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Know More about Peripheral Artery Disease (PAD)

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Vascular Surgery

Know More about Peripheral Artery Disease (PAD)

Dr. Digvijay Sharma
Senior Consultant - Vascular & Endovascular Surgery
Vascular Surgery

PAD is also called as Peripheral Vascular Disease (PVD) and Peripheral Artery Occlusive Disease (PAOD). If you are suffering from Peripheral Artery Disease (PAD), it means that the narrowed arteries will reduce blood flow to your limbs. This can decrease circulation and lead to death of tissue. Below mentioned are the most common reasons for you to visit the Cardio Vascular Doctor:

When is the need to visit a vascular surgeon?

Target Organ Artery Location Symptoms
Brain

Neck-Carotid

  • Stroke
  • Blindness
  • Transient ischemic attack
Intestines Abdomen
  • Pain in abdomen especially after meals.
  • Gangrene of intestines (This is an Emergency)
Kidney Abdomen
  • Hypertension
  • Decreasing kidney function
Limbs Arm, Leg
  • Pain on working, walking
  • Pain at rest
  • Blue/Black toes
  • Gangrene

It is expected that 20% of population above 65 years will have this condition while 30% diabetes patients are at a higher risk of having stroke and heart attack. Thus, diagnosing them is very critical. 

What are the Risk factors?

If you have any risk factor mentioned for more than 6 months duration, it is time that you visit the doctor immediately:

  • Hypertension-Increased Blood Pressure.
  • Diabetes
  • Smoking
  • Uncontrolled diabetes
  • Coagulation abnormalities
  • Kidney dysfunction
  • Homocysteine issues

Diagnosis will be delayed or missed in patients with conditions that limit mobility as symptoms will not manifest:

  • Arthritis
  • Severe lung disease
  • Heart failure
  • Diabetics with neuropathy – here the pain sensation being reduced diagnosis will be difficult.

Procedures That May Be Required

Amputations: This is the most common procedure as the patient can have delayed presentations and limbs are not salvageable at all time they reach the vascular clinic. The procedure is done to save the rest of the limb or life of the patient.
Revascularization procedures- This is done to increase the blood supply to the target organ to prevent organ deaths.

   i. Open surgeries

          a. Endarterectomy – Unblocking.
          b. Bypass – Block left as it is alternative blood supply route is created

  ii. Endovascular procedures

          a. Angioplasty +/- Stenting
          b. Atherectomy – Drilling or laser ablation through the block and making the blood vessel diameter wider.

Few points to remember

  • Usually procedures will not be needed if vascular consultation is timely.
  • There is not one procedure to all the PAD patients and based on the patient profile, the procedures must be individually planned.
  • The group of patients is extremely disadvantaged with only 50% living beyond 5 years of presentation.
  • The disease can be life threatening in patients whose arteries of the whole body is narrowing but steadily.

The final determinant of vascular surgeons success will be determined by the patient’s perception of enhancement in the quality of life of the patient’s remaining most valuable years.