How To Diagnose Peripheral Artery Disease & What Is The Best Medicine For It?

The peripheral arterial disease can be diagnosed by touching the pulse of the artery of the foot or measuring the blood pressure (ankle blood pressure) of the foot.(2)

Diagnosis of peripheral occlusive arterial disease is based on symptoms and the results of a physical examination.(3)

Depending on the severity of the disease, the best medicine is decided by the doctor.(4)

Peripheral arterial disease is an illness in which the arteries of the foot become narrowed or occluded mainly due to the progression of arteriosclerosis, and sufficient blood does not flow to the feet. Traditionally, the peripheral arterial disease was widely known as obstructive arteriosclerosis. It is a disease often caused by the formation of lipid deposits in blood vessels, which narrows the arteries and restricts blood flow, similar to coronary artery disease of the heart.

The peripheral arterial disease includes Buerger’s disease but about 95% of peripheral arterial disease is obstructive arteriosclerosis caused by arteriosclerosis. Therefore, peripheral arterial disease and arteriosclerosis obliterans are often used under the same name.(1)

How To Diagnose Peripheral Artery Disease?

It can be diagnosed by touching the pulse of the artery of the foot or measuring the blood pressure (ankle blood pressure) of the foot.(2)

Physical Examination Of The Symptoms: Diagnosis of peripheral occlusive arterial disease is based on symptoms and the results of a physical examination. The doctor examines the skin on the arms and legs to check for color and temperature and gently presses on the skin before releasing it to see how quickly it returns to its original color. These observations can help determine if enough blood is circulating. We also perform tests that directly measure blood pressure and blood flow.(3)

Blood Pressure And Blood Flow Measurement: Blood pressure is measured using a standard blood pressure cuff and a special electronic stethoscope. Systolic blood pressure is measured on both arms and legs. If the blood pressure in the ankle is lower than a certain value compared to the blood pressure in the arm (less than 90% of the blood pressure in the arm), there is insufficient blood flow to the leg, and peripheral obstructive arterial disease can be diagnosed.

Pulse Assessment: A pulse assessment is also useful in assessing blood flow. Doctors and nurses first examine the underarms of the left and right arms, elbows, wrists, groin, ankles, feet, and the back of the knee. When an artery becomes clogged, the pulse from there becomes weaker or completely invisible.

Measurement Of Tissue Oxygen: Transcutaneous oxygen tension measurement measures the oxygen level in tissues under the skin. This test indirectly measures blood flow because oxygen is carried to the tissue by the blood. The test is painless and is done by placing a sensor on the skin of the affected leg or arm and top of the chest. The sensor’s electrodes warm the area under the skin to temporarily dilate the blood vessels, making it easy to measure oxygen levels with the sensor.

Image Inspection: Doppler ultrasonography can be used to directly measure blood flow and confirm the diagnosis of peripheral occlusive arterial disease. This test will accurately delineate the narrowing or occlusion of blood vessels.

Usually, an angiography examination is done to have a clear picture of the abnormal artery before surgery or angioplasty.

For patients with arteriosclerosis, blood tests are done to measure cholesterol, blood sugar, and sometimes homocysteine levels to see if there are any risk factors. Blood pressure is measured several times to determine if the blood pressure is consistently high.

Blood tests may also be done to determine other causes of arterial stenosis or blockage, such as inflammation of blood vessels from autoimmune diseases.(3)

What Is The Best Medicine For Peripheral Artery Disease?

First, doctors will control the risk factors of arteriosclerosis such as smoking, hypertension, hyperlipidemia, diabetes, stress, and obesity by striving to quit smoking by keeping a balanced diet and moderate exercise. If that doesn’t help, drug treatments such as antiplatelet drugs will be given.

  • If arteriosclerosis is in progress, surgery to create a bypass or catheter treatment to open a narrowed blood vessel with a balloon is performed.
  • Drug therapy is the most basic treatment method, and it is used depending on the severity of the disease.(4)
  • Mild (Coldness, Numbness, etc.): To improve ischemic symptoms Antiplatelet drugs are used.
  • Moderate (Intermittent Claudication): To Prevent future vascular complications such as myocardial infarction and angina, Antiplatelet drug + vasodilator is used.
  • After Percutaneous Angioplasty/Stent Placement: For recurrence prevention, antiplatelet drugs, anticoagulant drugs are given.
  • Severe (Ischemic Ulcer Case): For conservative treatment Antiplatelet drug, an anticoagulant drug, the vasodilator is used.

List of major therapeutic agents:

  • Antiplatelet And Related Drugs: It acts to prevent the action of platelets, which causes clogging of arteries and improves blood flow.
  • Anticoagulants: Prevents blood from clotting and improves blood flow.
  • Peripheral Vasodilator: It has the effect of making it difficult to form blood clots and the effect of expanding blood vessels to improve blood flow.

In cases with severe numbness, resting pain, and ulcers, revascularization (percutaneous angioplasty or vascular bypass) is performed as medical treatment is often not sufficient.

References:

  1. Fowkes FGR, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nature Reviews Cardiology. 2017;14(3):156.
  2. Lawall H, Huppert P, Espinola-Klein C, Zemmrich CS, Ruemenapf G. German guideline on the diagnosis and treatment of peripheral artery disease–a comprehensive update 2016. Vasa. 2017;46(2):79-86.
  3. Notash AY, Elyasinia F, Molavi B. Evaluating the Success of Endovascular Treatment in Patients with Peripheral Artery Disease. 2019.
  4. Kullo IJ, Rooke TW. Peripheral artery disease. New England Journal of Medicine. 2016;374(9):861-871.

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