In
Medicine (
Vascular Surgery ), (PAOD) (also known as '''Peripheral vascular disease''' or PVD) is a collator for all
Disease caused by the obstruction of large peripheral
Arteries , which can result from
Atherosclerosis ,
Inflammatory processes leading to
Stenosis , an
Embolism or
Thrombus formation.
It causes either
Acute or
Chronic Ischemia .
Peripheral artery occlusive disease is commonly divided in the Fontaine stages:
- I: mild Pain on walking (" Claudication ")
- II: severe pain on Walking relatively shorter distances (intermittent claudication)
- III: pain while resting
- IV: loss of sensation to the lower part of the extremity
- V: Tissue loss ( Gangrene )
All causes of
Atherosclerosis are also causes of PAOD. There is, however, a strong preponderance of
Diabetic people who
Smoke . A known diabetic who smokes runs an approximately 30% risk of
Amputation within 5 years.
Upon suspicion of PAOD, the first-line test is the
Ankle Brachial Pressure Index (/'''ABI''') which is a measure of the fall in blood pressure in the arteries supplying the legs. A reduced ABPI (less than 0.9) is consistent with PAOD. Values of ABPI below 0.8 indicate moderate disease and below 0.5 severe disease.
The next step is generally a form of
Angiography , where a catheter is used to inject radiodense contrast agent into the
Femoral Artery and selectively guided to the artery in question. Stenosis of the arteries can be identified, and generally correlates with the patient's
Symptom s.
Dependent on the severity of the disease, the following steps can be taken:
- Conservative measures include Smoking Cessation (cigarettes promote PAOD and are a risk factor for Cardiovascular Disease ). Regular exercise for those with claudication helps open up alternative small vessels () and the limitation in walking often improves. Medication with Aspirin , Clopidogrel and Statins , which reduce clot formation and cholesterol levels, respectively can help with disease progression and address the other cardiovascular risks that the patient is likely to have.
- Angioplasty (PTA or percutaneous transluminal angioplasty) can be done on solitary lesions in large Arteries , such as the Femoral Artery .
- Occasionally, Bypass grafting is needed to circumvent a seriously stenosed area of the arterial vasculature. Generally, the Saphenous Vein is used, although artificial ( Gore-Tex ) material is often used for large tracts when the veins are of lesser quality.
- Rarely, Sympathectomy is used - removing the nerves that make arteries contract, effectively leading to vasodilatation.
- When Gangrene of toes has set in, Amputation is often a last resort to stop infected dying tissues from causing Septicemia .
Arterial Thrombosis or embolism has a dismal prognosis, but is occasionally treated successfully with
Thrombolysis .
Many PAOD patients also have
Angina Pectoris or have had
Myocardial Infarction . There is also an increased risk for
Stroke .
