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We talk about peripheral arterial disease in more detail.
A history of smoking, high blood pressure, raised cholesterol, coronary heart disease and diabetes are all risk factors for developing peripheral arterial disease. Age is also a factor, and around one in five people in the UK who are over 60 are believed to have some form of it, although many of these will be asymptomatic. Having a family history of peripheral arterial disease also increases your risk of developing it.
When we stop, the problem soon resolves itself.
The amount of oxygen the muscles need to receive from the blood diminishes and in a moment or two the impaired arteries have been able to supply the temporary deficit. This condition is known as intermittent claudication.
Often both legs are affected, although one may be more symptomatic. When our arteries are narrowed, how far we can walk before we encounter this symptom will depend on how badly they are affected and how fast we walk.
Intermittent claudication can progress to a situation where, even at rest, there is pain in the legs. This may affect your sleep and be detrimental to your quality of life.
There is also the danger of further progression to ulcer formation or gangrene. It should be emphasised that this is a rare development and that usually intermittent claudication does not progress beyond the level described above.
Diagnosis is made by examination of the pulses and by comparing blood pressure in a patient's arm and ankle (a test called the ankle-brachial pressure index). If blood pressure is lower in the leg than the arm, this indicates the likelihood of a diagnosis of peripheral arterial disease. Once peripheral arterial disease has been diagnosed, it is important to treat the causes of the problem to stop it deteriorating and possibly spreading and causing blockages in arteries other than those already affected.
In other cases, where the demands of a job or other aspects of a patient's lifestyle require a much greater degree of mobility, more invasive treatment options may need to be considered and these will be outlined later.
Even following referral to hospital, in some cases it may be considered advisable to ask patients to wait a little prior to undergoing treatment, to see if their mobility improves over time. A consultant will weigh up the risks and benefits of intervention versus conservative, non-surgical treatment, and in many cases will advise the latter.
Embarking on a combination of lifestyle changes and taking your prescribed medication regularly will help to considerably minimise this risk.
Clearly if you are a smoker, it is important that you stop. Dietary changes to help lower the bad cholesterol (LDL) in the blood will be of benefit, as well as taking prescribed medication to treat raised cholesterol levels and high blood pressure. Another drug which is recommended by the National Institute for Health and Care Excellence (NICE) to help with claudication is naftidrofuryl oxalate (Praxilene).
Exercise - especially walking - is beneficial to improve arterial health, strengthen leg muscles and improve walking distance. It is recommended that these periods of exercise last at least 20 minutes and are undertaken three or more times a week. It is worth bearing in mind that anything you can do to help the arteries in your legs will also help all the other arteries in your body.
The surgical option is available if conservative measures, such as the lifestyle changes mentioned above and medication for conditions which are in themselves risk factors in the presence of PAD, are failing to provide adequate control and symptom relief.
Before deciding to perform surgery, your consultant will scan your arteries to see where and how long the blockages are and to consider the pros and cons of operating on them. The consultant will take into account your age and mobility level and needs when selecting the best intervention to offer you.
A surgical bypass involves attaching a tube (either an artificial artery or a surface vein taken from your leg) above and below the blockage in your artery. This allows blood to flow from the undamaged portion of the artery through the bypass and back into the artery below the blockage.
This is a considerably bigger operation than an angioplasty and you would need to stay in hospital for a week or so and to be out of action for some six weeks.
Bypass grafts are reserved either for patients who have had repeat angioplasties which have ultimately become blocked again, requiring further intervention, or for patients with long and complicated blockages whose cases are complex.
Because of this, there is a higher risk attached to them but they can often treat blockages that could not be adequately addressed by an angioplasty alone and they have a better long-term success rate.
Surgeons may choose to combine an angioplasty with a surgical bypass, as the techniques are not mutually exclusive and can deliver good results when used together.
While surgery for severe cases of PAD has an impressively high success rate, it is fair to say that often simple compliance with advice, exercise and prescribed medication render surgery unnecessary. When intermittent claudication is mild, it is best treated with non-surgical measures and may even resolve with these.