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Mike Craig is a 68-year-old male client who is referred to the vascular clinic by his primary care provider, or PCP. Mr. Craig has a history of type 2 diabetes, hypertension, and dyslipidemia, and he’s been experiencing intermittent leg pain in his lower legs while taking walks with his dog.
An ankle-brachial index, or ABI, is performed which confirmed a diagnosis of peripheral artery disease, or PAD. Peripheral arterial disease, or PAD for short, is the progressive narrowing of the arteries that supply peripheral tissues and organs, so basically all arteries except for the heart and brain.
As a result, there’s reduced blood supply to these tissues, which ultimately become ischemic. There are some factors that may put an individual at risk for PAD.
Non-modifiable risk factors include increasing age, male sex, and having a family history of PAD. On the other hand, modifiable risk factors include smoking, obesity, and having a sedentary life, as well as predisposing conditions like diabetes, dyslipidemia, and hypertension.
The most common cause of PAD is atherosclerosis, which is a buildup of fatty and fibrous material just under the inner lining of a blood vessel, forming a plaque.
This buildup usually happens over the course of years. Eventually, the lumen of the vessel becomes so narrow that it results in reduced perfusion to the tissue it tends to supply.
PAD can be worsened by an embolism. This happens when an embolus, which is a piece of blood clot or fatty deposit, breaks off from an atherosclerotic plaque from an upstream artery, and gets lodged in a narrower peripheral artery, blocking its blood flow.
Now, in most cases PAD affects the arteries supplying the legs. When less blood gets to the muscle tissue in the legs, that tissue becomes ischemic, causing a type of cramping pain that is often referred to as intermittent claudication.
Initially though, when the client’s at rest, there’s enough blood to meet the tissue’s demands, so they’ll be asymptomatic. But if the client starts walking or exercising, then the leg muscles start to work harder and demand more blood, which causes the claudication.
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