Peripheral arterial disease

Peripheral arterial disease
Peripheral Artery Disease (PAD)

By: Mohammed Labib Salem

Professor of Immunology – Faculty of Science

Director of the Center of Excellence for Cancer Research

Tanta University – Egypt

Dr.. Adel Salah Bagosh

General Practitioner – Shubramles Hospital – Egypt

Peripheral arterial disease is a disease caused by complications of atherosclerosis. Where the accumulation of LDL (LDL) on the wall of blood vessels to the narrow arteries, large and small, which impedes the flow of blood to the parties, resulting in a lack of blood supply necessary for the tissues, especially with muscle effort may increase these constraints to become tissues even during periods of rest. More damage by increasing these constraints.

Peripheral arterial disease is common in the limbs, especially in the legs, more than any other part of the body. The most vulnerable areas are the aorta and its branches, particularly the femoral and popliteal arteries, the sinus artery, or the large tibial artery. Youth is more likely to develop peripheral arterial disease, but it is common in older people over the age of 40. The global prevalence rate is between 3 and 12 percent. The number of patients in America and Europe is 27 million. The number of cases requiring hospitalization is estimated at 413,000 cases per year of peripheral arterial disease.

Causes of peripheral vascular disease:

As the disease is a form of atherosclerosis, most of the risk factors that cause heart disease also increase the risk of infection such as: (smoking – high blood pressure – diabetes – high cholesterol levels in blood – obesity), but there are some differences, on the face In particular, the type of human race – Americans and Africans – is more likely to occur, and men are more susceptible than women to the disease and increase the incidence of aging and in families with heart disease.

Symptoms:

Many people with peripheral arterial disease may not have any symptoms at all. However, early diagnosis and treatment is of paramount importance because people with the disease may have arteriosclerosis in other arteries of the body, increasing the chances of a heart attack or stroke. The earliest and most common symptoms of peripheral arterial disease are called “intermittent limp” (intermittent claudication) and usually suffer from muscle pain caused by muscle contraction, but the symptoms of this disease may appear in the form of numbness, tingling, fatigue or stress. Whatever the shape of the symptoms, the limp appears when the muscles can not supply enough oxygen. The limp appears during the exercise and goes after minutes of rest. People with mild dislocations can walk long distances before the symptoms appear, but people with severe peripheral arterial disease may experience pain after walking for only a few meters. The location of the pain depends on the location of the blockages.

The most important symptoms are symptoms that appear during rest. They appear when the blockages are so severe that muscles, while relaxed, can not get enough oxygen. The most common symptoms are foot pain. At first the pain is very tired when the man is raised, especially when lying in bed at night. However, if the disease is developed, the pain will be persistent and can not be alleviated by sitting or standing, as may appear in patients with moderate to severe cases of peripheral arterial disease ulcers or other skin problems in the foot and men.

The most serious symptoms are known as “critical limb ischemia”. Is tissue damage due to lack of blood and oxygen. In cases of peripheral arterial disease, these symptoms can occur as a result of blockage in the narrow artery leading to the occurrence of gangrene or amputation of the limbs. Terminal ischemia is a real emergency condition that requires immediate treatment to prevent gangrene, amputation or death. Although the symptoms of pain during rest is a less urgent emergency, it also requires angiogenesis (either surgery or operation to remove the narrowing of the arteries and placing supports in them). However, patients with intermittent limp can respond well to treatment, by changing their lifestyle along with taking medication, so early diagnosis and treatment are very important.

Diagnosis:

To diagnose the risk of peripheral arterial disease, the doctor examines the patient’s pulse. Although the muscles of the man cover the arteries, the doctor can monitor the pulses at the top of the foot, in the ankle, behind the knee, and in the convergence of the thighs. It is important that the doctor check the pulses in both men and examine the skin areas. In the case of peripheral arterial disease, the skin does not receive enough oxygen-saturated blood. Over time, the skin becomes cold, thin and shiny, while hair growth declines. The patient is subjected to a blood test to determine the level of cholesterol, blood sugar and kidney function.

Ankle brachial index is the only test used to diagnose peripheral vascular disease. This test compares blood pressure in your ankle with blood pressure in your arm. If the blood pressure in your lower leg is less than the pressure in your arm, you may have peripheral vascular disease.

Other tests can be performed to diagnose peripheral vascular disease:

• Angiogram: injects blood coloring into the blood vessels and uses the catheter with X-rays to show if the arteries are narrow or blocked.
• Ultrasound: This test uses sound waves to output images of the blood vessels on a monitor.
• Magnetic resonance imaging (MRI) MRI scan: A special scanning technology is used to look for clogged blood vessels.

the cure:

• If the disease is in its early stages, treatment is done with the treatment of the carcinogenic factors of atherosclerosis. If the disease in its late stages may be resorting to surgical intervention sometimes.

• People with peripheral vascular disease are at increased risk of heart attack and stroke; therefore, it is very important to address risk factors for cardiovascular disease:

• Smoking cessation – control of blood pressure – increase physical activity (exercise prescribed by the doctor in a special style) – weight reduction – low consumption of saturated fat – low cholesterol food – foot care.

Medications:

• Cholesterol-lowering drugs: The level of LDL should be reduced to no more than 70 mg / dL and the majority of statins are used to achieve these goals. Statin therapy also reduces the risk of heart attack and stroke in patients with peripheral arterial disease.

• Drugs to improve symptoms to reduce leg pain: These drugs increase the blood flow of the limbs and the expansion of blood vessels and help prevent the formation of blood clots in this regard is described as a drug Cilostazol, which appears more effective than an old drug Pentoxifyllin pentoxifyllin

• Anticoagulants: peripheral vascular patients are more likely to develop blood clots that may cause further damage. Doctors recommend taking aspirin from small doses daily or clopidogrel as an alternative to those who can not take aspirin.

Surgery:

Some patients with mild to severe peripheral arterial disease may need treatment to restore blood flow to their legs
Road:

• Angioplasty: The expansion of blood vessels in the balloon is a process in which a small balloon connected to the balloon is inserted into the artery; the balloon is then inflated to open the narrow artery. A stent can be left in place to keep the artery open.

• Artery bypass: If the previous procedure does not work, the doctors resort to making a parallel parallel to the blocked artery, after extracting part of the vein of the patient or the use of an industrial vessel to work the metaphor, so that the blood flows instead of the blocked vessel.

Recent research:

Stem Cell Therapy:

Because of the health status of many patients that do not allow for surgical intervention of moderate and severe cases of peripheral arterial disease, it was necessary to seek safe and effective treatment for these patients. Stem cell therapy is a promising hope for patients with peripheral arteries.

Adult stem cells are taken from the patient’s bone marrow. These stem cells undergo some laboratory medical procedures to increase their number and then inject them into the damaged blood vessels. The stem cells form new angiogenesis vessels that improve blood flow to damaged tissues. Thus reducing the symptoms and increase walking distance and save the injured patient from amputation of the leg. This type of treatment has already been tested on many patients in the world, including Egypt. This type of cellular therapy has shown a great ability to neutralize the disease without resorting to amputation. In the near future will spread this treatment, especially since it is easy to get a large number of stem cells of blood and not bone marrow after a conservative injection to form these cells in the bone marrow and transfer to the blood within 3-5 days, reducing the need for the patient to the process of exertion The bone marrow.

Patient Advice & Tips:

Patients with stress and diabetes – the most exposed to peripheral arterial disease – should follow a diet and daily life to prevent the occurrence of disease and prevent heart attacks and stroke. The first steps of treatment should be considered if the disease occurs by:

• Non-smoking: A cessation of smoking leads to the cessation of peripheral artery disease.

• Healthy diet: Eating foods contain fiber, especially vegetable foods such as vegetables and fruits, reducing fatty foods that contain high cholesterol and meat. This will help lower levels of cholesterol and other fats in the blood and also control blood pressure.

• Good follow-up of stress and diabetes.

• Regular exercise: Helps the muscles to use oxygen properly, which increases the distance of walking that results in pain. Exercise should be practiced according to the instructions and exercise programs to be prepared by the doctor.

• Foot care and consult your doctor if any foot injuries occur, especially for diabetics.

Dr.. Mohammed Labib Salem

Dr.. Adel Baggosh