Peripheral Arterial Disease and Circulatory Insufficiency in the Lower Extremities � Symptoms, Causes and Treatment
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Peripheral Arterial Disease and Circulatory Insufficiency in the Lower Extremities � Symptoms, Causes and Treatment

The circulatory insufficiency of Peripheral Arterial Disease can have a number of significant negative impacts on a patientÂ’s quality of life. However, an understanding of the symptoms, causes and treatment of this condition can support patients in their recovery to normal functionality.

Peripheral Arterial Disease is caused by the occlusion of arteries in the lower extremities by atherosclerotic plaques - depositions of cholesterol, cells and other debris which line the artery walls. These plaques cause circulatory insufficiency - a lack of oxygenated blood flow to the extremities - which can result in a significant decrease in a patient’s systemic health and overall quality of life. This article investigates the symptoms, causes and treatment of Peripheral Arterial Disease and circulatory insufficiency in the lower extremities.

Circulatory insufficiency is indicated first and foremost by intermittent claudication - the onset during exercise of pain, typically in the calf region, which is only relieved by rest. The pain results from hypoxia (lack of oxygen) in the active muscles of the leg in response to inadequate blood flow. The pain is often subjectively described as a “dull ache” rated at 3 to 4 out of 10 on average, and it can significantly affect the patient’s ability and motivation to participate in recreational activities and exercise.

Other symptoms of circulatory insufficiency include a lagging capillary refill in the toes, a cool and rudy quality of the lower dependent extremities (eg. when the patient is seated), weak or unpalpable Dorsalis pedis and Posterior tibial pulses, thickened toenails, oedematous feet and ankles and dullness to sensation. Typically, these symptoms occur bilaterally, however depending on the extent of plaque deposition one leg may be more significantly affected than the other.

Circulatory insufficiency in patients with Peripheral Arterial Disease requires priority treatment because of the risk of associated tissue ulceration and necrosis. Reduced blood flow to the lower limbs results in the ineffective perfusion of nutrients to, and removal of wastes from, surrounding muscle and skin tissue. As a result, there is a high risk for the development of gangrenous infection and/or non-healing ulcerative wounds. The alteration in sensation in the lower extremities, particularly with regards to touch and temperature, is characteristic of peripheral neuropathy (hypoxic nerve damage) - the first stage in the development of infected and/or non-healing wounds. Such wounds may further impede a patient's mobility and independence.

Circulatory insufficiency may also force key body organs to undertake an increased workload, causing in many cases irreparable systemic damage. Circulatory insufficiency results in the activation of certain compensatory mechanisms within the body which are designed to counteract the impaired perfusion to the lower extremities. For example, there is an increased cardiac workload in response to high resistance in the occluded arteries of the extremities, and this is typically indicated by an increase in blood pressure. Hypertension may result in renal stress, among other complications, and similarly the backward vascular pressure resulting from the occluded arteries may cause in pulmonary oedema and related problems.

The effective treatment of the circulatory insufficiency of Peripheral Arterial Disease is therefore critical. Treatment may be as simple as correcting the lifestyle factors which result in the development of plaques in the artery walls. Consuming a diet low in cholesterol, reducing or eliminating cigarette smoking and undertaking regular, moderate exercise may prevent the formation of new plaques, and enable the body’s immune system to progressively degrade existing plaques. Medications may also assist with this. In severe cases of Peripheral Arterial Disease, vascular surgery may be required to bypass blockages and restore adequate bloodflow to the lower extremities.

The circulatory insufficiency of Peripheral Arterial Disease can have a number of significant negative impacts on a patient’s quality of life. However, an understanding of the symptoms, causes and treatment of this condition can support patients in their recovery to normal functionality.

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