Peripheral artery disease: Pathophysiology, Causes, Symptoms, Diagnosis and Treatments, Animation

(USMLE topics) PAD: Pathophysiology, Causes, Signs and symptoms, Complications, Risk factors, Diagnosis and Treatments. This video is available for instant download licensing here:
Voice by: Ashley Fleming
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Peripheral artery disease, PAD, is a common circulatory condition in which peripheral arteries are narrowed, reducing blood flow. While PAD can occur in any organ or body part, the lower limbs are the most commonly affected.
The major cause of PAD is the building up of plaques in arteries, known as atherosclerosis. Plaques are deposits of lipids, fibrous tissue and calcium, that accumulate slowly overtime. Less commonly, an artery may suddenly be blocked by a blood clot, or embolus. Rarer causes include blood vessel inflammation, injury, or unusual anatomy of ligaments or muscles.
The impact of reduced blood flow, or ischemia, is most remarkable when there is a higher demand for blood supply, such as during physical activities. This is why people who are not very active may not experience any symptoms initially. It also explains the most tell-tale sign of PAD, known as intermittent claudication - a painful or tired feeling in the legs that occurs while walking, but is rapidly relieved by rest. The affected leg and foot may lose color and feel cold, especially when the foot is elevated. There may also be a lack of growth of toenails and hair.
The location of pain depends on the site of obstruction. The more proximal the site of blockage, the more widespread the pain. The calf is the most common site of pain.
As the disease progresses, patients may experience pain even during rest. This advanced stage is known as critical limb ischemia, a chronic, slow-developing condition. Patients may develop ulcers that heal slowly or not at all; and death of tissue, or gangrene, may occur. The risk for loss of limb is significantly increased at this stage.
Acute limb ischemia happens when there is a sudden block of blood flow, typically due to an embolism or thrombosis. Acute limb ischemia is an emergency threatening loss of limb.
Any factors that increase risks for atherosclerosis also increase risks for PAD. Because atherosclerosis can affect any artery in the body, PAD patients are also likely to have coronary artery disease or carotid artery disease.
Diagnosis is based on symptoms, medical history, physical exam, and a number of tests.
The purpose of the physical exam is to look for signs such as weak pulses, whooshing sounds of obstructed blood flow, and evidence of poor wound healing.
Blood tests are done to evaluate cholesterol, triglyceride, and blood sugar levels.
Ankle-brachial index test, or ABI test, is commonly performed to compare blood pressures in the ankle and the arm. An ABI lower than 0.9 indicates PAD.
Imaging procedures may be performed to identify the affected arteries.
Treatments aim to relieve symptoms, re-establish blood flow to reduce risk of losing a limb, and stop progression of atherosclerosis to lower risk of heart attack and strokes. Treatment options include lifestyle changes, exercise programs, medications, and/or procedures to open or bypass blockages in the arteries.
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