WHAT IS PERIPHERAL ARTERIAL DISEASE (PAD)?
The information on this page is intended to benefit and inform patients who may have been diagnosed with PAD
Peripheral arterial disease (PAD) is a narrowing of the arteries that supplies blood to your legs. The narrowed arteries cannot carry enough blood, which may cause you to experience pain in your legs when walking or doing daily activities. Most people however, may never have any symptoms and do not realise they have PAD until it leads to a heart attack or a stroke.
WHAT CAUSES PAD?
PAD is caused by the same thing that can cause a heart attack or stroke, blocked arteries.
A blocked artery is caused by a blood clot. Blood clots occur in the arteries because fatty material (called plaque) that is deposited in the arterial wall ruptures. The plaque builds up (a process called atherosclerosis) and narrows the artery; when this plaque ruptures, the blood clot forms over the rupture and can block the artery. The process of a blood clot forming over the plaque rupture is called atherothrombosis.
Atherosclerosis causes progressive narrowing of the arteries where plaque is deposited in the arterial wall. Atherothrombosis is when plaque ruptures and blood clots are formed that cause the blockage of an artery.
There are four common stages in the development of PAD:
Stage 1: Artery narrowing
The arteries begin getting more narrow but with no other symptoms. PAD develops gradually and can remain unnoticed for long periods. In many cases, it only causes symptoms in the elderly. However, the rate at which the disease develops can vary significantly depending on the individual.
Stage 2: Claudication
Most people with PAD will not experience any symptoms but for those who do, this is normally the first. Also called “intermittent claudication”, it is fatigue, discomfort or pain in the muscles of the legs.
It will normally occur when walking. Specifically, the pain often occurs in the calves, upper legs, buttocks or feet. The pain is a signal that the muscles are suffering from lack of oxygen. Walking puts them under increased strain, so that more oxygen and more efficient blood circulation is required. However, this is not possible due to reduced blood flow in the narrowed arteries.
Stage 3: Advanced PAD: Pain at rest
Failure to stop the progression of PAD leads to the increasing deterioration of the blood circulation. In addition to pain when walking, you may experience pain even at rest, particularly at night if your legs are raised.
Stage 4: Tissue damage
Without proper blood flow, wounds cannot heal. Even a small cut will have difficulty healing. This could lead to infections and permanent tissue damage. In the worst cases, amputation may even be necessary if adequate blood flow cannot be restored. Please note however that amputation occurs in only a very small minority of patients.
RISK OF HEART ATTACK OR STROKE?
If you have PAD then you are at even greater risk of a heart attack or stroke. You face the same risk of heart attack or stroke as a patient who has already had one. Reducing the overall risk factors will also reduce the risk of having a heart attack or stroke.
WHAT ARE THE RISK FACTORS?
The risk factors for PAD are the same as for a heart attack or stroke. Each individual risk factor increases with risk of PAD. The combination of several risk factors makes it particularly dangerous and greatly increases the risk of PAD.
There are certain factors which cannot be influenced, such as age, gender, and predisposition. However, some risk factors are reversible.
The following are a list of the main risk factors for PAD, most of which you can reduce based on your lifestyle choices:
- Diabetes – Diabetes greatly increases the risk of PAD as well as heart attack or stroke. If you have diabetes, you need to take extra precaution and discuss this with your doctor
- High blood pressure
- High cholesterol
- Unhealthy diet
- Lack of exercise
- Excessive alcohol consumption
- Being overweight
HOW TO REDUCE YOUR PAD RISK?
The best way is prevention. You should be aware of the risk factors and make sure you keep them under control. Also, your doctor may prescribe drugs and procedures, which may be used to help prevent or treat PAD.
There are several ways you can reduce your PAD risk, which includes the following:
- Do not smoke
- Eat a healthy diet
- Exercise regularly
- Maintain a healthy weight
- Avoid stress
- Keep your cholesterol low
- Keep your blood pressure low
- Avoid excessive alcohol consumption
In the early stages of PAD, walking exercises are used for treatment. The goal is to reduce symptoms and increase walking distance. Regular exercise has also been shown to be highly effective treatment which can improve the blood flow. Your doctor will be happy to discuss a suitable fitness program with you.
In addition to reducing risk factors, drugs are also used to help prevent and/or treat PAD.
Anti-platelet drugs interact with the blood platelets. The drug prevents the platelets from clumping together and forming clots over the plaque ruptures caused by atherothrombosis. The commonest of these drugs is aspirin.
Fat lowering drugs lower cholesterol. The commonest of these are called statins.
Blood pressure lowering drugs. If your own doctor has found you to have high blood pressure there are a number of very effective ‘anti-hypertensive’ mediations. Many patients need more than one to control their blood pressure.
Your own doctor may also prescribe drugs to strengthen the heart pumping ability such as ACE inhibitors and angiotensin 2 blockers.
There are a few medications which increase walking distance by some meters, however the most important treatments for PAD are stop smoking, keep walking and take an antiplatelet drug, a lipid lowering drug, and an antihypertensive if required.
SURGICAL OR ‘ENDOVASCULAR’ OPTIONS
Surgical procedures are generally only considered in significant cases of PAD. The type of procedure used depends on many factors, including the extent of the disease and the location of the arterial narrowing.
Angioplasty is a process where a narrowed artery is re-opened by threading a wire (catheter) through the artery until it reaches the narrowing. A balloon that is on the tip of the catheter is then inflated which pushes back the plaque or blood clot that caused the narrowing. The artery is re-opened and the blood can flow normally again. In many cases, a small piece of metal called a stent is used to ensure that the artery remains open. The stent is placed around the balloon so when the balloon is inflated, it expands the stent. The catheter is removed but the stent stays in place.
In some cases a bypass operation may be more advantageous. This process involves taking a vein from somewhere else in your body and creating a new path for the blood to flow. It is similar to a bypass for the heart.
The long-term success of angioplasty or bypass operation depends on how consistently you control your risk factors.
Having PAD is not pleasant, but there are simple and effective ways to reduce your PAD risk. By following the advice of your doctor and reducing your PAD risk, it is possible to live a healthy lifestyle.
Author: Professor Jill Belch
Ugonjwa wa Mshipa wa Mviringo (PAD) Habari zilizotajwa hapa zinatumiwa kuwahusu wagonjwa ambao wamepatikana na ugonjwa wa mishipa ya damu (PAD) ambao ni ugonjwa wa mishipa ya damu inayosambaza damu kwenye miguu. Mshipa huo haufanyi kazi kwa kiasi cha kutosha, na huenda ukasikia maumivu ya miguu wakati wa kutembea au kufanya shughuli za kila siku. Hata hivyo, watu wengi hawawezi kuwa na dalili yoyote na hawajui kuwa wana PAD mpaka itakaposababisha mshtuko wa moyo au kiharusi. Ni nini husababisha PAD? PAD ni ugonjwa wa moyo unaosababishwa na ugonjwa wa moyo au kiharusi, ambao ni ugonjwa wa mishipa ya damu. Mshipa uliofungwa husababishwa na kuganda kwa damu. Matofali ya damu hutokea katika mishipa ya damu kwa sababu mafuta (yanayoitwa plaque) ambayo huwekwa katika ukuta wa mishipa ya damu huvunjika. Plaque huongezeka (mchakato unaoitwa atherosclerosis) na kupanua mshipa; wakati plaque hii inapovunjika, damu hufanyiza nguzo juu ya kuvunjika na inaweza kuzuia mshipa. Utaratibu wa kuganda kwa damu kunakofanyizwa juu ya kuvunjika kwa bamba huitwa atherothrombosis. Atherosclerosis husababisha kupungua kwa mishipa ya damu ambapo mchanga huhifadhiwa katika ukuta wa mishipa ya damu. Atherothrombosis ni wakati plaque ruptures na damu clots ni kuundwa kwamba kusababisha kuziba ya mshipa. Kuna hatua nne za kawaida katika maendeleo ya PAD: Hatua ya kwanza: Artery narrowing: Arteries kuanza kupata nyembamba zaidi lakini bila dalili nyingine. Ugonjwa wa PAD huanza hatua kwa hatua na unaweza kuendelea kwa muda mrefu bila kuonekana. Katika visa vingi, husababisha dalili tu kwa wazee. Hata hivyo, kiwango cha ugonjwa huo kinaweza kutofautiana sana ikitegemea mtu mmoja-mmoja. Hatua ya pili: Claudication: Watu wengi wenye PAD hawatapata dalili yoyote, lakini kwa wale ambao wanafanya hivyo, hii ni kawaida ya kwanza. Pia huitwa " claudication ya mara kwa mara", ni uchovu, usumbufu au maumivu katika misuli ya miguu. Kwa kawaida itatokea unapotembea. Hasa, maumivu mara nyingi hutokea katika viuno, miguu ya juu, viuno au miguu. Maumivu ni ishara kwamba misuli inakabiliwa na ukosefu wa oksijeni. Kutembea huwafanya wawe chini ya mkazo mkubwa, hivyo oksijeni zaidi na mzunguko wa damu wenye ufanisi zaidi huhitajiwa. Hata hivyo, hilo haliwezekani kwa sababu ya kupungua kwa mtiririko wa damu katika mishipa iliyofupika. Hatua ya 3 - PAD ya hali ya juu: maumivu wakati wa kupumzika: Kushindwa kuzuia maendeleo ya PAD husababisha kuzorota kwa mzunguko wa damu. Mbali na maumivu wakati wa kutembea, unaweza kupata maumivu hata wakati wa kupumzika, hasa usiku ikiwa miguu yako imeinuliwa. Hatua ya 4: Uharibifu wa tishu: Bila mtiririko wa damu sahihi, majeraha hayawezi kupona. Hata jeraha dogo litakuwa na ugumu wa kupona. Hilo laweza kusababisha maambukizo na uharibifu wa kudumu wa tishu. Katika visa mabaya zaidi, huenda ikawa lazima hata kumkata mtu mkono ikiwa mtiririko wa damu hauwezi kurudishwa. Hata hivyo, tafadhali kumbuka kwamba upungufu hutokea katika idadi ndogo sana ya wagonjwa. Hatari ya Mshtuko wa Moyo au Mshtuko wa Moyo? Ikiwa una PAD, basi una hatari kubwa zaidi ya kupatwa na mshtuko wa moyo au kiharusi. Unakabiliwa na hatari sawa ya mshtuko wa moyo au kiharusi kama mgonjwa ambaye tayari amekuwa na moja. Kupunguza sababu za hatari kwa ujumla pia kupunguza hatari ya kuwa na mshtuko wa moyo au kiharusi. Ni Nini Vitu Vinavyoweza Kukufanya Uwe na Hatari? Sababu za hatari za PAD ni sawa na za mshtuko wa moyo au kiharusi. Kila sababu ya hatari ya mtu binafsi huongezeka na hatari ya PAD. Mchanganyiko wa mambo kadhaa ya hatari hufanya iwe hatari sana na huongeza sana hatari ya PAD. Kuna mambo fulani ambayo hayawezi kuathiriwa, kama vile umri, jinsia, na mwelekeo. Hata hivyo, baadhi ya mambo yanayoweza kusababisha ugonjwa huo yanaweza kubadilika. Vipengele vya hatari vya ugonjwa wa PAD ni vichache, na unaweza kupunguza kwa kuzingatia chaguo lako la maisha: - Kisukari - Kisukari huongeza hatari ya ugonjwa wa PAD na mshtuko wa moyo au kiharusi. Ikiwa una ugonjwa wa kisukari, unahitaji kuchukua tahadhari ya ziada na kuzungumzia hili na daktari wako - shinikizo la damu la juu - cholesterol ya juu - lishe isiyo na afya - ukosefu wa mazoezi - matumizi ya pombe kupita kiasi - kuwa na uzito kupita kiasi Jinsi ya kupunguza hatari yako ya PAD? Njia bora ni kuzuia. Unapaswa kuwa na ufahamu wa sababu za hatari na kuhakikisha kwamba unaziweka chini ya udhibiti. Daktari wako anaweza pia kuagiza dawa na taratibu ambazo zinaweza kutumika kuzuia au kutibu PAD. Kuna njia kadhaa za kupunguza hatari ya PAD, ambayo ni pamoja na: - Usivute sigara - Kula chakula cha afya - Fanya mazoezi mara kwa mara - Kudumisha uzito wa afya - Kuepuka mkazo - Weka cholesterol yako chini - Weka shinikizo la damu yako chini - Kuepuka matumizi ya pombe kupita kiasi Katika hatua za mapema za PAD, mazoezi ya kutembea hutumiwa kwa matibabu. Lengo ni kupunguza dalili na kuongeza umbali wa kutembea. Mazoezi ya kawaida pia yameonyeshwa kuwa matibabu yenye matokeo sana ambayo yanaweza kuboresha mtiririko wa damu. Daktari wako atafurahi kujadili na wewe mpango unaofaa wa mazoezi ya mwili. Kwa kuongezea kupunguza hatari, dawa za kulevya zinatumiwa pia kuzuia na kutibu ugonjwa wa PAD. Dawa za kuzuia kuenea kwa vidonda vya damu huingiliana na vidonda vya damu. Dawa hiyo huzuia vidonge vya damu visijikusanyike pamoja na kufanyiza makundi ya damu juu ya kupasuka kwa bamba linalosababishwa na atherothrombosis. Dawa ya kawaida zaidi kati ya dawa hizo ni aspirin. Dawa za kupunguza mafuta hupunguza kolesteroli. Dawa za kawaida kati ya hizo huitwa statini. Dawa za kupunguza shinikizo la damu. Kama daktari wako mwenyewe amegundua una shinikizo la damu la juu kuna idadi ya ufanisi sana 'anti-hypertensive' mediations. Wagonjwa wengi huhitaji zaidi ya moja ili kudhibiti shinikizo lao la damu. Daktari wako anaweza pia kuagiza dawa za kuimarisha uwezo wa moyo wa pumping kama vile ACE inhibitors na angiotensin 2 blockers. Kuna dawa chache ambazo huongeza umbali wa kutembea kwa mita kadhaa, hata hivyo matibabu muhimu zaidi ya PAD ni kuacha kuvuta sigara, endelea kutembea na kuchukua dawa ya antiplatelet, dawa ya kupunguza lipid, na antihypertensive ikiwa inahitajika. Upasuaji au ‘endovascular chaguzi Upasuaji kwa ujumla ni tu kuchukuliwa katika kesi muhimu ya PAD. Aina ya utaratibu unaotumiwa inategemea mambo mengi, kutia ndani kiwango cha ugonjwa na mahali ambapo mshipa umepunguka. Angioplasty ni mchakato ambapo mshipa uliopunguzwa hufunguliwa tena kwa kutumia waya (kateter) kupitia mshipa huo hadi ufikie mkato. Kisha, puto lililo kwenye ncha ya catheter hufurika na kuondoa damu au chembe ya damu iliyokuwa imesababisha upungufu huo. Mshipa huo hufunguliwa tena na damu inaweza kutiririka kwa kawaida tena. Katika visa vingi, kipande kidogo cha chuma kinachoitwa stent hutumiwa kuhakikisha kwamba mshipa huo unabaki wazi. Stent ni kuweka karibu na puto hivyo wakati puto ni inflated, ni kupanua stent. Catheter huondolewa lakini stent hubaki mahali pake. Katika visa fulani upasuaji wa kuondoa damu huenda ukawa wenye manufaa zaidi. Utaratibu huu unahusisha kuchukua mshipa kutoka mahali pengine mwilini mwako na kuunda njia mpya ya damu. Ni sawa na njia ya kuondoa moyo. Ufanisi wa muda mrefu wa angioplasty au upasuaji wa bypass unategemea jinsi unavyoweza kudhibiti mambo ya hatari. Kuwa na PAD sio jambo la kupendeza, lakini kuna njia rahisi na za ufanisi za kupunguza hatari yako ya PAD. Kwa kufuata ushauri wa daktari wako na kupunguza hatari ya PAD, inawezekana kuishi maisha ya afya. Mwandishi: Profesa Jill Belch