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Peripheral artery occlusive disease (PAOD) is also known as peripheral vascular disease (PVD) and peripheral artery disease (PAD) and includes all diseases that result from the obstruction of the large peripheral arteries, the arteries carrying blood to the head, internal organs and limbs. Obstruction may be caused by atherosclerosis, the clogging and hardening of the artery walls; stenosis, the narrowing of the artery walls; an embolism, a blockage caused by a blood clot, a piece of tissue, an air bubble, or a foreign object; or the formation of blood clots. It causes either acute or chronic ischaemia which is an inadequate blood flow and a lack of vital oxygen and nutrients to the organs and limbs concerned.
Risk Factors for Peripheral Vascular Occlusive Disease
Peripheral artery occlusive disease is an extremely common and serious problem affecting more than 20 percent of patients over 70 years of age in this country. Peripheral arterial disease generally results from atherosclerosis or “hardening of the arteries” leading to impaired circulation to the extremities and other vital organs. The major risk factors for peripheral vascular disease include a history of smoking, diabetes, high blood pressure, high cholesterol levels, and advanced age. Peripheral vascular disease can usually be diagnosed by a careful history and physical examination. A high index of suspicion is important for patients with risk factors for peripheral vascular disease. When necessary, noninvasive tests are available to evaluate blood flow to the lower extremities to assess the degree and location of blocked arteries.
Symptoms of Peripheral Vascular Occlusive Disease
A variety of symptoms or problems are suggestive of peripheral vascular disease. Pain in the leg muscles (particularly calves) with walking or other vigorous exercise may be due to blocked arteries and is called “claudication”. Patients with more advanced arterial blockages may have severe aching pain in their toes or feet at night, which is relieved by getting out of bed and walking around or simply hanging one’s foot over the side of the bed. The most severe forms of lower extremity peripheral vascular disease manifest as ulcerations or sores of the toes and feet that fail to heal and gangrene.
Treatment of Peripheral Vascular Occlusive Disease
The long-term preservation of life and limb requires aggressive management of peripheral vascular disease. The most important factors in long-term disease management include complete smoking cessation, and accurate control of diabetes and high blood pressure. Blood cholesterol levels should be carefully controlled with dietary modifications and medications if necessary. A regular walking program is an important component of long-term health. Once peripheral arterial occlusions have advanced to the degree that patients are truly disabled or have limb-threatening lesions, invasive management of their peripheral vascular disease is indicated. Generally, patients undergo arterial imaging with either magnetic resonance angiography or standard contrast angiography. Based on the degree of arterial occlusion and the patient’s anatomy, they may be offered several treatment options.
Whenever applicable, patients are treated with less invasive balloon angioplasty of the occluded vessels, with or without arterial stent placement. In cases where the blockages are too diffuse or severe, open surgical bypass operations are performed to restore circulation to the distal leg and foot. An individualized treatment plan is designed for each patient depending on their degree of symptoms, overall medical status, and the anatomy of their arterial blockages.
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