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Peripheral Arterial Disease (PAD)

Peripheral arterial disease is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood. NIH - National Heart, Lung, and Blood Institute

About Peripheral Arterial Disease (PAD)

Peripheral arterial disease (P.A.D.) is a disease in which plaque (plak) builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood.

When plaque builds up in the body's arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis). Over time, plaque can harden and narrow the arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach. This article focuses on P.A.D. that affects blood flow to the legs.

Overview

Blocked blood flow to your legs can cause pain and numbness. It also can raise your risk of getting an infection in the affected limbs. Your body may have a hard time... Read more about Peripheral Arterial Disease

What works? Research summarized

Evidence reviews

Effectiveness and safety of sarpogrelate hydrochloride for peripheral arterial disease: a systematic review

Bibliographic details: Gao W, Wang F, Liu GJ, Ran XW.  Effectiveness and safety of sarpogrelate hydrochloride for peripheral arterial disease: a systematic review. Chinese Journal of Evidence-Based Medicine 2012; 12(3): 341-346 Available from: http://www.cjebm.org.cn/en/oa/DArticle.aspx?type=view&id=201203016

[Effectiveness of therapeutic physical exercise in patients with intermittent claudication due to peripheral arterial disease: a review]

Bibliographic details: Cebria Iranzo MA, Sentandreu Mano T, Baviera Ricart MC, Igual Camacho C.  [Effectiveness of therapeutic physical exercise in patients with intermittent claudication due to peripheral arterial disease: a review]. [Efectividad del ejercicio fisico terapeutico en pacientes con claudicacion intermitente por enfermedad arterial periferica: una revision.] Fisioterapia 2010; 32(4): 172-182

Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis

Bibliographic details: Simpson EL, Kearns B, Stevenson MD, Cantrell AJ, Littlewood C, Michaels JA.  Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis. Health Technology Assessment 2014; 18(10): 1-251

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Summaries for consumers

Prostanoids for treating people with severe peripheral arterial disease of the legs

People with severely narrowed arteries of the lower limbs may suffer rest pain, ulcers, or gangrene, and this problem is called critical limb ischaemia. There is no option other than amputation for patients who present with critical limb ischaemia and who are unsuitable for rescue or reconstructive intervention of the arteries. The question is whether specific drugs such as prostanoids reduce mortality and progression of the disease, including amputations, more than placebo or other treatments. This review of 20 trials did not find any conclusive evidence that prostanoids provided long‐term benefit. Prostanoids seem to have efficacy regarding rest‐pain relief and ulcer healing. Iloprost may also have favourable results regarding major amputations. The more frequently reported adverse events when using prostanoids were headache, facial flushing, nausea, vomiting and diarrhoea

Screening for peripheral arterial disease

Peripheral arterial disease (PAD) is caused by fatty deposits on the walls of the arteries (or atherosclerosis) that leads to narrowing of the arteries (or stenosis) and obstructions in the major vessels supplying the lower legs. PAD can cause discomfort or pain in the lower legs when walking. People with PAD have an increased risk of death, heart and cerebrovascular disease and often receive treatment to manage their cardiac risk. They suffer from significant functional limitations in their daily activities, and the most severely affected are at risk of limb loss. Many people with PAD do not have any symptoms. Only some people have discomfort or pain in the lower legs when walking, so PAD often goes undetected. One possible way to identify this disease is to screen the population at increased risk of PAD. It is important to determine the effectiveness of screening in preventing heart and cerebrovascular diseases or further progression of PAD.

Antiplatelet agents for reducing risks in patients with peripheral arterial disease and cramping pain in legs on walking

Peripheral arterial disease (PAD) refers to the blocking of large arteries. Patients with peripheral arterial disease as a result of narrowing of the arteries in the legs may present with cramping pain in the legs or buttocks on walking; this is also known as intermittent claudication (IC). This group of patients are at high risk of a heart attack, stroke and death. Treatment often involves stopping cigarette smoking and the optimising of other risk factors such as diabetes, high blood pressure and cholesterol. Another treatment often used to reduce the risk of heart attacks and strokes in patients with IC is antiplatelet treatment. Antiplatelets make the blood less sticky and therefore block the formation of blood clots, thereby preventing blockages in arteries which can cause heart attacks and strokes. Antiplatelet treatments include drugs such as aspirin, clopidogrel and dipyridamole, but there is limited evidence to date on the benefits of antiplatelet therapy in patients with IC. Twelve studies with a total of 12,168 patients were included in this review. The analyses show that, in patients with IC, antiplatelet agents reduced the risk of death from all causes, and from heart attack and stroke combined when compared with placebo. When aspirin was compared with other antiplatelet agents, there was some evidence that the alternative antiplatelet had a more beneficial effect in reducing all cause mortality or of suffering a cardiovascular event such as heart attack or stroke. However, this was based on only two trials. Antiplatelet usage, however, does increase the risk of indigestion and may also increase risk of major bleeding events. Despite its widespread use, the evidence for first line use of aspirin in patients with IC is weak and further research is required to determine whether aspirin would be better replaced by a different class of antiplatelet agent which has a greater beneficial effect with fewer side‐effects.

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Terms to know

Atherosclerosis
Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen-rich blood to your heart and other parts of your body.
Blood Cholesterol
A type of fat produced by the liver and found in the blood. Cholesterol is also found in some foods. The body uses cholesterol to make hormones and build cell walls.
Calcium
A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.
Lipids
A term for fat in the body. Lipids can be broken down by the body and used for energy.
Peripheral
On or near an edge or constituting an outer boundary; the outer area.
Plaque
In medicine, a small, abnormal patch of tissue on a body part or an organ. Plaques may also be a build-up of substances from a fluid, such as cholesterol in the blood vessels.
Tissue
A group of cells that act together to carry out a specific function in the body. Examples include muscle tissue, nervous system tissue (including the brain, spinal cord, and nerves), and connective tissue (including ligaments, tendons, bones, and fat). Organs are made up of tissues.

More about Peripheral Arterial Disease

Photo of an adult

Also called: Peripheral artery disease

See Also: Intermittent Claudication

Other terms to know: See all 7
Atherosclerosis, Blood Cholesterol, Calcium

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