The Peripheral Arteries and their Circulatory System

Peripheral Artery Disease – Understanding the narrow lumens

Deposition of the plaque leads to the narrowing of the lumen, which compromises the perfusion or flow of blood to the affected organ. It is most common in pelvis and legs. Numbness and pain in the region are the common symptoms of PAD. This condition also increase the chances of infection and in extreme and rare cases, can lead to gangrene and limb amputation.

Prospective patients with PAD

With the present life style, the risk of developing PAD has increased ten-fold. The following are the risk factors for developing PAD:

• Smoking: Smoking increases the chances of developing PAD by four times as much. Hence, smoking cessation can be the first step to healthy living
• Obesity: Maintaining a healthy Body-Mass Index (BMI) reduces the risk of PAD. BMI>25 are especially at a higher risk
• Physical Activity: Exercising and physical activity not only reduces the risk of PAD but in patients with PAD enables them to walk a longer distance without pain
• Altered lipid profile: In patients with altered lipid profile, the level of cholesterol is high, which increases the risk of developing PAD
• Hypertension and Diabetes: Both high blood pressure and high glucose levels put the patients at a higher risk of PAD
• Old age: People who are 40 years and over are more prone in developing PAD

Gene mutation

In PAD, gene matters. In a study of different ethnic groups, African-Americans, even after the adjustments of age and other risk factors, showed a greater chance of developing PAD. This study therefore suggests that since an ethnic group has an ancestral pool of genes, it is more likely that African Americans that have gene polymorphisms, are more likely to develop PAD.

Another very good example that helps us to understand the association of genetics and pathogenesis of PAD is as follows: The polymorphism of eNOS gene is believed to reduce nitric oxide availability causing endothelial dysfunction. Sticchi et al (2010) showed that the presence of eNOS −786 C/4a haplotype in smokers significantly predisposes PAD.

Inflammation is recognised as an important aspect in pathogenesis of atherosclerosis, the cause of PAD. Interleukins, cytokines, chemokines are some of the inflammatory modulators. Flex et al (2007) found that the polymorphism of some of the genes related to these modulators- IL-6, E-selectin, ICAM-1, MCP-1, MMP-1, and MMP-3 genes had significant relationship with pathogenesis of PAD.

Breaking through the plaque

Lifestyle modification is the first step to managing PAD. Medications and surgical management of PAD follows up. Surgical procedures include Bypass Grafting, Angioplasty, Stenting and Atherectomy.