APA Peripheral Vascular Disease Essay Paper

APA Peripheral Vascular Disease Essay Paper

APA Peripheral Vascular Disease Essay Paper

Arteries deliver oxygen-rich blood from the heart to every part of the body, and the peripheral arteries carry blood away from the heart to the arms and legs. Peripheral Arterial Disease (PAD) develops when these arteries begin to build up plaque, obstructing and narrowing the passageway and preventing blood, oxygen, glucose from flowing to the legs. The buildup of fat, cholesterol and other substances causes of the pain and discomfort patients experience in their legs as the muscles and tissue starve for blood. Just like how the build up of plaque in the heart causes a heart attack, blocked blood flow in the legs causes a “heart attack” of the tissue and muscle in the legs and can lead to the death of the limb and ultimately the need for amputation.APA Peripheral Vascular Disease Essay Pape

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If lifestyle modifications and medications are not enough to treat PAD, our physicians at Pedes Orange County utilize a combination of Angiogram, Atherectomy, Stenting, and Angioplasty to restore healthy blood flow through the arteries to all parts of your feet and legs. Our physician can also address arterial obstruction that occurs in other arteries such as in the arms or the renal artery that carries blood to the kidneys.

Peripheral arterial disease (PAD), also called “peripheral vascular disease” or “claudication,” occurs when blood flow to the legs is reduced or completely blocked by atherosclerosis (hardening of the arteries). When blood flow to one or both legs can’t keep up with demand, the result is leg pain while walking (“intermittent claudication”) and other symptoms. If blood flow to the legs is completely blocked, tissues in the leg and/or foot die, increasing the risk of amputation.APA Peripheral Vascular Disease Essay Paper

Although PAD most frequently affects the legs and feet, it can also affect arteries that carry blood from the heart to the head, arms, heart and other internal organs. According to the US National Heart, Lung, and Blood Institute, PAD affects 8 to 12 million people in the United States, especially those over the age of 50. According to The Lancet medical journal, as of 2010, the number of people with PAD is estimated at 202 million world-wide.

If peripheral vascular disease (PVD) occurs only in the arteries, it is called peripheral artery disease (PAD). Most cases of PVD affect the arteries as well, so the terms are often interchangeable.

In this article, we take a close look at PVD, including causes, symptoms, diagnosis, and treatments.

Fast facts on PVD:

  • PVD affects an estimated 1 in 20 Americans over 50 years of age.
  • Common risk factors include being over 50, smoking cigarettes, and having high blood pressure or high cholesterol.
  • Common symptoms include pain and cramps in the legs, hips, and buttocks.
  • According to the Centers for Disease Control and Prevention (CDC), PVD affects men and women equally.
  • Arteriosclerosis and atherosclerosis are among the most common causes of PVD.APA Peripheral Vascular Disease Essay Paper
Types of peripheral vascular disease

There are two main types of PVD:

  • Organic PVD results from changes in the blood vessels caused by inflammation, plaque buildup, or tissue damage.
  • Functional PVD happens when blood flow decreases in response to something that causes the blood vessels to vary in size, such as brain signals or changes in body temperature. In functional PVD, there is no physical damage to the blood vessels.
Symptoms
PVD commonly affects the legs.

Signs and symptoms of PVD often appear gradually. They occur more commonly in the legs than the in arms because the blood vessels in the legs are further from the heart.

Pains, aches, or cramps while walking are typical symptoms of PVD. However, up to 40 percent of people with PVD or PAD do not experience any leg pain.

Pains, aches, and cramps related to walking, which is known as claudication, might occur in the following areas:

  • buttock
  • calf
  • hip
  • thigh

Symptoms of claudication often develop when someone is walking quickly or for long distances. The symptoms typically go away with rest. However, as PVD progresses, symptoms can get worse and become more frequent. Leg pain and fatigue may persist even while resting.APA Peripheral Vascular Disease Essay Paper

Other symptoms of PVD include:

  • leg cramps when lying down
  • pale or reddish-blue legs or arms
  • hair loss on the legs
  • skin that is cool to the touch
  • thin, pale, or shiny skin on the legs and feet
  • slow-healing wounds and ulcers
  • cold, burning, or numb toes
  • thickened toenails
  • slow or absent pulse in the feet
  • heavy or numb sensations in the muscles
  • wasting away of the muscle (atrophy
  • Causes

Causes of PVD vary and depend on the type a person has.

Causes of organic PVD

Arteriosclerosis, which is caused by changes in the structure of the blood vessels, is a common cause of organic PVD.

Atherosclerosis, which is a specific type of arteriosclerosis, occurs when plaque (fats and other substances) build up in the blood vessels. Atherosclerosis can restrict blood flow, and if left untreated, can cause clots. Clots block the arteries and cause loss of limbs or organ damage.

Common risk factors for atherosclerosis include:

  • high blood pressure (hypertension)
  • high cholesterol or triglycerides
  • inflammation from arthritis, lupus, or other conditions
  • insulin resistance
  • smoking

The following conditions may cause structural changes in the blood vessels:

  • Buerger’s disease
  • chronic venous insufficiency
  • deep vein thrombosis (DVT)
  • Raynaud’s syndrome
  • thrombophlebitis
  • varicose veins

Injury, inflammation, or infection in the blood vessels may also cause structural changes in the blood vessels.

Causes of functional PVD

Functional PVD occurs when blood vessels have an increased response to brain signals and environmental factors. Common causes of this include:APA Peripheral Vascular Disease Essay Paper

  • cold temperatures
  • drug use
  • feeling stressed
  • using machines or tools that cause the body to vibrate

Smokers and people over the age of 50 are at an increased risk of developing PVD.

In general, the risk factors for PVD are similar to those for arteriosclerosis. They include:

  • Age. People aged 50 years and over are more likely to get PVD and PAD.
  • Being overweight or obeseincreases risk of arteriosclerosis, PVD, and other cardiovascular conditions.
  • Lifestyle choices. People who smoke, use drugs, avoid exercise, or have an unhealthful diet are more likely to get PVD.
  • Medical and family history. PVD risk rises for people who have a history of cerebrovascular disease or stroke. Those with a family history of high cholesterol, hypertension, or PVD are also at higher risk.
  • Other medical conditions. People with high cholesterol, hypertension, heart disease, or diabetes are at an increased risk of developing PVD.
  • Race and ethnicity. African American people tend to develop PVD more frequently.

If a person suspects they have PVD, it is essential that they see a doctor. Early diagnosis and treatment can improve the outlook for the disease and prevent severe complications from occurring.APA Peripheral Vascular Disease Essay Paper

A doctor will diagnose PVD by:

  • Taking a full medical and family history, which includes details of lifestyle, diet, and medication use.
  • Performing a physical examination, which includes checking the skin temperature, appearance, and the presence of pulses in the legs and feet.

They may also order tests to confirm a diagnosis or rule out other conditions. Several other disorders can mimic the symptoms of PVD and PAD.

Diagnostic tests used to diagnose PVD include:

  • Angiography. Angiography involves injecting dye into the arteries to identify a clogged or blocked artery.
  • Ankle-brachial index (ABI). This non-invasive test measures blood pressure in the ankles. The doctor then compares this reading to blood pressure readings in the arms. A doctor will take measurements after rest and physical activity. Lower blood pressure in the legs suggests a blockage.
  • Blood tests. Although blood tests alone cannot diagnose PVD, they can help a doctor check for the presence of conditions that can increase a person’s risk of developing PVD, such as diabetes and high cholesterol.
  • Computerized tomography angiography (CTA). A CTA imaging test shows the doctor an image of the blood vessels, including areas that have narrowed or become blocked.
  • Magnetic resonance angiography (MRA). Similar to a CTA, magnetic resonance angiography highlights blood vessel blockages.
  • Ultrasound. Using sound waves, an ultrasound allows the doctor to see blood circulation through the arteries and veins.APA Peripheral Vascular Disease Essay Paper

Peripheral vascular disease (PVD) is a nearly pandemic condition that has the potential to cause loss of limb or even loss of life. PVD manifests as insufficient tissue perfusion initiated by existing atherosclerosis acutely compounded by either emboli or thrombi. Many people live daily with significant degrees of PVD; however, in settings such as acute limb ischemia, this latent disease can suddenly become life-threatening and necessitate emergency intervention to minimize morbidity and mortality.[1, 2]

Peripheral artery disease is a narrowing of the peripheral arteries serving the legs, stomach, arms and head. (“Peripheral” in this case means away from the heart, in the outer regions of the body.) PAD most commonly affects arteries in the legs.

Both PAD and coronary artery disease (CAD) are caused by atherosclerosis. Atherosclerosis narrows and blocks arteries in critical regions of the body.APA Peripheral Vascular Disease Essay Paper

Quick facts about PAD

The most common symptoms of PAD involving the lower extremities are cramping, pain or tiredness in the leg or hip muscles while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again.

Be aware that:

  • Many people mistake the symptoms of PAD for something else.
  • PAD often goes undiagnosed by healthcare professionals.
  • People with peripheral arterial disease have a higher risk of coronary artery disease, heart attack or stroke.
  • Left untreated, PAD can lead to gangrene and amputation.

View our interactive PAD library

Added risks for PAD

Other factors can increase your chances for peripheral artery disease, including:

  • Your risk for peripheral artery disease increases with age.
  • High blood pressure or high cholesterol puts you at risk for PAD.
  • If you smoke, you have an especially high risk for PAD.
  • If you have diabetes, you have an especially high risk for PAD.

If you’re at risk for peripheral artery disease or have been diagnosed with PAD, it’s worth knowing that:

  • PAD is easily diagnosed in a simple, painless way.
  • You can take control: Follow your doctor’s recommendations and strive to lead a heart-healthy lifestyle.
  • Some cases of PAD can be managed with lifestyle changes and medication.
Atherosclerosis and PAD

If you have atherosclerosis, that means that plaque has built up inside your artery walls. Plaque is made up of deposits of fats, cholesterol and other substances. Atherosclerosis in the peripheral arteries is the most common cause of PAD.

To see how plaque limits blood flow, view our interactive PAD library.

What happens is this: First, plaque builds up enough to narrow an artery, which chokes off blood flow. Next, if that plaque becomes brittle or inflamed, it may rupture, triggering a blood clot to form. A clot can further narrow the artery, or completely block it.

If that blockage remains in the peripheral arteries of the legs, it can cause pain, changes in skin color, difficulty walking and sores or ulcers. Total loss of circulation to the legs and feet can cause gangrene and the loss of a limb.

If the blockage occurs in a carotid artery, it can cause a stroke.APA Peripheral Vascular Disease Essay Paper

Watch an atherosclerosis and PAD animation

It’s important to learn the facts about PAD. As with any disease, the more you understand, the more you’ll be able to help your doctor make an early diagnosis. PAD has common symptoms, but many people with PAD never have any symptoms at all.

Treatment

Effective PVD treatment aims to slow or stop disease progression, manage pain and other symptoms, and reduce the risk of serious complications.

PVD treatment plans usually involve lifestyle changes. Some people may also require medication, and severe cases may require surgical treatment.

Lifestyle changes include:

  • engaging in regular exercise, including walking
  • eating a balanced diet
  • losing weight if necessary
  • quitting smoking
Medication

Medications to treat PVD include:

  • cilostazol to reduce claudication
  • pentoxifylline to treat muscle pain
  • clopidogrel or aspirin to stop blood clotting

Co-occurring conditions may also require medicines to keep symptoms under control. For example, some people may need:

  • statins (such as atorvastatin and simvastatin) to reduce high cholesterol
  • angiotensin-converting enzyme (ACE) inhibitors for hypertension
  • metformin or other diabetes medications to manage blood sugar APA Peripheral Vascular Disease Essay Paper
Surgery

People with severe PVD might require surgery to widen arteries or bypass blockages. Surgical options are:

  • Angioplasty. This involves inserting a catheter that is fitted with a balloon into the damaged artery and then inflating the balloon to widen the artery. Sometimes, the doctor will place a small tube (stent) in the artery to keep it open.
  • Vascular bypass surgery. Also known as a vascular graft, this procedure involves reconnecting blood vessels to bypass a narrow or blocked part of a vessel. It allows blood to flow more easily from one area to another.

If PVD is left undiagnosed and untreated, it can cause severe or life-threatening complications such as:

  • gangrene (tissue death), which can require amputation of the affected limb
  • heart attack or stroke
  • impotence
  • severe pain that restricts mobility
  • slow-healing wounds
  • potentially fatal infections of the bones and blood APA Peripheral Vascular Disease Essay Paper
Prevention

A person can reduce their risk of developing PVD by:

  • quitting smoking, or not starting
  • engaging in at least 150 minutes of cardiovascular activity, such as walking or running, each week
  • eating a balanced diet
  • maintaining a healthy body weight
  • managing blood sugar, cholesterol, and blood pressure levels

When diagnosed early, PVD is often easily treated with lifestyle modifications and medications.

A doctor can monitor a person’s improvement by measuring the distance they can walk without claudication. If treatments are effective, people should be able to gradually walk longer distances without pain.

Early intervention may prevent the condition from progressing and can help to avoid complications. Anyone experiencing any of the symptoms of PVD should see a doctor.

The sudden development of pale, cold, and aching limbs with loss of pulses is a medical emergency and requires immediate treatment.APA Peripheral Vascular Disease Essay Paper

Atherosclerosis is the pathological process in the coronary arteries, cerebral arteries, iliac and femoral arteries, and aorta that is responsible for coronary heart disease (CHD), stroke, and peripheral arterial disease (PAD). It begins during childhood in the intima of the large elastic and muscular arteries with deposits of lipids, principally cholesterol and its esters, in macrophages and smooth muscle cells (Figure 19-1). The lesions, called fatty streaks, produce only minimal intimal thickening and cause no disturbances in blood flow during early childhood, but they rapidly become more extensive during adolescence. In young adults, more lipid is deposited at some sites, and a core of lipid and necrotic debris becomes covered by a cap of smooth muscle and fibrous tissue. These changes produce elevated lesions called fibrous plaques that project into the lumen and begin to disturb blood flow.

The relationship between fatty streaks and fibrous plaques has been one of the most controversial aspects of the pathogenesis of atherosclerosis. The coronary arteries differ from most other arteries by having a prominent intimal layer of longitudinal smooth muscle and fibrous tissue that is apparent even in childhood. By the age of 20, the thickness of this layer is about equal to that of the media, even when it does not contain abnormal lipid (Stary, 1987a,b). This fibromuscular intimal layer occurs in all populations, even in those not predisposed to coronary atherosclerosis in adulthood (Geer et al., 1968) and is considered to be a normal anatomic structure rather than an atherosclerotic lesion.APA Peripheral Vascular Disease Essay Paper

Some evidence suggests that fibrous plaques are created by cellular proliferation and subsequent fatty degeneration without prior lipid deposition (Benditt, 1974), and some observations are not consistent with the progression of fatty streaks to fibrous plaques. For example, fatty streaks are more extensive in the thoracic aortas of children, but fibrous plaques are more extensive in the abdominal aortas of adults. Young women have more extensive fatty streaks in their coronary arteries and aortas than do young men, but among adults this pattern is reversed. (McGill, 1968).

Peripheral artery disease (PAD) is an abnormal narrowing of arteriesother than those that supply the heart or brain.[5][15] When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular disease.[4] Peripheral artery disease most commonly affects the legs, but other arteries may also be involved.[4] The classic symptom is leg pain when walking which resolves with rest, known as intermittent claudication.[2] Other symptoms include skin ulcers, bluish skin, cold skin, or abnormal nail and hair growth in the affected leg.[3] Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke.[4] Up to 50% of people with PAD do not have symptoms APA Peripheral Vascular Disease Essay Paper

The greatest risk factor for PAD is cigarette smoking.[4] Other risk factors include diabetes, high blood pressure, kidney problems, and high blood cholesterol.[7][16] The most common underlying mechanism of peripheral artery disease is atherosclerosis, especially in individuals over 40 years old.[6][17] Other mechanisms include artery spasm, blood clots, trauma, fibromuscular dysplasia, and vasculitis.[5][16] PAD is typically diagnosed by finding an ankle-brachial index (ABI) less than 0.90, which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm.[9] Duplex ultrasonography and angiography may also be used.[8] Angiography is more accurate and allows for treatment at the same time; however, it is associated with greater risks.[9]

It is unclear if screening for peripheral artery disease in people without symptoms is useful as it has not been properly studied.[18][19][17] In those with intermittent claudication from PAD, stopping smoking and supervised exercise therapy improve outcomes.[11][12] Medications, including statins, ACE inhibitors, and cilostazol may also help.[12][20] Aspirin does not appear to help those with mild disease but is usually recommended in those with more significant disease due to the increased risk of heart attacks.[17][21][22] Anticoagulants such as warfarin are not typically of benefit.[23] Procedures used to treat the disease include bypass grafting, angioplasty, and atherectomy APA Peripheral Vascular Disease Essay Paper

In 2015, about 155 million people had PAD worldwide.[13] It becomes more common with age.[24] In the developed world, it affects about 5.3% of 45- to 50-year-olds and 18.6% of 85- to 90-year-olds.[7] In the developing world, it affects 4.6% of people between the ages of 45 and 50 and 15% of people between the ages of 85 and 90.[7] PAD in the developed world is equally common among men and women, though in the developing world, women are more commonly affected.[7] In 2015 PAD resulted in about 52,500 deaths, which is an increase from the 16,000 deaths in 1990

Overall, however, evidence supports the association of fatty streaks with fibrous plaques. Lesions in the arteries of young adults have many histological and chemical characteristics of fatty streaks as well as fibrous plaques—an observation suggesting a continuous progression from one type of lesion to the other (Geer et al., 1968; Katz, 1981; Stary, 1987a,b). Furthermore, in contrast to the differences in location of fatty streaks and fibrous plaques in the aorta, the sites of fatty streaks in the coronary arteries of children are the most common sites of fibrous plaques in adults (Montenegro and Eggen, 1968). The major risk factors, hypercholesterolemia and hypertension, are closely associ-APA Peripheral Vascular Disease Essay Paper

ated with the extent of fibrous plaques in adults (Solberg and Strong, 1983). The few relevant data indicate that there is an association between serum cholesterol and low-density lipoprotein (LDL) cholesterol concentrations with fatty streaks in childhood (Freedman et al., 1988; Newman et al., 1986). Furthermore, it seems most likely that fatty streaks in children are labile, i.e., some may regress or remain as fatty streaks whereas others progress and evolve into fibrous plaques. This later process occurs particularly in the coronary arteries and abdominal aorta, where some fatty streaks are gradually converted to fibrous plaques by continued lipid deposition and reactive chronic inflammation and repair. For a review of this subject, see McGill (1988).

Regardless of their origin, fibrous plaques undergo a variety of qualitative changes in early middle age in the U.S. population, as illustrated in Figure 19-1. These changes result in  fibrous plaques that vary in their content of lipids, smooth muscle cells, connective tissue, calcium, and vessels. The most serious complication is ulceration of the connective tissue and smooth muscle cap of fibrous plaque, a change that exposes blood to the lipid-rich necrotic debris of the core and is likely to precipitate thrombosis. Another serious complication is hemorrhage into the plaque. This causes sudden swelling of the plaque and may precipitate ulceration and thrombosis.APA Peripheral Vascular Disease Essay Paper

Thrombosis overlying an advanced atherosclerotic fibrous plaque is the most common event that occludes the lumen of the coronary artery and causes ischemia. At a point, determined by such factors as blood pressure, collateral circulation, and tissue oxygen demand, the blood supply is reduced below a critical level and ischemic necrosis occurs in the tissue supplied by the affected artery.

Lesions in the coronary arteries lead to CHD, which is the most common and most serious manifestation of atherosclerotic cardiovascular diseases in middle-aged adults. The atherosclerotic process that occurs in the cerebral and peripheral arteries is similar to that which occurs in the coronary arteries, but the lesions usually develop a decade or two later than those in the coronary arteries.APA Peripheral Vascular Disease Essay Paper

Peripheral vascular disease is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta. The most common symptom of peripheral vascular disease is intermittent claudication. At other times, peripheral vascular disease leads to acute or critical limb ischemia. Intermittent claudication manifests as pain in the muscles of the legs with exercise; it is experienced by 2 percent of persons older than 65 years. Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. The standard office-based test to determine the presence of peripheral vascular disease is calculation of the ankle-brachial index. Magnetic resonance arteriography, duplex scanning, and hemodynamic localization are noninvasive methods for lesion localization and may be helpful when symptoms or findings do not correlate with the ankle-brachial index. Contrast arteriography is used for definitive localization before intervention. Treatment is divided into lifestyle, medical, and surgical therapies. Lifestyle therapies focus on exercise, smoking cessation, and dietary modification. Medical therapy is directed at reducing platelet aggregation. In addition, patients with contributing disorders such as hypertension, diabetes, and hyperlipidemia need to have these conditions managed as aggressively as possible. Surgical therapies include stents, arterectomies, angioplasty, and bypass surgery.APA Peripheral Vascular Disease Essay Paper

 In approximately one-third of all CHD cases, coronary artery occlusion causes a fatal arrhythmia within a few minutes or hours (sudden cardiac death). If the patient survives the first few hours, ischemic necrosis of the myocardium occurs (myocardial infarction). Afterward, the necrotic tissue is removed and replaced by connective tissue. The subsequent clinical outcome is determined, for the most part, by the amount and location of cardiac muscle that is lost. A few days after infarction, and before much connective tissue has formed, the heart may rupture at the site of infarction (cardiac tamponade). The patient surviving this stage may recover cardiac function as the remaining heart hypertrophies to compensate for myocardium lost by infarction. At any stage, the patient may die from failure of the heart to pump sufficient blood (congestive heart failure) or from a disturbance in the conduction system controlling the distribution of the contractile impulse (arrhythmia). Stenosis of the coronary arteries sometimes is sufficient to cause ischemic pain, but not infarction, especially on exertion (angina pectoris). This condition indicates the presence of severe lesions and high risk of myocardial infarction. All these syndromes (angina pectoris, myocardial infarction, sudden cardiac death) are included in the term coronary heart disease.APA Peripheral Vascular Disease Essay Paper

If thrombosis forms over an  atherosclerotic plaque in a cerebral artery, ischemic necrosis occurs in the brain (cerebral infarct). Cerebral infarction (one type of stroke) typically causes paralysis on the contralateral side due to lack of upper motor neuron  function, and  disturbances of speech, vision, hearing, and memory, depending on the anatomic location of the infarct. Death may occur due to involvement of the brain centers

controlling respiration or to cerebral edema. The necrotic tissue is converted to a liquid-filled cavity. Function is usually recovered to some degree as edema subsides, but neurons do not regenerate. Neural control of muscles and sensory organs may be regained in part as other pathways are developed. If the arterial occlusion is partial or temporary, temporary functional cerebral impairment may occur for a few minutes to a few  hours (transient ischemic attacks). These  episodes, which are analogous to angina pectoris, indicate that the patient has a high risk of developing cerebral infarction.APA Peripheral Vascular Disease Essay Paper

Another type of stroke is cerebral hemorrhage, which includes intracerebral hemorrhage (bleeding into  the brain) and  subarachnoid  hemorrhage (bleeding into the space between the arachnoid membrane and the surface of the brain). In an intracerebral hemorrhage, an artery within the brain ruptures and causes a large area of tissue destruction. Its clinical manifestations are similar to those of cerebral infarction, except that it is more rapid in onset and more likely to be fatal. This type of stroke is almost always associated with severe hypertension. Since hypertension augments cerebral atherosclerosis, it is a major risk factor for both cerebral infarction and intracerebral hemorrhage.

The rupture of an artery into the subarachnoid space is usually at the site of a developmental defect in the artery wall. Either the defect, or its rupture, or both may be enhanced by hypertension. The clinical manifestations of a subarachnoid hemorrhage are similar to those of other types of stroke.APA Peripheral Vascular Disease Essay Paper

Peripheral arterial disease (PAD) occurs when atherosclerosis and its complications in the abdominal aorta, iliac arteries, and femoral arteries produce temporary arterial insufficiency in the lower extremities upon exertion (intermittent claudication) or ischemic necrosis of the extremities (gangrene). In the abdominal aorta, weakening of the media underlying the atherosclerotic plaque leads to an aneurysm, which may become filled with a thrombus or rupture into the abdominal cavity.

The major risk factors associated with clinically manifest atherosclerotic diseases also are associated with the severity of atherosclerosis. In particular, LDL cholesterol levels are positively correlated with fibrous plaques and other advanced lesions, and high-density lipoprotein (HDL) cholesterol levels are inversely associated with advanced lesions (Solberg and Strong, 1983). Hypertension is more closely associated with advanced atherosclerosis in the cerebral arteries than in other arteries, a selective effect consistent with the identification of hypertension as the dominant risk factor for stroke. Cigarette smoking is associated with advanced atherosclerosis of the abdominal aorta and iliac-femoral arteries, and consequently with PAD (DHHS, 1983). Smoking also is associated with advanced coronary atherosclerosis, but the increased coronary atherosclerosis in smokers is not sufficient to account for their much greater risk of CHD; other mechanisms, particularly thrombosis, are probably involved. Diabetes mellitus also is associated with severity of atherosclerosis in all arteries. Men have more severe coronary atherosclerosis than women, just as they have a higher frequency of CHD, but there is no sex difference in the severity of atherosclerosis of the aorta or cerebral arteries.APA Peripheral Vascular Disease Essay Paper

In populations with low serum cholesterol levels, atherosclerosis is less severe in those without hypertension and diabetes. However, among the latter, the severity of the disease is less than in populations where hyperlipidemia  is prevalent (Robertson and Strong, 1968). Thus, hyperlipidemia, hypertension, and diabetes are additive in their effect on atherosclerosis, just as they are additive in their effect on risk of clinical disease. There is less information about the effects of cigarette smoking among different populations, but the evidence (Keys, 1980; Robertson et al., 1977) suggests that a similar relationship exists.

CHD risk factors for which no associations with severity of atherosclerosis have been found include physical activity and obesity (Solberg and Strong, 1983). The relationship of other putative risk factors to the severity of atherosclerosis has not been determined.APA Peripheral Vascular Disease Essay Paper

Results of animal experiments are consistent with observations in humans. LDL cholesterol and HDL cholesterol levels, and the ratio of the two lipoprotein cholesterol concentrations to one another are highly predictive of lesions in laboratory animals. High blood pressure combined with hyperlipidemia accelerates experimentally induced atherosclerosis. Despite several attempts, no effect of cigarette smoking on experimentally induced atherosclerosis has been demonstrated (Rogers et al., 1988).

 Peripheral vascular disease is the most common type of arterial disease, and a major risk factor for cardiac arrest and stroke. Specialized vein treatment can be the most effective way to manage peripheral vascular disease, but you can support these efforts with healthy changes to your lifestyle. These same healthy behaviors can also help prevent you from getting heart disease in the first part.APA Peripheral Vascular Disease Essay Paper

Control Your Carbohydrate Intake

Diabetes is a risk factor for peripheral vascular disease. Uncontrolled diabetes can cause blood vessel damage and dysfunction. If you have diabetes, you can help manage your blood sugar by following a diet with a controlled carbohydrate intake.

  • Consume a moderate amount of carbohydrates at each meal and snack.
  • Include protein and fat to balance the carbohydrates.
  • Limit sugars and refined grains.
  • Focus on vegetables, beans, reduced-fat dairy products, and whole grains as carbohydrate sources.

Limit Sodium and Increase Potassium

Too much sodium can lead to high blood pressure, or hypertension, which makes peripheral arterial disease worse. Limit your intake by avoiding adding salt at the table and reducing the amount you put in recipes. Also, be aware that many processed foods are high-sodium. Examples include canned soups, vegetables, and beans, bread, dressings, sauces, pickles, and cheese.APA Peripheral Vascular Disease Essay Paper

At the same time, increase your potassium intake, since potassium helps mitigate sodium’s effects. Fruits, vegetables, beans, and fish are good sources.

Choose Healthy Fats

Eating more healthy fats compared to unhealthy ones can improve your cholesterol levels, leading to less plaque and healthier arteries.

  • Limit saturated fats from butter, dairy products, and fatty meats.
  • Avoid trans fats from many fried foods and processed foods, such as snack cakes, crackers, cookies, and pastries.
  • Use plant-based oils for cooking.
  • Eat fatty fish regularly.

Exercise Regularly

Exercise helps you manage your weight, lower your blood pressure, and increase your “good” HDL cholesterol. Consult your cardiologist before starting an exercise program. In addition to hitting the gym most days, break up long periods of sitting with a minute or two of walking.APA Peripheral Vascular Disease Essay Paper

Treat Yourself Well

Heart doctors will tell you that improving your cardiovascular health can be as easy as treating yourself right. Get enough sleep each night, and work to reduce or manage stress in your life.

Be sure to continue to work closely with a local vein center if you have peripheral vascular disease. Lifestyle modifications can prevent it from getting worse, but you may need medical intervention, such as the following.

  • Surgery to place a stent to open up a severely blocked artery.
  • Surgery, known as atherectomy, to remove an atherosclerotic plaque.
  • Medications to reduce blood clotting.
  • Bypass surgery to go around the affected artery.

If you have risk factors for arterial disease, vein doctors at Tri-City Cardiology can examine and treat you. Prompt care is most effective.APA Peripheral Vascular Disease Essay Paper

The prevalence of peripheral artery disease is steadily increasing and is associated with significant morbidity, including a significant percentage of amputations. Peripheral artery disease often goes undiagnosed, making its prevention increasingly important. Patients with peripheral arterial disease are at increased risk of adverse cardiovascular outcomes which makes prevention even more important. Several risk factors have been identified in the pathophysiology of peripheral artery disease which should be modified to decrease risk. Smoking, hyperlipidemia, hypertension, and diabetes are among proven risk factors for the development of peripheral artery disease, thus smoking cessation, lipid control, blood pressure control, and glucose control have been tried and shown to be effective in preventing the morbidity associated with this disease. Pharmacologic agents such as aspirin and clopidogrel alone or in combination have been shown to be effective, though risk of bleeding might be increased with the combination. Anticoagulation use is recommended only for acute embolic cases. Other treatment modalities that have been tried or are under investigation are estrogen replacement, naftidrofuryl, pentoxifylline, hyperbaric oxygen, therapeutic angiogenesis, and advanced glycation inhibitors. The treatment for concomitant vascular diseases does not change in the presence of peripheral artery disease, but aggressive management of risk factors should be undertaken in such cases.APA Peripheral Vascular Disease Essay Paper

Peripheral Artery Disease (PAD – also known as Peripheral Vascular Disease or PVD) results from a progressive thickening of an artery’s lining caused by a buildup of plaque, which narrows or blocks blood flow, reducing the circulation of the blood to a specific organ or region of the body. This process, atherosclerotic occlusive vascular disease or atherosclerosis, is often called “hardening of the arteries.”

If the plaque surface becomes irregular or ulcerated, it may accumulate small blood clots and plaque contents. The particles (emboli) travel in the circulatory system, ultimately blocking flow through tiny blood vessels, which can also damage sensitive organs, such as the brain, by causing stroke.

Like many cardiovascular conditions, a heart-healthy lifestyle is significant to peripheral artery disease prevention. Follow these heart-healthy best practices to manage the risk factors you can control and know your risk. Take the coronary artery disease health evaluator​ to determine where you stand and talk to your physician about how you can improve the results.APA Peripheral Vascular Disease Essay Paper

Taking action to control your risk factors can help prevent or delay PAD and its complications. Know your family history of health problems related to PAD. If you or someone in your family has the disease, be sure to tell your doctor. Controlling risk factors includes the following:

  • Be physically active
  • Be screened for PAD. A simple office test, called an ankle-brachial index or ABI, can help determine whether you have PAD.
  • Follow heart-healthy eating​
  • If you smoke, quit. Talk with your doctor about programs and products that can help you quit smoking.
  • If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.

The lifestyle changes described above can reduce your risk of developing PAD. These changes also can help prevent and control conditions that can be associated with PAD, such as coronary heart disease, diabetes​, high blood pressure​, high blood cholesterol, and stroke​.APA Peripheral Vascular Disease Essay Paper

LIVING WITH PERIPHERAL ARTERY DISEASE

If you have peripheral artery disease, you’re more likely to also have coronary heart disease, heart attack, stroke, and transient ischemic attack (“mini-stroke”). However, you can take steps to treat and control PAD and lower your risk for these other conditions.

Living with Peripheral Artery Disease Symptoms

If you have PAD, you may feel pain in your calf or thigh muscles after walking. Try to take a break and allow the pain to ease before walking again. Over time, this may increase the distance that you can walk without pain.

Talk with your doctor about taking part in a supervised exercise program. This type of program has been shown to reduce PAD symptoms.

Check your feet and toes regularly for sores or possible infections. Wear comfortable shoes that fit well. Maintain good foot hygiene and have professional medical treatment for corns, bunions, or calluses.APA Peripheral Vascular Disease Essay Paper

An often effective treatment for PAD symptoms is regular physical activity. Your doctor may recommend a program of supervised exercise training for you, also known as cardiac rehabilitation. You may have to begin slowly, but simple walking regimens, leg exercises and treadmill exercise programs can ease symptoms. Exercise for intermittent claudication – poor circulation in leg arteries due to buildup of plaque – takes into account the fact that walking causes pain. The program consists of alternating activity and rest in intervals to build up the amount of time you can walk before the pain sets in. It’s best if this exercise program is undertaken in a rehabilitation center on a treadmill and monitored. If it isn’t possible to go to a rehabilitation center, your healthcare professional may recommend a structured community or home-based program that’s best suited to your situation.APA Peripheral Vascular Disease Essay Paper

Narrowing or blockage of the arteries supplying blood to the lower limbs, usually termed peripheral artery disease (PAD), is principally caused by athero-thrombosis. PAD is a leading cause of morbidity due to the associated functional decline and limb loss. Both asymptomatic and symptomatic PAD are significant predictors of cardiovascular disease (CVD) events and mortality [1]. Current evidence suggests that PAD represents a CVD risk equivalent to or worse than coronary artery disease requiring aggressive medical management [2].APA Peripheral Vascular Disease Essay Paper

The main recognized clinical presentations of PAD are intermittent claudication (IC) and critical limb ischemia (CLI). IC describes the symptoms of pain in the muscles of the lower limb brought on by physical activity which is rapidly relieved by rest. CLI is a more severe manifestation of PAD, which presents as rest pain, ischemic ulceration or gangrene of the foot. Patients with CLI have a high risk of limb loss and fatal or non-fatal vascular events, such as myocardial infarction (MI) and stroke [2]. Acute limb ischemia (ALI) occurs when there is a sudden interruption of blood flow to a limb typically due to an embolism or thrombosis [3]. In contrast to CLI, which typically develops over a prolonged period often preceded by IC, patients with ALI may not have preceding symptoms. ALI usually threatens limb viability more urgently than CLI possibly due to the absence of an established collateral blood supply to the limb.APA Peripheral Vascular Disease Essay Paper

Peripheral artery disease (PAD) is due to the blockage of the arteries supplying blood to the lower limbs usually secondary to atherosclerosis. The most severe clinical manifestation of PAD is critical limb ischemia (CLI), which is associated with a risk of limb loss and mortality due to cardiovascular events. Currently CLI is mainly treated by surgical or endovascular revascularization, with few other treatments in routine clinical practice. There are a number of problems with current PAD management strategies, such as the difficulty in selecting the appropriate treatments for individual patients. Many patients undergo repeated attempts at revascularization surgery, but ultimately require an amputation. There is great interest in developing new methods to identify patients who are unlikely to benefit from revascularization and to improve management of patients unsuitable for surgery. Circulating biomarkers that predict the progression of PAD and the response to therapies could assist in the management of patients. This review provides an overview of the pathophysiology of PAD and examines the association between circulating biomarkers and PAD presence, severity and prognosis. While some currently identified circulating markers show promise, further larger studies focused on the clinical value of the biomarkers over existing risk predictors are needed.APA Peripheral Vascular Disease Essay Paper

PAD blockages can result in severe pain, limited physical mobility and non-healing leg ulcers, and lead to amputation if the vessels cannot be revascularized. More than 1 million Americans are living with a limb loss as a result of diabetes and PAD,[2] and nearly half of these patients die within five years.[3] About 150,000 Americans undergo leg or foot amputations every year, mostly due to poor circulation caused by PAD.

About 25 percent of PAD cases will progress to critical limb ischemia (CLI), which is associated with complex occlusions in the tibial arteries. It is estimated that up to 20 percent of these occlusions are unable to be treated from the traditional femoral artery access site. However, recent advancements in technology and techniques have made the use of retrograde tibiopedal access (where physicians achieve access through the arteries in the foot or ankle) more popular, thereby expanding the treatment options available for PAD patients.APA Peripheral Vascular Disease Essay Paper

Watch the video, “State of Therapy for Critical Limb Ischemia.” This interview with Michael Jaff, M.D., medical director of Massachusetts General Hospital’s Fireman Vascular Center, explains the current trends and technologies in critical limb (CLI) ischemia at ACC.16. Jaff also discusses strategies used by hospitals to recruit patients into CLI programs.

In recent years there has been a revolution in endovascular therapy and we’re able to treat calcified and smaller vessels, meaning we can significantly improve blood flow and save limbs that once weren’t considered salvageable, and that saves lives,” said Julio Sanguily III, M.D., vascular surgeon with Martin Health System, Stuart, Fla., who presented a study on CLI at the 2015 International Symposium on Endovascular Therapy (ISET).

He explained that a good percentage of these patients not only have limbs salvaged but their quality of life greatly improved through interventional techniques. Sanguily said the key is to educate physicians who treat elderly patients and those with diabetes or kidney failure, the patients at highest risk for these problems. He said letting them know about new interventional options and providing them the ability to refer patients to a limb salvage program can help rapidly build a program. The number of amputations at Martin Health System fell by 79 percent over five years after the center implemented a limb salvage program. In 2014, he said 500 patients were evaluated with an angiogram to assess blood flow in the legs. Of these patients, only five had amputations (1 percent).APA Peripheral Vascular Disease Essay Paper

Whenever possible, PAD patients in the Martin Health System program received treatment to revascularize the legs, including percutaneous transluminal angioplasty (PTA), atherectomy and hyperbaric oxygen therapy. Sanguily said calcified plaque is the most challenging problem encountered in these interventions and atherectomy has proved particularly helpful in these lesions.

Peripheral Stents

The revascularization strategy for PAD differs from coronary artery disease (CAD). Instead of attempting a permanent repair to reopen vessels as in CAD, the vessels in the leg are treated with the expectation that the patient will need the same segments revascularized again in the future. PAD restenosis rates are very high with the use of both PTA and stents. Stents in the legs are exposed to torque and pressures not found in the heart, protected by the ribcage. This environment leads to high rates of in-stent restenosis and stent fractures.APA Peripheral Vascular Disease Essay Paper

These issues have led to development of specialty stents for PAD. Most peripheral stents are self-expanding, flexible and handle flexing and external crushing pressures better than rigid balloon expanded stents.

One of the most recent stents approved by the U.S. Food and Drug Administration (FDA) in December was Biotronik’s Astron for iliac lesions. The self-expanding stent is loaded on an over-the-wire delivery system available in diameters of 7, 8, 9 and 10 mm, and stent lengths of 30, 40, 60 and 80 mm. Astron’s 12-month primary patency rate was 89.8 percent, and the target lesion revascularization (TLR) rate was 1.4 percent. Additionally, patients demonstrated improvement in their ambulatory function and quality of life at 12 months compared to baseline as evaluated by the walking impairment questionnaire score, a common PAD screening tool.APA Peripheral Vascular Disease Essay Paper

In February, Biotronik announced a partnership with Maquet Medical Systems in which Maquet will expand its product portfolio into PAD using Biotronik’s devices. In 2014, an estimated 176,800 patients in the United States received an iliac stent, and that number is expected to grow annually, offering new growth opportunities for companies with PAD portfolios.[4]

Last August, Boston Scientific received FDA clearance for the Innova self-expanding stent for the superficial femoral artery (SFA) or proximal popliteal artery (PPA). The platform consists of a nitinol self-expanding bare metal stent available in diameters from 5-8 mm and lengths of 20-200 mm. This stent platform serves as the foundation for the Eluvia drug-eluting vascular stent in development. The SFA and PPA present a challenging environment for stents, and the flexibility, radial strength and fracture resistance of the Innova Stent are designed specifically for this anatomy.APA Peripheral Vascular Disease Essay Paper

One-year clinical trial outcomes assessing the Eluvia drug-eluting stent reflect a primary patency rate of more than 96 percent. These results represent the highest 12-month primary patency reported for an interventional treatment of femoropopliteal artery lesions among comparable trials. Results from the MAJESTIC trial were presented at the 2015 Cardiovascular and Interventional Radiological Society of Europe (CIRSE) meeting last fall. Data included a low 12-month TLR rate of 3.8 percent, with no observed stent fractures and no amputations. The prospective, multicenter clinical trial enrolled 57 patients across Europe, Australia and New Zealand, with an average lesion length of 70.8 mm. The trial included a high percentage of complex lesions, with 46 percent of lesions classified as total occlusions and 65 percent identified as severely calcified. Data from the trial are expected to support global regulatory submissions.

Boston Scientific has received an investigational device exemption (IDE) from the FDA to begin a global, pivotal study of the Eluvia drug-eluting stent. The IMPERIAL trial, designed to support future regulatory submissions and patient enrollment, is expected to begin in the coming months.APA Peripheral Vascular Disease Essay Paper

The FDA cleared Covidien’s EverFlex self-expanding stent in 2014. The device is indicated for use in the SFA and PPA. It is available in a size matrix from 20-200 mm and is deliverable through a 6 French catheter. Its spiral-cell connection and peak-to-peak connection nodes are designed to disperse force uniformly, while the three-wave peak design resists compression and provides good wall apposition. Medtronic has since acquired Covidien, adding the stent and the rest of Covidien’s PAD products to its portfolio.

Medtronic also received FDA clearance for the Protege GPS self-expanding stent in early 2015. The stent is indicated for lesions of the common and external iliac arteries. The news followed the nine-month results of the DURABILITY Iliac study, presented at the 2014 VIVA (Vascular Interventional Advances) meeting. The prospective, multi-center, non-randomized clinical study demonstrated 95.8 percent nine-month primary patency by Kaplan-Meier analysis and 98.6 percent freedom from target vessel revascularization.APA Peripheral Vascular Disease Essay Paper

The first drug-eluting, self-expanding stent, approved by the FDA in 2012, was the Cook Medical Zilver PTX. Five-year data from the Zilver PTX Randomized Controlled Trial of Paclitaxel-Eluting Stents for Femoropopliteal Disease showed primary patency of 66.4 percent in the SFA. This compares to 43.4 percent patency for patients with PTA or provisional bare metal stent placement. The multicenter, prospective, randomized study included 479 patients.

Peripheral vascular disease is a manifestation of systemic atherosclerosis that leads to significant narrowing of arteries distal to the arch of the aorta. The most common symptom of peripheral vascular disease is intermittent claudication. At other times, peripheral vascular disease leads to acute or critical limb ischemia. Intermittent claudication manifests as pain in the muscles of the legs with exercise; it is experienced by 2 percent of persons older than 65 years. Physical findings include abnormal pedal pulses, femoral artery bruit, delayed venous filling time, cool skin, and abnormal skin color. Most patients present with subtle findings and lack classic symptoms, which makes the diagnosis difficult. The standard office-based test to determine the presence of peripheral vascular disease is calculation of the ankle-brachial index. Magnetic resonance arteriography, duplex scanning, and hemodynamic localization are noninvasive methods for lesion localization and may be helpful when symptoms or findings do not correlate with the ankle-brachial index. Contrast arteriography is used for definitive localization before intervention. Treatment is divided into lifestyle, medical, and surgical therapies. Lifestyle therapies focus on exercise, smoking cessation, and dietary modification. Medical therapy is directed at reducing platelet aggregation. In addition, patients with contributing disorders such as hypertension, diabetes, and hyperlipidemia need to have these conditions managed as aggressively as possible. Surgical therapies include stents, arterectomies, angioplasty, and bypass surgery.APA Peripheral Vascular Disease Essay Paper

The No. 1 killer on the planet is heart disease, which accounts for one in four deaths, according to the Centers for Disease Control and Prevention. What makes heart disease so deadly is the progressive buildup of plaque in the arteries, which narrows the inner walls, restricting and ultimately blocking the flow of blood.

  • Peripheral artery disease (PAD) is primarily caused by plaque in the arteries that supply blood to the body. It generally indicates systemic atherosclerosis and an increased risk for cardiovascular events.
  • People with diabetes, those who smoke, the elderly, and those with cardiovascular disease are particularly at risk for PAD.
  • This bulletin highlights some of the issues concerning PAD diagnosis and treatment in Canada, and summarizes the available information on two of the many new endovascular devices used to treat PAD in the legs:
    • ○ Shockwave Lithoplasty System (Shockwave Medical): balloon angioplasty with lithotripsy (sound waves) to disrupt calcified plaque
    • ○ Pantheris Lumivascular Atherectomy System (Avinger, Inc.): directional atherectomy guided by optical coherence tomography.
  • Currently there is a lack of good quality, comparative evidence to guide clinical practice on many of the new endovascular technologies used to treat PAD.APA Peripheral Vascular Disease Essay Paper

When fatty deposits clog the arteries that supply blood to the legs, even a short walk can cause leg cramping and pain. This condition, called claudication, comes from the Latin word claudicatio, meaning “to limp.” It’s the hallmark of peripheral artery disease, or PAD, which affects roughly one in seven people over the age of 60.

People with PAD are also likely to have clogged arteries (atherosclerosis) in the heart. In fact, they may be even more prone to heart attacks and strokes than people with heart disease who have already had one of those problems.

“PAD is a particularly dangerous form of atherosclerosis,” says Dr. Marc Bonaca, a vascular specialist at Harvard-affiliated Brigham and Women’s Hospital. Doctors don’t routinely screen people for PAD, but the test is easy and harmless (see “Detecting PAD”). Dr. Bonaca encourages people with risk factors for atherosclerosis, such as smoking, diabetes, and high blood pressure, to get screened for PAD — especially if they have leg pain when walking. The pain usually occurs in the calf but may also arise in the thighs or buttocks.

 

A test called the ankle-brachial index can diagnose PAD. Using a special cuff, the doctor measures the blood pressure in your ankles and compares it with the blood pressure reading in your arms, at rest and sometimes after a brief period of exercise. When your blood vessels are healthy, the readings should closely match. A big difference between the arm and the ankle signals that blood isn’t moving well through clogged vessels in your lower body.

One of the most effective therapies for leg pain due to PAD — an approach called supervised exercise training — should soon become more widely available and affordable. Thanks to a policy approved last year, Medicare will now cover supervised exercise training for PAD, and other insurance companies will likely follow suit.

The therapy, which requires a doctor’s referral, also includes counseling about healthy lifestyle habits. But the main focus is on the exercise, which is typically done on a treadmill with coaching from an exercise therapist.APA Peripheral Vascular Disease Essay Paper

Meeting with a trained therapist to exercise several times a week tends to be more effective than home exercise because people are more motivated and tend to work harder, says Dr. Bonaca. Medicare will cover up to 36 sessions of 30 to 60 minutes each over a 12-week period, with the possibility of approval for an additional 36 sessions over time.

Ask your doctor if you qualify for supervised exercise therapy, and get a referral. Academic medical centers with cardiac rehabilitation programs are likely your best bet. Attending one of these supervised programs may offer added advantages, such as better care coordination for drug therapy. This often includes cholesterol-lowering statins and aspirin. Recent research suggests that for some people with PAD, more potent therapies to lower cholesterol and prevent blood clots may be appropriate.APA Peripheral Vascular Disease Essay Paper

Arteries are the blood vessels that deliver oxygen-rich blood from the heart to different tissues in the body. When plaque builds up and blood flow becomes inhibited, these clogged or blocked arteries can lead to more serious problems such as heart attack, stroke and other cardiovascular diseases. So what can you do to keep your arteries healthy and free of blockage? Food can be used as a natural remedy to regress blockage and prevent further damage to your arteries. Here are 10 of the best foods you can eat to free your arteries of build-up.

1. Asparagus

Asparagus is one of the best foods to cleanse your arteries. Full of fiber and minerals, it helps lower blood pressure and prevent blood clots that can lead to serious cardiovascular illness. It works within the veins and arteries to alleviate inflammation that may have accumulated over time. It boosts the body’s production of glutathione, an antioxidant that fights inflammation and prevents damaging oxidation that causes clogged or blocked arteries. It also contains alpha-linoleic acid and folic acid, which prevent hardening of the arteries.

There are many great recipes for asparagus. Steam it, roast it, grill it and even eat it raw in salads.APA Peripheral Vascular Disease Essay Paper

2. Avocado

Avocado helps reduce the “bad” cholesterol and increase the “good cholesterol” that helps to clear the arteries. It also contains vitamin E, which prevents cholesterol oxidation, as well as potassium, which is known to lower blood pressure. Avocados are a delicious replacement for mayo on a sandwich, or as a salad topping, and of course, in guacamole.

3. Broccoli

Broccoli can prevent artery clogging because it is loaded with vitamin K, which prevents calcium from damaging the arteries. Broccoli also prevents cholesterol oxidation and is full of fiber, which lowers blood pressure and reduces stress. Stress can lead to tearing and plaque build-up of arterial walls. These little trees also contain sulforaphane, which helps the body use protein to prevent plaque build-up in the arteries.

It is recommended to have two to three servings of broccoli per week for the maximum benefits. Broccoli is another versatile vegetable—it tastes great grilled, roasted or steamed and is a great side dish.APA Peripheral Vascular Disease Essay Paper

4. Fatty Fish

Fatty fish—mackerel, salmon, sardines, herring and tuna—are rich in healthy fats, which can help to clear the arteries. Omega-3 fatty acids help to increase the “good” cholesterol while reducing triglyceride levels, decreasing blood vessel inflammation and the formation of blood clots in the arteries, and can even lower blood pressure.

The American Heart Association (AHA) recommends people eat fish at least twice per weekto reduce plaque build-up. Baked and grilled fish are the most optimal for heart health.

5. Nuts

Instead of reaching for the cookie jar, try a healthier alternative—nuts. Almonds are the best choice because they are high in monounsaturated fats, vitamin E, fiber and protein. The magnesium in almonds also prevents plaque formation and lowers blood pressure. Walnuts are another good source of omega-3 fatty acid, which will reduce “bad” cholesterol and raise “good” cholesterol levels, which in turn lowers the risk of plaque build-up in the arteries.APA Peripheral Vascular Disease Essay Paper

The AHA recommends three to five servings per week (one serving is equivalent to a handful). Nuts also make a great salad topper.

6. Olive Oil

Olive oil is rich in monounsaturated oleic acid, an essential fatty acid that lowers “bad” cholesterol and raises “good” cholesterol. Rich in antioxidants, it is one of the healthiest oils to use in cooking or for dressings.

Use olive oil instead of butter and drizzle over salad or pasta. It is recommended to choose 100 percent organic virgin olive oil for maximum health benefits.

7. Watermelon

This summertime favorite is a great natural source of the amino acid L-citrulline, which boosts nitric oxide production in the body. Nitric oxide causes the arteries to relax, decreases inflammation and can help lower blood pressure. Watermelon also helps to modify blood lipids and lowers belly fat accumulation. Less fat in the abdominal area lowers the risk of heart disease.APA Peripheral Vascular Disease Essay Paper

8. Turmeric

The main component of this spice is curcumin, which is a power anti-inflammatory. Inflammation is a major cause of arteriosclerosis, or the hardening of the arteries. Turmeric also reduces the damage to arterial walls, which can cause blood clots and plaque build up. Turmeric also contains vitamin B6, which helps to maintain healthy levels of homocysteine, which can cause plaque buildup and blood vessel damage in excess amounts.

Turmeric can be an ingredient in many dishes, both sweet and savory. One way to get your daily dose is by drinking a glass of warm turmeric milk daily. If you’ve never cooked with it before, now’s the time to get creative for your health!APA Peripheral Vascular Disease Essay Paper

9. Spinach

This dark, leafy green is filled with potassium, folate and fiber, which helps lower blood pressure and prevents artery blockage. One serving per day helps lower homocysteine levels, a risk factor for heart diseases such as atherosclerosis.

It doesn’t matter if you eat it raw or cooked, the benefits are the same. So try it in salads, smoothies and even on your omelet.

10. Whole Grains

Whole grains contain soluble fiber, which binds to the excess LDL cholesterol in your digestive tract and removes it from your body. Whole grains also contain magnesium, which dilates blood vessels and keeps your blood pressure at regular levels.

The AHA recommends at least six daily servings of whole grains, so trade your carbs for whole-grain alternatives like whole-grain breads, whole wheat pastas, brown rice, quinoa, barley and oatmeal to improve cholesterol levels and keep your arteries clear.

Better attention to four common health factors—smoking, diabetes, blood pressure, and cholesterol—could go a long way to preventing a stealth condition known as peripheral artery disease (PAD). That’s the upshot of a Harvard-based study published today in JAMA. Prevention is important because PAD can cause widespread damage, limit activity, and sometimes lead to death.APA Peripheral Vascular Disease Essay Paper

PAD can be a catchall term for problems in arteries that supply organs and tissues other than the heart. But it usually refers to blockages in the arteries that supply blood to the legs and other body parts below the heart. PAD is typically caused by atherosclerosis—the accumulation of cholesterol-filled plaque inside arteries—the same thing that causes most heart attacks and strokes. When plaque limits blood flow, it can cause a variety of problems. PAD can cause leg pain when walking or abdominal pain after eating. It can cause kidneys to fail. Severe PAD can lead to foot or leg amputation. And because of the atherosclerosis connection, many people with PAD die from a heart attack, sudden cardiac arrest, or stroke.

Despite all this, PAD often flies under the radar. “Unfortunately, many people—and that includes doctors—aren’t aware of peripheral artery disease, or they attribute its symptoms to something else, like arthritis or getting older,” says Dr. Reena L. Pande, director of the Vascular Diagnostic Lab at Brigham and Women’s Hospital and Instructor in Medicine at Harvard Medical School.APA Peripheral Vascular Disease Essay Paper

About one-third of people with PAD have no signs or symptoms of it, says Dr. Pande. Another third have vague symptoms such as low mobility or loss of strength that can be difficult to trace to PAD. The final third have clear symptoms, such as leg pain when walking, sores that don’t heal, coldness in a leg or foot, or, in men, problems getting or keeping an erection.

The new study, one of the largest and longest of its kind, followed the health of almost 45,000 male health professionals for 25 years. In this group, the factors that most strongly influenced the development of PAD were the same “big four” that are largely responsible for heart disease and stroke: smoking, diabetes, high blood pressure, and high cholesterol. A whopping 96% of those diagnosed with PAD had one or more of these problems.

Individually, each factor doubled the risk of developing PAD. Men with all four were 16 times more likely to have developed PAD. Those with none of the factors were six times lesslikely to have developed it. The longer a man had diabetes or high cholesterol, or the longer or more he smoked, the higher the risk of developing PAD.APA Peripheral Vascular Disease Essay Paper

“These data are in line with results of earlier studies, and underscore approaches we can take to prevent PAD,” says Dr. Pande.

Identifying, treating PAD

One of the problems of tackling PAD is that it is often silent. The U.S. Preventive Services Task Force doesn’t yet recommend checking seemingly healthy people for it. But it’s a good idea to be checked if you have leg pain while walking that goes away when you rest. An evaluation for PAD may also make sense if you have heart disease, carotid artery disease, or kidney disease, or if a parent or sibling has peripheral artery disease.

As the saying goes, prevention is the best medicine. Quitting smoking and keeping blood pressure, cholesterol, and blood sugar under control can prevent PAD from getting established, or slow the disease process and possibly improve symptoms. Treating PAD begins with those four strategies and also includes

  • exercise
  • a healthy diet
  • taking medications as needed to protect the heart and arteries.APA Peripheral Vascular Disease Essay Paper

Peripheral artery disease (also referred to as “peripheral arterial disease” or “PAD”) is a condition marked by a narrowing of the blood vessels outside of your heart. This narrowing results from the buildup of plaque on the walls of the arteries that carry blood to your arms and legs.

PAD often restricts blood flow to the legs, leaving them painful or numb. In severe cases, the lack of blood flow can induce gangrene (tissue death).

People with PAD are known to have an increased risk of death from heart attack and stroke.

After implant surgery, you may experience redness, swelling, or soreness at the site. Limit movement of your arm and avoid heavy lifting so you don’t disturb the incision. Try to avoid any quick or sudden movements that might dislodge the leads. Your doctor will have a list of activities that you should avoid after your procedure. There might be a small lump under the skin where the CRT device is located, so avoid wearing tight clothing that could rub or irritate the skin at the implant site. Carefully follow your doctor’s instructions and keep your incision clean and dry.APA Peripheral Vascular Disease Essay Paper

 Peripheral vascular disease (PVD) is the presence of systemic atherosclerosis in arteries distal to the arch of the aorta. As a result of the atherosclerotic process, patients with PVD develop narrowing of these arteries. The most common symptom of PVD is intermittent claudication, which manifests as pain in the muscles of the legs with exercise and is experienced by 2 percent of persons older than 65 years.1 In one study of out-patients in the United States, PVD was present in 29 percent of patients.2 This study included patients older than 70 and patients 50 to 69 years of age with a history of cigarette smoking or diabetes mellitus. The greatest modifiable risk factor for the development and progression of PVD is cigarette smoking. Cigarette smoking increases the odds for PVD by 1.4 for every 10 cigarettes smoked per day

It is no wonder that heart disease and other health problems are becoming more and more common because of our modern lifestyle. The main reason for these diseases is the lack of physical activity of many people who do not exercise regularly. According to the WHO (World Health Organization), a person already suffers from a lack of exercise if they move less than 90 minutes daily. Are you one of those people who do not move enough?APA Peripheral Vascular Disease Essay Paper

In addition to the effects associated with a sedentary lifestyle, heart disease and other diseases are also promoted by an unhealthy diet, stress at work, and fear of everyday problems.

This leads to a growing number of people neglecting their health and deciding against physical activity; Only a healthy lifestyle ensures emotional balance and daily well-being!

For those of us who do not move enough and may even avoid routine medical examinations, this Aktiv Watch is the perfect helper: a smartwatch that tracks all vital signs like a medical assistant on the wrist.

If you’ve been told that you have peripheral artery disease (PAD), this means that your heart isn’t pumping blood fast enough through your legs, arms, kidneys or the rest of your body’s vital organs. The potential consequences, such as stroke or heart attack, can be catastrophic. But you can take steps to make sure that this doesn’t happen to you.APA Peripheral Vascular Disease Essay Paper

Danger signs
One of the first signals of trouble may be achiness in your arms when you move them, or your legs may hurt when you walk or try to exercise. The temporary pain you’re feeling is caused by impeded blood flow, also known as intermittent claudication.

The pain indicates that not enough blood is getting through the veins in your arms or legs because they have been blocked, probably by large deposits of plaque. It can be serious, but luckily, it can also be reversed.

Lifestyle changes to fight PAD
What can you do? According to the Mayo Clinic, PAD can respond well to a series of lifestyle changes. They suggest:

  • Quit smoking
  • Switch to a low-fat, heart-healthy diet
  • Exercise more
  • Shed extra weight

You need a doctor’s help to battle PAD, so don’t try to do it alone. It merits serious attention, especially if you have diabetes, which often makes PAD worse. Drugs, such as anticoagulants, calcium channel blockers or cholesterol-lowering medications can help, too.APA Peripheral Vascular Disease Essay Paper

Explore other options
If your PAD doesn’t get better with diet and drugs, it may be time to think about other treatment methods, such as:

Angioplasty. This common procedure usually requires just mild sedation and an overnight hospital stay. The procedure involves inserting a long, thin tube through your arteries to the site of blockage. Then, a tiny balloon on the end of the tube is inflated to push away plaque.

Stenting. After some angioplasty procedures or in cases when an artery is weakened, place a mesh-tube support (a stent) within the artery to support it.

Endarterectomy. More severe cases of PAD might call for a procedure called an endarterectomy, during which the blood vessel is opened and plaque buildup is cleaned out.

Bypass surgery. Bypass means that a section of bad blockage is avoided by installing a new artery—made from either another of your own blood vessels or an artificial fabric—that channels blood around the damaged area.APA Peripheral Vascular Disease Essay Paper

If you’ve just been diagnosed with PAD, time may be on your side. You can jump on the healthy-living bandwagon right now and reverse this disease. Even if you need surgery, the good news is that much of PAD’s damage can be undone.

Sometimes I wonder how mainstream medicine has gotten so far off track. These days, the hospitals and big medical practices are more concerned about making money than in keeping people healthy.

Here’s the situation – as many as 80 million Americans have heart disease. Tens of millions more suffer from diabetes, putting them at high risk for heart disease, too.

Heart disease usually involves circulation problems, especially in your legs. So now some doctors are aggressively pushing screening for a condition known as PAD (peripheral arterial disease).

They’re targeting the tens of millions of people with heart disease, hoping to sell them risky, expensive vascular surgery.

Unfortunately, this scheme is working. From 2000 through 2008, the number of patients having surgery on their arteries annually had more than doubled!APA Peripheral Vascular Disease Essay Paper

But here’s the interesting part – studies have repeatedly shown that you can get the same results from safe, inexpensive “non-invasive” therapies, such as an exercise program.

In other words, some vascular surgeons are keeping themselves busy by recommending angioplasties and stents for patients who could get the exact same outcome with regular walks and a few other lifestyle changes.

Make no mistake – PAD is a serious condition, and if it’s not treated, the complications can be very serious. But surgery isn’t the answer.

Inserting tubes known as stents in leg arteries or clearing clogged arteries with tiny balloons (angioplasty) may be touted as a high-tech solution to the problem. But the truth is, surgical solutions don’t even come close to living up to the hype.

In fact, what doctors should be explaining to people is that heart disease affects more than just your heart. It impacts your entire body, reducing circulation to all organs.

And just as heart disease can be minimized with a healthy diet, exercise, and appropriate supplements, so can PAD.APA Peripheral Vascular Disease Essay Paper

Heart disease is caused by clogging and hardening of the arteries (atherosclerosis). But the clogging and hardening process occurs in arteries all through the body, not just in the chest. It’s not unusual, for example, for these patients to suffer from impotence, too.

When arteries in your legs harden, the condition is called peripheral arterial disease (PAD). Patients say their legs feel heavy or tired while walking.

Other symptoms include pain, numbness, or bluish or cold feet, as well as open or very slow healing sores on the feet. If the condition isn’t treated, tissue in the legs or feet can die and gangrene may set in, leaving amputation as the only option.

If you have PAD, you have a choice of treatments. You can go the surgery route, and spend weeks or months in painful recovery.

Or you can take your health into your own hands, and use these tried-and-true lifestyle changes to turn the condition around.

If you’re experiencing any symptoms of PAD, an “ankle/brachial index” test can give your doctor an idea of how well your blood is flowing and whether or not PAD is a problem for you.

If you are diagnosed with PAD, here are my six suggestions for natural treatment:
1.IF YOU SMOKE, STOP. This is non-negotiable. Smoking makes heart disease and PAD worse, so stop smoking before it kills you. There are many options available to help you quit. Do yourself a favor and check them out.

2. Eat a nutritious, whole foods diet. That means no processed or prepared or fast food. Instead, try the Mediterranean diet, which has been proven to improve PAD symptoms. You will miss all of the fat, sugar, and salt in these foods at first. But my patients tell me once they see how good they feel when they’re eating “real food,” they don’t want to go back. Ever.

3. Exercise regularly. Please don’t ignore this one or make yourself crazy with workout equipment and gym memberships. Exercise can be as simple as a walk through the mall. Just get up and get moving.

4. Get a grip on high blood pressure. Start with seven, half-cup servings of fruits and vegetables daily, for their blood-lowering potassium. Meditation and other forms of stress management are natural remedies for high blood pressure, too.

5. Keep a tight lid on blood glucose levels if you are diabetic or insulin resistant. High blood sugar damages the artery linings, making them more vulnerable to PAD.

6. Take heart-friendly supplements.  My PAD patients have gotten excellent results from adding a few supplements to their daily regimen.APA Peripheral Vascular Disease Essay Paper

  • Start with 1,000 mg daily of a purified omega-3 essential fatty acids (EFAs) product.
  • An additional 120 mg of Coenzyme Q10 (CoQ10) can help protect arteries, while supporting a healthy heart muscle.
  • Curcumin (500 to 1,500 mg daily) reduces inflammation and keeps your heart healthy. Look for a product enhanced for better absorption.
  • Take a product that combines systemic enzymes, such as serrapeptase, nattokinase, protease, lipase, bromelain, papain, rutin, and amla. This type of supplement helps prevent blood clots, a danger for everyone, but especially for PAD sufferers.

If you’re suffering with PAD symptoms, know that taking these steps to improve your health can really pay off. You’ll not only feel better, but you’ll be enjoying better mobility, too. APA Peripheral Vascular Disease Essay Paper

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