Peripheral Arterial Disease (PAD) and Claudication

Signs:

One of the hallmarks of arterial claudication is that it occurs intermittently. It disappears after a brief rest and the patient can start walking again until the pain recurs. The following signs are general signs of atherosclerosis of the lower extremity arteries:

• cyanosis
• atrophic changes like loss of hair, shiny skin
• decreased temperature
• decreased pulse
• redness when limb is returned to a "dependent" position

All the "P"s

• Pallor increase
• Pulses decreased
• Perishing cold
• Pain
• Paraesthesia
• Paralysis

Risk Factors:

The risk factors for claudication are the same as those for developing atherosclerosis, including:

• Smoking
• High cholesterol
• High blood pressure
• Obesity (a body mass index over 30)
• Diabetes
• Age older than 70 years
• Age older than 50 years if you also smoke or have diabetes
• A family history of atherosclerosis, peripheral artery disease or claudication

Treatments:

Quitting smoking and controlling cholesterol are the two best ways to slow PAD progression.

The most important risk factors for PAD include:

• Smoking. Smoking is the number one risk factor for PAD, and smoking even a few cigarettes a day can interfere with PAD treatment. Smoking increases the risk for PAD by 2 - 25 times, with the danger being higher when other risk factors are present. Between 80 - 90% of patients with PAD are current or former smokers. Progression to a more critical state of illness is likely for patients who continue to smoke. [For more information, see In-Depth Report #41: Smoking.]
• Diabetes. People with type 2 diabetes have 3 - 4 times the normal risk for PAD and intermittent claudication. In fact, their risk for PAD is higher than their risk for heart disease. People with type 2 diabetes also tend to develop PAD at an earlier age and have more severe cases. Patients with both diabetes and PAD are at high risk for complications in the feet and ankles. Poor blood sugar (glucose) control increases the risk of developing PAD. [For more information, see In-Depth Report #60: Diabetes - type 2.]
• Unhealthy cholesterol and lipid levels. The risk for PAD increases by 5 - 10% with every 10 mg/dL increase in total cholesterol levels. Levels of HDL ("good cholesterol") below 40 mg/dL and high triglyceride levels also increase the risk for PAD. LDL ("bad cholesterol") levels should be kept below 100 mg/dL in all patients with PAD, and probably as low as 70 mg/dL when other risk factors are present (such as diabetes, coronary artery disease, smoking, and HDL below 40 mg/dL). [For more information, see In-Depth Report #23:Cholesterol.]
• Hypertension. High blood pressure, especially when combined with other cardiovascular risk factors, increases the chances for PAD. [For more information, see In-Depth Report #14: High blood pressure.]

Peripheral artery disease and intermittent claudication | University of Maryland Medical Center http://j.mp/1Jf29vG
University of Maryland Medical Center

What is an ankle-brachial index?

The ankle-brachial index (ABI) is a measurement that is useful to your physician in evaluating the adequacy of the circulation in your legs. It can also be used to follow the improvement or worsening of leg circulation over time. To obtain the ABI, your physician measures your blood pressure in your ankle and in your arm. Your physician will compare the two numbers by forming a ratio to determine your ABI.

Normally, the blood pressures in your ankle and arm should be about equal. But if your ankle pressures are lower than your arm pressures, your leg arteries are probably narrowed.

To perform the ABI, your physician may use an ordinary blood pressure cuff and an ultrasound device. The ABI helps your physician diagnose arterial disease in the legs, but it is a general test and it does not specifically identify which arteries are blocked.

Ankle-Brachial Index (ABI) http://j.mp/1Jf1f2q