What is arteriosclerosis obliterans?

Atherosclerosis obliterans, or peripheral arterial disease (PAD), is a medical condition that negatively affects the blood vessels and circulation in a person's lower extremities and can contribute to nerve and tissue damage. Caused by a narrowing or hardening of the arterial walls, arteriosclerosis obliterans can lead to serious complications. Atherosclerosis obliterans can be treated with medication, surgery, or lifestyle changes, depending on the severity of the disease presentation and the individual's overall health.

Peripheral arterial disease results from a hardening of the arteries caused by a buildup of plaque. As plaque builds up, the arteries narrow and blood flow becomes increasingly limited. By affecting the arteries that supply the legs and feet, PAD can cause the muscles in these areas to work twice as hard, whether the individual is moving or resting. People with a history of smoking, high cholesterol, or a stroke may be more susceptible to developing PAD. Additional conditions that may contribute to the development of arteriosclerosis obliterans may include diabetes, hypertension, and heart disease.

People with PAD may experience a gradual onset of signs and symptoms of poor circulation. Initially, symptoms may only manifest when the person participates in activities that force the leg muscles to work harder than normal, such as walking uphill or briskly. Over time, symptoms may manifest more quickly, even though the individual does not exercise as much as when the first signs appeared. While resting, the individual may notice that their feet become tingly or numb and are pale or cool to the touch. As symptoms progress, the individual may develop moderate to severe chronic pain in their legs and feet.

Atherosclerosis obliterans can be diagnosed by administering a variety of tests. During an initial exam, a doctor may check the affected limb for a weakened pulse and low blood pressure. When a stethoscope is applied to the artery, the blood flow may sound abnormal, a condition known as an arterial murmur. Those whose PAD has progressed may show tight calf muscles or have a bluish tint to the skin, known as cyanosis, which can be discovered during a physical exam. Diagnostic tests may include magnetic resonance angiography (MRA), computed tomography (CT) angiography of the affected area, and Doppler ultrasound.

Treatment for PAD may include the use of over-the-counter or prescription medications to thin the blood, prevent clots from forming, and relieve pain. Severe cases of peripheral arterial disease that negatively affect one's ability to work or function may require surgery. Arterial bypass surgery or angioplasty and stent placement may be used, depending on the severity of the individual's condition. Extreme cases of PAD may require amputation of the affected limb if there is no other viable treatment option.

Arterial bypass surgery is an invasive procedure performed under general anesthesia. During the procedure, the surgeon makes an incision over the affected artery and places clamps on each end of the blockage. The blocked portion of the artery is replaced with a graft that is sewn into place. The graft may be made from tissue taken from another blood vessel located in another part of the body or from man-made material. With the blockage removed and new arterial tissue in place, the clamps are removed and blood flow is restored.

An angioplasty and stenting procedure is similar to the one used for the heart. During the procedure, the individual may be given a local anesthetic and a mild sedative to help them relax. Using image-guided technology, such as live X-rays, a small incision can be made in the groin area and a catheter, known as a guidewire, is inserted into the blocked artery. A second catheter, equipped with a balloon, is passed along the guidewire to the blockage where it is inflated to open the artery. While the balloon is in place, a stent is placed in the artery to help keep it open, and the balloon is deflated and removed.

Lifestyle changes may also be recommended to help manage and relieve symptoms associated with PAD. People who smoke may be advised to stop smoking, as smoking contributes to arterial constriction and impairs circulation. Changes in diet, proactive steps to lower cholesterol, and regular exercise may also be recommended to help manage symptoms.

Complications associated with peripheral arterial disease can include the development of gangrene, amputation, blood clots, and heart disease. Risks associated with surgical procedures for PAD can include infection, shortness of breath, and stroke. Additional complications associated with surgery may include nerve or tissue damage, allergic reaction to materials used or medications administered, and excessive bleeding.

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