Peripheral artery disease

Disease caused by the obstruction of large arteries by atherosclerosis.

It is commonly divided in the four Fontaine stages:

• I: mild pain on walking ("intermittent claudication")
• II: severe pain on walking a short distance
• III: pain while resting
• IV: tissue loss (gangrene)

All causes of atherosclerosis are also causes of PAOD. There is, however, a strong preponderance of diabetics and smokers.

Upon suspicion of PAOD, the first-line test is arteria brachialis and pedis index (ABPI). This compares the blood pressure in the arms with that in the legs. If the flow in the legs is substantially less (<90% of the arm flow) then an exercise test (with or without doppler ultrasound testing) might confirm that the flow is decreased even further during exercise.

Conservative measures include medication with Aspirin and statins, which reduce clot formation and cholesterol levels, respectively.

Angioplasty can be done on solitary lesions in large arteries.

Occasionally, bypass grafting is needed to circumvent a seriously stenosed area of the arterial vasculature. Generally, the saphenous vein is used, although artificial (Gore-tex) material is often used for large tracts when the veins are of lesser quality.

When gangrene of toes has set in, amputation is often a last resort to stop infected dying tissues from causing septicemia.

Many PAOD patients also have angina pectoris or have had myocardial infarction. There is also an increased risk for stroke.