Arteriosclerosis obliterans, or peripheral artery disease (PAD), is a medical condition that adversely affects blood vessels and circulation in a person's lower extremities and may contribute to nerve and tissue damage. Caused by a narrowing or hardening of the arterial walls, arteriosclerosis obliterans can lead to serious complications. Arteriosclerosis obliterans may be treated with medication, surgery, or lifestyle changes, depending on the severity of the disease's presentation and the overall health of the individual.
Peripheral artery disease results from a hardening of the arteries brought about by the accumulation of plaque. As the plaque builds up, the arteries narrow and blood flow becomes increasingly limited. Affecting the arteries that supply the legs and feet, PAD may cause the muscles in these areas to work twice as hard, whether the individual is moving or at rest. Individuals with a history of smoking, high cholesterol, or stroke may be more susceptible to developing PAD. Additional conditions that may contribute to the development of arteriosclerosis obliterans may include diabetes, hypertension, and heart disease.
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Individuals with PAD may experience a gradual onset of signs and symptoms of poor circulation. Initially, symptoms may only manifest when the person participates in activities that force the leg muscles to work harder than normal, such as walking uphill or briskly. Over time, symptoms may manifest more quickly, even though the individual is not exercising as much as when the signs first appeared. While resting, the individual may notice that his or her feet become tingly or numb and are pale or cold to the touch. As symptoms progress, the individual may develop moderate to severe chronic pain in his or her legs and feet.
Arteriosclerosis obliterans may be diagnosed through the administration of a variety of tests. During an initial examination, a physician may check the affected limb for a weakened pulse and low blood pressure. When a stethoscope is applied to the artery, blood flow may sound abnormal, a condition known as an arterial bruit. Those whose PAD has progressed may demonstrate shrunken calf muscles or have a bluish hue to their skin, known as cyanosis, which may be discovered during a physical examination. Diagnostic tests may include a magnetic resonance angiography (MRA), computerized tomography (CT) angiography of the affected area, and a Doppler ultrasound.
Treatment for PAD may include the use of over-the-counter or prescription medications to thin the blood, prevent clots from forming, and alleviate pain. Severe cases of peripheral artery disease that adversely affect one’s ability to work or function may require surgery. Arterial bypass surgery or angioplasty and stent placement may be utilized, depending on the severity of the individual’s condition. Extreme cases of PAD may necessitate amputation of the affected limb if no other treatment option is viable.
Arterial bypass surgery is an invasive procedure conducted under general anesthesia. During the procedure, the surgeon makes an incision over the affected artery and places clamps on each end of the blockage. The clogged portion of the artery is replaced with a graft that is sewn into place. The graft may be made of tissue taken from another blood vessel located elsewhere in the body or from man-made material. With the blockage removed and new arterial tissue in place, the clamps are removed and blood flow is restored.
An angioplasty and stent placement procedure is similar to that utilized for the heart. During the procedure, the individual may be given a local anesthetic and mild sedative to help him or her relax. Using image-guided technology, such as live X-ray, a small incision may be made in the groin area and a catheter, known as a guide wire, is inserted into the blocked artery. A second catheter, outfitted with a balloon, is passed along the guide wire to the blockage where it is inflated to open the artery. While the balloon is in place, a stent is positioned in the artery to help keep it open, and the balloon is deflated and removed.
Lifestyle changes may also be recommended to help manage and alleviate the symptoms associated with PAD. Individuals who smoke may be advised to quit, since smoking contributes to arterial constriction and impairs circulation. Dietary changes, proactive steps to reduce cholesterol, and regular exercise may also be recommended to help manage symptoms.
Complications associated with peripheral artery disease may include the development of gangrene, amputation, blood clots, and heart disease. Risks associated with surgical procedures for PAD may include infection, breathing difficulty, and stroke. Additional complications associated with surgery may include nerve or tissue damage, allergic reaction to materials used or medications administered, and excessive bleeding.