Peripheral Artery Disease: Definition

00:01 Welcome back to the next lecture in the advanced vascular medicine series. We are going to continue to talk about peripheral arterial disease in this lecture. We will talk about peripheral artery disease in the legs. We will talk about arterial embolism that is a blood clot travelling in the blood stream and causing damage. And we will talk about carotid artery disease that can lead to strokes.

00:29 Let's start with peripheral artery disease, usually in the legs. This is the one form that is most common. Let's talk about the definition first. Peripheral arterial disease is narrowing of the arteries that do not supply the heart or the brain and as I said before most commonly affects the leg arteries. The natural history of this condition is uncertain because usually patients don’t die from the peripheral vascular disease. They die from artherosclerosis of the heart or the brain which results in a heart attack or a stroke.

01:10 However, the disease is very debilitating, in that the people are unable to walk and exercise. They can even develop gangrene and require amputation. Muscles are deprived of oxygen and nutrients particularly when they are working hard. So patients develop the symptom of intermittent claudication that is cramping or discomfort in the calf or buttock when they walk, particularly if they climb stairs or walk a hill.

01:43 As I mentioned the symptom can be intermittent claudication that is discomfort in the leg when the patient walks but this can progress to gangrene, that is death of tissue, usually the toes. You can see changes in the skin with hair loss, cramping can occur with walking as part of the intermittent claudication symptom. Patients may develop fatigue because of the poor circulation. They may develop heaviness in their legs, pain and discomfort in the legs and buttocks even at rest if the narrowings in the blood vessels are very severe, and as we have talked about before the poor leg circulation can result in muscle wasting, skin wasting, hair loss and gangrene on the tips of the toes. And all of these are late symptoms usually the earliest symptom is intermittent claudication, that is discomfort when the patient walks, it gets better when they stand quietly and blood flow is restored into the muscle and the muscle rests.