Introduction:

Peripheral artery disease (PAD) refers to peripheral arterial disease or peripheral vascular disease (which includes both arteries and veins). They are most often caused by a buildup of fatty deposits in the arteries. PAD affects the blood vessels causing them to narrow, therefore restricting the blood flow to the arms, kidneys, stomach, and most commonly, the legs. The morbidity of PAD has risen significantly in recent years, and the common ones include arteriosclerotic occlusive disease, arteriovenous thrombosis, and aneurysm. Among the elderly over 60, the morbidity of PAD is up to 80%.

Risky factors:

（1）Family history of heart disease, high blood pressure and high cholesterol

（2）>50 years old

（3）Overweight or obese

（4）Lack of activity, have the sedentary lifestyle

（5）Smoking

（6）Diabetes

People with the history of coronary heart disease, heart attack or the stroke will have a higher chance to suffer from peripheral vascular disease.

Symptoms：

Only 60% of people with peripheral artery disease have symptoms. Symptoms are almost always caused by insufficient blood in the leg muscles. Symptoms depend in part on which artery is involved and the degree of blood flow restriction.

The most common symptom of peripheral artery disease is pain, which sometimes appears in one or both calves, thighs or buttocks. Pain often occurs when walking or climbing stairs and stops when resting. It can feel like a feeling of heaviness, tension or fatigue in the leg muscles. 

Other symptoms include: hip pain, numbness, tingling or weakness in the legs, burning or soreness in the feet or toes at rest, non-healing leg or foot ulcers, cold or discoloration on one or both legs or feet (pale, cyan, dark red), loss of leg hair, impotence.

When symptoms of peripheral vascular disease appear in the legs or feet, you should go to see a doctor. Usually peripheral artery disease is not an emergency, but it should not be ignored.

Medical evaluation of symptoms and effective treatment can prevent further damages to the heart and blood vessels, avoiding more serious events such as heart attack, stroke or loss of feet and toes.

How is peripheral artery disease diagnosed?

（1）Intermittent Claudication Questionnaire(ICQ) - It is used by many medical professionals to diagnose peripheral arterial disease. It is a series of 6 problems and a pain chart. The correct rate of diagnosing peripheral arterial disease can be as high as 90% in people with symptoms.

（2）Ankle-brachial index – This is one of the most widely used tests for patients with intermittent claudication. Intermittent claudication is pain associated with peripheral vascular disease caused by vascular stenosis. The pain is sometimes visible. In this test, the blood pressure of the arm and the leg is compared. In a healthy person, the blood pressure of the leg should be higher than that of the arm.

（3）ABI> 0.9: normal;

（4）ABI = 0.71-0.90: mild peripheral vascular disease;

（5）ABI = 0.41-0.70: moderate peripheral vascular disease;

（6）ABI <0.4: severe peripheral vascular disease.

（7）Treadmill Test - Check the blood pressure of the arms and legs before and after exercise (walking on a treadmill until symptoms appear). A significant drop in leg blood pressure and ABI after exercise indicates the peripheral vascular disease. If you cannot walk on a treadmill, other testing methods can be accepted. If the pulse of the leg cannot be palpable, a portable Doppler blood flow probe can be used to quickly determine whether there is arterial blood flow. For example, angiography, ultrasound, CTA, or MRI can be used to help determine where the blood vessel is blocked.

（8）Angiography and Arteriography - It is an important method to guide during the procedure, but this method cannot be used for patients with renal insufficiency. In addition to ultrasound examinations, CT and MRI imaging techniques are also available, which are not only minimally invasive but also effective. Of course, balloon dilatation can be performed on the occlusion of the artery found during arteriography, which is often impossible to do at the same time when other inspection methods are used.

（9）Ultrasonic Examination - It is a widely used non-invasive inspection method. Any abnormalities in blood vessels or obstruction of blood flow can be detected.

（10）MRI - The use of magnetic fields to obtain images of internal structures.

Treatment options for peripheral artery disease

1. Conservative treatment

Anticoagulation, thrombolysis, and blood vessel expansion are usually used to control the condition of PAD; Taking appropriate physical exercises and controlling the risk factors of arteriosclerosis. This method has a certain effect on early stenosis lesions.

2. Surgical treatment

（1）Bypass surgery: An artificial blood vessel or autologous blood vessel is transplanted at both ends of the diseased blood vessel so that the blood can bypass the diseased part and reach the distal end of the limb. However, the surgical trauma is large, the recovery is slow, and there are many complications. And it needs to be performed under general anesthesia, and the inflow occluded part flows out.

（2）Intravascular interventional therapy: It’s also known as minimally invasive treatment No surgery is required, the procedure time is short, the patient is less painful, and the symptoms are improved significantly. Generally only local anesthesia is required, which is suitable for elderly and frail patients. The operation can be repeated, and for relapsed patients, interventional treatment can be performed again.

（3）Balloon dilatation: Through skin puncture, a catheter with a balloon is sent to the stenosis section of the artery, after the balloon is inflated, and the narrowed blood vessel will be opened. Although this way does not leave anything in the human body, the rate of restenosis and obstruction in short term is high.

（4）Stent angioplasty: The catheter loaded with the metal stent is punctured through the skin to reach the part of stenosis or occlusion, and the stenosis is supported by the stent to open up the narrow blood vessel, allowing the blood flow to flow through. Probability of restenosis after surgery is lower than balloon dilatation angioplasty.

（5）Percutaneous atherectomy: The plaque is removed by inserting a small cutting knife into the artery.