Peripheral arterial disease [PAD] is a common circulatory problem in which narrowed arteries reduce the blood flow to the limbs.
This causes symptoms, most notably leg pain when walking – a condition called intermittent claudication [IC].
PAD may be a sign of widespread accumulation of fatty deposits in the arteries (atherosclerosis).
This condition may be reducing blood flow to the heart and brain as well.
PAD can be treated with exercise, with a healthy diet and, quitting smoking.
Early diagnosis and treatment is important to stop the heart disease and stroke.
SIGNS AND SYMPTOMS
It can be mild or severe.
Intermittent claudication [IC] causes muscle pain or cramps in the legs or arms, triggers by activity, such as walking, and disappears after a few minutes of rest.
The location of the pain depends on the location of the clogged or narrowed artery. Calf pain is most common.
When PAD progresses, “Ischemic rest pain” can occur where even at rest the pain continues.
Other signs and symptoms of peripheral arterial disease include:
Leg numbness or weakness
Cold legs or feet
Sores on the toes, feet or legs that will not heal
A change in the color of the legs
Hair loss on the feet and legs
Changes in the nails
Atherosclerosis (plaques in the walls of the artery).
When PAD affects the arteries that supply blood to the heart muscle, it can cause chest pain (angina) and sometimes a heart attack.
When it occurs in the arteries in the neck and the brain, it can cause a stroke (paralysis).
Injury or infection can also cause PAD.
Above 50 years
High blood pressure
People who smoke or have diabetes have the greatest risk of complications from PAD — such as tissue death (gangrene) in a leg due to reduced blood flow.
SCREENING AND DIAGNOSIS
A weak or absent pulse below a narrowed area of the artery.
Whooshing sounds (bruits) over the arteries that can be heard with a stethoscope.
Evidence of poor wound healing in the area where the blood flow is restricted.
Decreased blood pressure in the affected limb
Ankle-brachial index (ABI): This test compares the BP in the lower limb with the BP in the arm. Patient may walk on a treadmill and have readings taken before and immediately after exercising to capture the severity of the narrowed arteries during walking.
Electrocardiogram (ECG). Blood tests . To measure cholesterol and the level of C-reactive protein, which is a marker for heart disease. Ultrasound .
Magnetic resonance angiography (MRA)
Computed tomography angiography (CTA).
Critical limb ischemia (CLI)
Treatment for PAD has two major goals.
The first is to manage symptoms.
The second is to stop the progression of atherosclerosis throughout the body to reduce the risk of heart attack and stroke.
Lifestyle should be changed and smoking should be stopped.
Drugs can be used to prevent blood clots, lower blood pressure and cholesterol.
Varicose veins [VV] are gnarled, enlarged veins.
The word "varicose" comes from the Latin root "varix," which means "twisted."
Any vein may become varicose, but the veins most commonly affected are those in the legs and feet.
That's because standing and walking upright increases the pressure in the veins in the lower body.
VV and spider veins — a common, mild and medically insignificant variation of varicose veins — are simply a cosmetic concern.
VV can cause aching pain and discomfort. Sometimes the condition leads to more serious problems.
VV may also signal a higher risk of other disorders of the circulatory system.
Common condition in the United States, affecting up to 15 percent of men and up to 25 percent of women.
SIGNS AND SYMPTOMS
An achy or heavy feeling in the legs, and burning, throbbing, muscle cramping and swelling in the lower legs. Prolonged sitting or standing tends to make the legs feel worse.
Itching around one or more of the veins.
Skin ulcers near the ankle, which represent a severe form of vascular disease and require immediate attention.
Varicose veins are dark purple or blue in color and may appear twisted and bulging — like cords.
They commonly appear on the backs of the calves or on the inside of the leg.
They can form anywhere on the legs, from the groin to the ankle.
Spider veins are similar to varicose veins, but they're smaller.
Spider veins are found closer to the skin's surface and are often red or blue.
They occur on the legs, but can also be found on the face.
Spider veins vary in size and often look like a spider's web or a tree branch.
To return blood to the heart, the veins in the legs must work against gravity.
Muscle contractions in the lower legs act as pumps, while toned, elastic vein walls help blood return to the heart.
Tiny one-way valves in the veins open as blood flows toward the heart then close to stop blood from flowing backward.
As the patient get older the veins can lose elasticity, causing them to stretch.
The valves in the veins may become weak, allowing blood that should be moving toward the heart to flow backward.
Blood pools in the veins, and the veins enlarge and become varicose.
The veins appear blue because they contain deoxygenated blood, which is in the process of being recirculated.
Some pregnant women develop varicose veins.
Pregnancy increases the volume of blood in the body, but decreases the flow of blood from the legs to the pelvis.
This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in the legs.
VV may surface for the first time or may worsen during late pregnancy, when the uterus exerts greater pressure on the veins in the legs.
Hemorrhoids are varicose veins located in and around the anus.
Age . Aging causes wear and tear on the valves in the veins that help regulate blood flow. Eventually, that wear causes the valves to malfunction.
Sex . Women are more likely than men are to develop the condition. Hormonal changes during pregnancy, premenstruation or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase the risk of varicose veins.
Genetics . If other family members had varicose veins, there's a greater chance the patient will too.
Obesity . Being overweight puts added pressure on the veins.
Standing for long periods of time . The blood doesn't flow as well if the patient is in the same position for long periods.
SCREENING AND DIAGNOSIS
In making a diagnosis, the doctor will examine the legs while standing and will look for swelling and ask the patient to describe the pain and aching in the legs.
Finally, the doctor may perform an ultrasound test to see if the valves in the veins are functioning normally or if there's any evidence of a blood clot.
The primary care doctor may recommend that the patient see a doctor who specializes in vein conditions (phlebologist) or a doctor who treats skin conditions (dermatologist or dermatology surgeon).
Extremely painful ulcers may form on the skin near varicose veins, particularly near the ankles.
Ulcers are the result of long-term "water logging" of these tissues, caused by increased pressure of blood within affected veins.
Brownish pigmentation usually precedes the development of an ulcer.
See the doctor immediately if the patient suspect an ulcer.
Occasionally, veins deep within the legs become enlarged.
In such cases, the affected leg may swell considerably.
Any sudden leg swelling warrants urgent medical attention because it may indicate a blood clot — a condition known medically as thrombophlebitis.
Treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery.
Less invasive techniques generally allow varicose veins to be dealt with on an outpatient basis.
Self-help measures – such as exercising, losing weight, not wearing tight clothes, elevating the legs and avoiding long periods of standing or sitting – can ease pain and prevent varicose veins from getting worse.
Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.
Varicose Vein Treatments
Endoscopic vein surgery.
Be a cautious consumer
When it comes to treatment options for varicose veins, it pays to be a cautious health consumer.
Advertisements claiming "unique," "permanent" or "painless" methods to remove varicose veins may be appealing, but they may not actually measure up to those claims.
Before undergoing any procedure, ask the doctor about any health risks and possible side effects.
The patient may want to inquire about treatment costs, as well.
Most insurance policies don't cover the expense of elective cosmetic surgery for varicose veins.
In many cases, if the patient have signs or symptoms such as swelling and bleeding, insurance may cover the treatment.
Current treatments for varicose veins and spider veins are highly successful; however, it's possible that varicose veins can recur.
PREVENTION There is no way to completely prevent varicose veins, but improving the circulation and muscle tone can reduce the risk of developing varicose veins or getting additional ones. Traditional, common-sense approaches include:
Exercise . Get the legs moving. Walking is a great way to encourage blood circulation in the legs. The doctor can recommend an appropriate activity level for the patient.
Don't sit with the legs crossed . This position can aggravate circulation problems.
Watch the weight, and the diet . Shedding excess pounds takes unnecessary pressure off the veins. What the patient eat makes a difference, too. Follow a low-salt, high-fiber diet to prevent the swelling that may result from water retention and constipation.
Watch what the patient wear . Avoid high heels. Low-heeled shoes work calf muscles more, which is better for the veins. Don't wear tight clothes around the waist, legs or groin. Tight panty-leg girdles, for instance, can restrict circulation.
Elevate the legs . To improve venous circulation, take several short breaks daily to elevate the legs above the level of the heart. For example, lie down with the legs resting on three or four pillows.
Avoid long periods of sitting or standing . Make a point of changing the position frequently to encourage blood flow. Try to move around at least every 30 minutes.
Arm exercise may reduce leg pain caused by peripheral arterial disease
Mean age of the subjects was 67 years, 27% had diabetes mellitus, and 87% had a history of smoking.
Arm ergometry using a hand bike, treadmill walking, or a combination of the two.
Measured maximal walk distance and time to onset of pain with exercise at baseline and at 12 weeks.
It's possible that the heart begins to pump more efficiently, under increased pressure with exercise, such that blood and oxygen reach the legs better.
Arm exercise may stimulate growth factors, resulting in a sprouting of new blood vessels in the legs...it may cause the release of substances that would improve endothelial function and it may cause the vessels [in the leg] to dilate, allowing more blood flow to the leg muscles.
While symptoms were most improved with treadmill exercise and combination training, the improvement with arm exercise alone was significantly improved over baseline in the arm ergometry patients, Dr. Treat-Jacobson announced.