical therapies, psychotherapy and
for patients who fail standard treatments, it covers alternative therapies such
as plasmapheresis and hyperbaric oxygen. Seneff also covers experimental
treatments still in clinical studies. His treatment of the subject is
comprehensive and empathetic. He devotes a chapter to coping skills, which
will benefit all diabetes patients. The sections on physical modalities are also very valuable. Many of these
patients are on multiple medications already and are reluctant to take
additional medicines.. Senneff found that many patients have gotten considerable
relief from non-medical treatments. Alan Sherman, DPM
8-12 million people in the U.S. have a silent condition that
could cost them a leg or their lives.
Most have never heard of their
condition: peripheral artery disease (PAD).
Many have no symptoms, except perhaps
slight pain or tingling in the leg.
Check your symptoms on WebMD to see if you may have this disease.
back to main "Complications" page
Symptoms, Causes, Treatment & Prevention
Peripheral Artery Occlusive Disease (PAOD)
also known as Peripheral Vascular Disease (PVD) and Peripheral Arterial Disease (PAD)
Mini Site Index
What is Peripheral Artery Disease (PAD)?
Signs and Symptoms
Diabetes and PAD
References and Source Links
Peripheral artery occlusive disease (PAOD is also known as peripheral
vascular disease [PVD]) is a term for all disease caused by the obstruction of large peripheral
arteries, which can result from atherosclerosis, inflammatory processes leading
to stenosis, an embolism or thrombus formation. It causes either acute or chronic ischemia. It can also effect the lymph vessels.
What is Peripheral Artery Disease (PAD)?
PAD, is a disease of the blood
vessels. The arteries supplying blood to the limbs get blocked and
usually affects one or both legs but it can also affect the arms
or "peripheral" body organs (that is, any organ other than the brain, the heart,
or the lungs).
thickening of the walls of the arteries due to cholesterol-filled plaques, is usually the cause of PAD. Occasionally,
PAD occurs suddenly when a blood clot formed in the heart or in
another blood vessel breaks off and wedges itself in a smaller artery.
Signs and Symptoms
Many people do not know that they have a problem. They may think that they only have back or muscle pain-related problems, when in fact, they could have PAD. The most common symptom is cramping, pain or tiredness in the leg
or hip muscles while walking or climbing stairs. Typically, this pain
goes away with rest and returns when you walk again. Other symptoms include:
- Muscle pain in buttocks, calf, leg, or back
- Slight pain or tingling in legs
- Pain that worsens with movement and exercise
- Foot or leg pain at rest
Approximately 75% of all persons with PAD do not have any symptoms; those that do usually mistake them for something else. PAD affects both men and women but men are more likely to experience symptoms than women.
If you have diabetes, you are at risk for developing PAD. Other risk factors include:
- Cigarette smoking (major risk factor for
PAD; smokers who develop PAD are diagnosed about 10 years earlier
- Diabetes mellitus
- High blood pressure
- Physical inactivity (exercise increases the distance that
individuals with PAD can walk without pain and also helps to decrease the risk
of heart attack or stroke. Note: supervised exercise programs are one of the
treatments for PAD patients.) High blood cholesterol (LDL)
- Family history of vascular or heart disease
- Age (being over age 50 increases risk of developing PAD)
Peripheral artery occlusive disease is commonly divided into (Fontaine) stages:
- I: mild pain on walking ("claudication")
- II: severe pain on walking
relatively shorter distances (intermittent claudication)
- III: pain while resting
- IV: loss of sensation to the lower part of the extremity
- V: tissue
All causes of atherosclerosis are also causes of PAOD. There
is, however, a strong preponderance of diabetic people who smoke. A known diabetic
who smokes runs an approximately 30% risk of amputation within 5 years.
Upon suspicion of PAOD, the first-line test is the Ankle brachial pressure index
(ABPI/ABI) which is a measure of the fall in blood pressure in the
arteries supplying the legs. A reduced ABPI (less than 0.9) is consistent with
PAOD. Values of ABPI below 0.8 indicate moderate disease and below 0.5 severe
The next step is generally a form of angiography, where a catheter is used to inject
radiodense contrast agent into the femoral artery and selectively guided to the
artery in question. Stenosis of the arteries can be identified, and generally
correlates with the patient's symptoms.
Dependent on the severity of the disease, the following steps can be
- Conservative measures include Smoking cessation (cigarettes promote PAOD
and are a risk factor for cardiovascular disease). Regular
exercise for those with claudication helps open up alternative small vessels
(collateral flow) and the limitation in walking often improves.
Medication with aspirin and statins, which reduce clot formation and
cholesterol levels, respectively can help with disease progression and address
the other cardiovascular risks that the patient is likely to have.
- Angioplasty(PTA or
percutaneous transluminal angioplasty) can be done on solitary lesions in large
arteries, such as the femoral artery.
- Occasionally, bypass grafting is
needed to circumvent a seriously stenosed area of the arterial vasculature.
Generally, the saphenous
vein is used, although artificial (Gore-Tex) material is often used for large tracts when
the veins are of lesser quality.
- Rarely, sympathectomy
is used - removing the nerves that make arteries contract, effectively leading
- When gangrene of toes has set
in, amputation is often a last
resort to stop infected dying tissues from causing septicemia.
thrombosis or embolism has a dismal prognosis, but is occasionally treated
successfully with thrombolysis.
When the parts of the body fed no longer being by the blocked blood vessels organs and tissues don't get enough
oxygen and nutrients. This causes damage and tissues ad organs can die if blood flow
doesn't improve. Without treatment a person could lose a leg or die.
PAD can lead to gangrene (tissue death) and amputation, something diabetes may also be at increased risk for without PAD. It is therefore, very important to follow your doctor's instructions on managing blood glucose, diet, and exercise.
Disorders Associated with PAD
Many PAOD patients also have angina pectoris or have had myocardial
infarction. There is also an increased risk for stroke.
Diabetes and PAD
Diabetes itself is a risk factor for PAD. Hyperglycemia (high blood glucose levels) is a major contributing factor to many complications of diabetes. A healthy diet, exercise, and stress management care plan all will help you to better control your blood glucose levels and reduce your risk of developing PAD or other complications.
Know your target and ranges for your blood glucose. If you are insure, ask your doctor to write it down for you. Staying in those ranges is one of the most important aspects of diabetes daily care.