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The Cardiovascular SystemPeripheral Arterial Disease Synonyms : Charcot’s Syndrome, Intermittent Claudication, Myasthenia Angiosclerotica Clinical features, Diagnosis, Management, Prognosis, Nutrition, Herbs, Disease
of the peripheral arteries is most commonly due to atherosclerosis.
Atherosclerosis may be defined as chronic arterial disease characterised by
formation of raised fibro-fatty plaques in the intima (inner layer of a blood
vessel wall) that cause narrowing of
a blood vessel and
impairment of blood flow (ischaemia). The precise pathologic
mechanism of atherosclerosis is unknown, but it is very well known that high
concentrations of cholesterol in the serum are very important. It is possible
that atherosclerosis occurs as an abnormal response of the blood vessels to
chronic irritation (e.g., smoking) or endothelial injury due to shear stress
caused by long standing hypertension. Risk factors
associated with atherosclerosis: 1.
Modifiable:
smoking,
elevated blood pressure, diabetes mellitus, elevated cholesterol (LDL),
decreased physical activity, obesity, stress 2.
Nonmodifiable:
age, sex (male to female ratio 6:1), race, heredity (familial predisposition) Atheromatous peripheral vascular disease is more common in men than women, is strongly associated with smoking, and affects legs more than arms. Clinical features: < BACK TO TOP >
Symptoms
are related to insidious development of tissue ischaemia.
The
initial symptom is intermittent claudication, which is a discomfort,
ache, cramp or tired feeling in the calves or buttocks that comes on with
walking and disappears with rest (claudication is derived from a Latin word
for limping).
Disease
progression is indicated by a reduction in the distance that the patient can
walk without symptoms.
Eventually
there is rest pain in the affected limb, which gets worse at night.
Pulses
in the leg and foot are diminished or absent, the limb is cold and often numb
with tingling sensations, the skin is pale and hair growth is absent.
Clinical
features are best remembered as ?Ps? pain, pallor, pulseless (diminished
pulses), paraesthesiae, paresis (weakness) and perishing (cold).
Small
patches of skin necrosis may appear, typically on the toes or heel,
occasionally on the leg, often after a minor injury; they tend to heal very
slowly. Finally, gangrene may occur, usually starting with one or more toes; this outcome is especially common in diabetics who tend to suffer from accelerated atherosclerosis. Diagnosis: < BACK TO TOP >
History
and clinical findings are often very suggestive.
Doppler
ultrasound can give information about the blood flow through arteries, and is
most widely used today.
Angiography
(X-ray after the contrast had been injected into the artery through a
catheter) is an invasive technique that allows an accurate assessment of the
presence and extent of vascular stenosis.
Magnetic
resonance angiography offers images similar to contrast angiography without
the need for catheters or radiation, and may eventually supersede it
completely. Plain radiographs (X-ray) of the extremities have minimal diagnostic values in occlusive disease and may sometimes detect vascular calcification consistent with atherosclerosis. Management < BACK TO TOP >
Treatment
often proves difficult because treatment options are limited.
Patients
are advised to stop smoking and lose weight if obese, in diabetics blood
glucose control should be optimised.
Regular
exercise should be encouraged because it can increase collateral blood flow.
Vasodilator
drugs (e.g., calcium antagonists, oxypentifylline [Trental]) are sometimes
prescribed but frequently are not very helpful because the changes are
irreversible.
Prophylactic
foot care performed by the patient or a podiatrist is essential (regular
hygiene, clean socks, appropriate shoes etc.) Surgery is considered for severe disability, intractable pain or limb in jeopardy (percutaneous transluminal angioplasty with stent implantation, surgical reconstruction such as bypass grafting, amputation in case of gangrene). Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP > Nutrition that alleviate or prevent Peripheral Arterial Disease :- Herbs < BACK TO TOP > Herbs that alleviate or prevent Peripheral Arterial Disease :- (source : -) |
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