Peripheral Artery Disease

Peripheral vascular disease, or PVD, is a circulation disorder in which the legs, feet, and other parts of the body's muscle do not receive enough blood flow. 

The condition occurs when sticky plaque, that builds up in the arteries, hardens and blocks the vessels; limiting the flow of oxygen & nutrient rich blood to the limbs.

Although many individuals with PVD do not have symptoms others experience painful cramping that impacts their quality of life.  

One symptom of peripheral arterial disease is called intermittent claudication (throbbing) which occurs when pain develops in the calf, thigh or buttock muscles after walking short distances. 

PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles.

PVD can result in an increased dependency on family members and affect your ability to get around an to work.

Lifestyle changes 

Eat a healthy diet, exercising regularly, stopping smoking, lose weight (if you're overweight or obese) and moderate your consumption of alcohol.

Medication

The underlying causes should also be treated, including high blood pressure, high cholesterol and diabetes.

Statins, anti-hypertensives, anti-platelets, aspirin and clopidogrel are typically used but common side effects include indigestion and an increased risk of bleeding.

National Institute for Clinical Excellence (NICE) provides national guidance and advice to improve health and social care in the UK. NICE recommends naftidrofuryl oxalate for the treatment of leg pain triggered by exercise (intermittent claudication), for around three to six months, to see if it improves the symptoms. If the treatment isn't effective, after this time, it will be stopped.

Surgery 

There are two main types of revascularisation treatment for PAD:

· Angioplasty – where a blocked or narrowed section of artery is widened by inflating a tiny balloon inside the vessel

· Artery bypass graft – where blood vessels are taken from another part of your body and used to bypass the blockage in an artery

With treatment, most people's symptoms remain relatively stable and some people may experience an improvement in their pain.

Both angioplasty and bypass surgery carry a small risk of serious complications such as: a heart attack, stroke, limb amputation and even death. 

Critical limb ischaemia (CLI) can develop if the blood flow to the legs becomes severely restricted. This is an extremely serious complication that can be challenging to treat and in extreme cases amputation might be necessary.

Symptoms of CLI include:

· A severe burning pain in your legs and feet that continues even when you're resting

· Noticeable loss of muscle mass in your legs

· The skin turning pale, shiny, smooth and dry with wounds and ulcers (open sores) appearing on your feet and legs that don't heal and require regular attention by a district nurse

· The skin on the toes or lower limbs becoming cold and numb, turning red and then black, and/or beginning to swell and produce foul-smelling pus, causing severe pain (gangrene-black)

 Carbon dioxide is colour and odourless gas that is heavier than air. When bathing (to chest height) in a “dry carbon dioxide” the gas is absorbed through the hair follicles and skin into the capillaries and connective tissues. This (vasodilation) expands the blood vessel’s diameter which improves blood flow and the removal of waste products as well as increasing the transport of oxygen, nutrients and glucose to the tissues.

Effects:

Within the first couple of minutes a client experiences pleasant heat and perspiration.

Blood pressure is decreased typically by 15-20mmHg Systolic and 10-15mmHg Diastolic.

Benefits last up to six months:

· Helps to alleviate Stroke related Neuropathic pain

· Better blood flow increases energy levels alleviates fatigue and improves mood

· Cognition may improve

· Eyesight may improve

· Alleviates wheezing

· Helps to improve independence and improves quality of life

· Helps improve lymphatic fluid drainage (gravitational oedema) - meaning shoes fit properly

Gradually walking distance will improve