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Peripheral arterial disease (PAD), also referred to as peripheral vascular disease, occurs when fatty deposits accumulate in the arteries, hindering blood flow. Initially, this condition often impacts the legs, causing noticeable symptoms there first.
The British Heart Foundation mentions that approximately one in five individuals over 60 years old experiences some form of PAD. The primary symptom of this condition is intermittent claudication, characterized by cramp-like pain in the leg muscles during activities like walking or exercising, which eases upon resting. Those with intermittent claudication have a heart attack risk three to five times higher than average. About 10% of individuals with intermittent claudication progress to critical limb ischaemia, the most advanced stage of PAD.
At this severe stage, the outlook is unfortunately poor, with half of the patients possibly facing death within five years, often due to other arterial blockages elsewhere, such as in the heart.
Without treatment, PAD prevents the cardiovascular system from supplying adequate blood and nutrients to certain body parts, leading to ongoing pain, ulcers, and potentially gangrene, starting typically in the feet due to their distance from the heart.
In severe situations, PAD may become life-threatening or result in necessary amputations, cautions Patrick Coughlin, a Consultant Vascular and Endovascular Surgeon at Addenbrooke’s Hospital. If you notice these symptoms, it is crucial to talk to your GP, who might refer you to a vascular specialist to assess the blood flow in your legs.
Approximately 1% to 2% of people with intermittent claudication are at risk of needing an amputation within five years. Therefore, PAD stands as one of the key causes of lower-limb amputation in the UK.
By the time ulcers or gangrene symptoms manifest, it’s “often too late for us to improve circulation,” says Coughlin. This leaves patients with only amputation, ulcer management or palliative care as treatment options in more severe cases.
PAD is managed by addressing the symptoms, such as surgeries to enhance blood supply to the legs, lifestyle modifications to reduce your risk of a heart attack and walking programmes to improve claudication.
However, the expert pointed out: “If you have claudication, national guidelines recommend enrolling in a three to six-month walking programme. This is unfortunately not widely available on the NHS due to funding.
“If you can’t access one, you can still follow a structured walking programme on your own, or ask if there’s a cardiac rehabilitation-type programme you can go on.”