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Peripheral Artery Disease (PAD) in Seniors

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Peripheral arteries are all the arteries other than the aorta but the term primarily refers to the arteries of the extremities – the arms and legs. Narrowing of the peripheral arteries leads to diminished blood supply to the affected region giving rise to symptoms of peripheral artery disease. The arteries could also be blocked due to fatty deposits (atherosclerosis) or clots. The disease is quite common among smokers and is more often seen in the senior years. It is one of the main causes of symptoms seen in the hands and legs in the senior years.

Symptoms of Peripheral Artery Disease

Most of the symptoms of peripheral artery disease involves the leg. Since the lower leg and feet are the furthest away from the heart, the pressure in the arteries may not be sufficient at this distance to overcome the narrowing. The main symptom is leg pain which tends to arise during walking or climbing stairs. The pain is usually not present at rest. The pain can be mild or even disabling pain which can restrict activities of daily living. It is known as claudication.

Cramping could be present more commonly in the calf muscles or thighs after minimal to moderate activity. Other symptoms of diminished blood supply could be seen such as leg numbness, cold feet, diminished hair growth, ulcers, poor wound healing and discoloration of the skin on the legs. Pulses are not easily detected or similar on both sides. As the disease progresses and becomes severe, pain can be present even at rest. Symptoms are usually unilateral if the disease is due to blockage due to clots.

Causes and Risk Factors

Any cause that would lead to narrowing of the arteries can lead to peripheral artery disease. Narrowing is usually caused due to blockage of arteries by fatty plaques – a condition known as atherosclerosis. High blood pressure causes thickening of the arteries and contributes to atherosclerosis. It is therefore an important component in the development of peripheral arterial disease.

Other major factors that contribute to the development of peripheral arterial disease includes high blood cholesterol, diabetes mellitus, cigarette smoking and obesity. A previous injury to an artery, infection or other conditions that can affect the arteries may contribute to peripheral arterial disease in the long term. It often becomes evident only in the senior years despite starting earlier in life.

Treatment

Lifestyle changes should be instituted along with medication for any underlying contributing factors. Lifestyle measures include :

  • Regular cardiovascular exercise.
  • Discontinuing smoking.
  • Controlling the diet – low fat and low sodium diets.

Medication will be used to treat hypertension, hypercholesterolemia and diabetes. By controlling these conditions, the narrowing of the artery can be slowed down or even reversed to some degree. Anticoagulants are also used to prevent blood clots from suddenly blocking the narrowed artery thereby cutting off the blood supply and leading to a condition known as acute limb ischemia. In acute cases, thrombolytic drugs (clot busters) may be used to restore the blood flow.

Surgical measures are reserved for severe cases. This is similar to a narrowed artery elsewhere in the body. The artery is widened and a stent is placed within it to keep it in the wider state. In very rare instances, a bypass surgery is done to reroute the blood flow around the narrowed part of the artery. Ulcers that do not heal, have become severely infected and the presence of gangrene may warrant surgical amputation of a portion of the leg.


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