Peripheral Artery Disease and the Ankle Brachial Index

In the United States, it is estimated that 18 percent of individuals over the age of 70 will suffer from peripheral artery disease, also known as PAD. With these statistics, the onset of PAD will often lead to a decrease in life expectancy by five to 10 years. Understanding what peripheral artery disease is, the importance of the Ankle Brachial Index test and what treatments to expect, will assist those suffering from the extremity pain so often associated with PAD.

In patients suffering from PAD, the most common symptoms lie in the sudden onset of chest pain or pain in the calf, thighs or buttocks. Most often, patients with these extremity and chest pains will seek the advice of a physician and, through a standard medical history and Ankle Brachial Index test, the physician may determine the patient suffers from peripheral artery disease. PAD is a common condition later in life which involves an occlusion of the arteries, most often leading to stroke and heart attack. For advanced stages of PAD, patients may exhibit gangrene, loss of hair in the lower extremities and decreased skin temperature in the extremity affected. When suffering from these advanced symptoms, various treatment options, including surgery, may be indicated. For initial complaints of PAD related symptoms, the doctor must first confirm the diagnosis.

Diagnosing peripheral artery disease includes a variety of tests, in addition to a physical examination of the extremities. PAD tests include blood work to assess cholesterol levels, the presence of diabetes and to rule out other health related illnesses or disorders. In addition to the laboratory blood work, the physician will order an Ankle Brachial Index study. Painless, the Ankle Brachial Index study will measure the rate at which the blood pressure changes, while pumping blood to the lower body during rest, as well as during activity. To perform the test, a blood pressure cuff is placed at the artery levels, with the systolic pressure measured, in both the ankle and elbow while at rest. Upon completion, the patient will be instructed to walk on a treadmill for five minutes after which the same blood pressure readings will be recorded. The systolic pressures are measured in a ratio or change percentage with an index below 1 considered abnormal. In fact, patients with an index of 0.8 to 0.5, peripheral artery disease is most certainly present and a 0.5 index indicating severe progression. So, once diagnosed, how is peripheral artery disease treated?

Treatment of PAD is provided in a program similar to most diseases. Diet modifications as well as a modest exercise programs are recommended. Exercise, generally, is limited to walking and suggested at a minimum of no less than 30 minutes per day, three days per week. In addition to diet and exercise, patients who smoke are placed on a smoking cessation program as tobacco is considered a direct toxin to the vascular system and, if continued, will negatively affect the treatment of PAD. The physician will also begin administration of three antiplatelet agents including aspirin. The antiplatelet agents, in the treatment of peripheral artery disease, will work to reduce the risk of further occlusion and, thereby, further reduce the risk of heart attack and stroke. Blood test results revealing high cholesterol levels will also be addressed by the physician and, most commonly, treated through a cholesterol lowering medication.

For patients suffering from the symptoms of peripheral artery disease (PAD), performing daily living activities can be severely inhibited. Through the use of proper diagnostic studies, including the Ankle Brachial Index test, the diagnosis can easily be confirmed and treatment can be administered immediately. Without the Ankle Brachial Index study, treatment may not be administered appropriately which may lead to a fatal cardiac event.

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