Lower limb Peripheral Arterial Disease (PAD) occurs when
An artery is affected by atherosclerosis (narrowing/hardening of arteries by fatty deposits)
Its lumen will get narrowed or occluded
Blood supply to the corresponding organ will be diminished
Sites of arteries that are frequently affected by atherosclerosis include
The reduction in blood supply caused by atherosclerosis to the lower limb may cause deterioration in walking capacity, pain in the foot and toes, ulcer or gangrene, and even limb loss depending on the severity of the disease.
Lower limb PAD signifies that:
You have higher cardiovascular risks throughout the body (e.g. heart attack and stroke)
Your walking capacity and quality of life may be adversely affected
You may suffer from chronic pain and even limb loss
The following are people at risk of PAD:
People aged more than 50
People with diabetes, hypertension or hyperlipidaemia
What are the symptoms?
Early disease could be totally without symptoms (asymptomatic).
More severe disease can present as
tightness or soreness of the calf muscle after certain period of walking
muscles responsible for walking do not get enough blood supply during exercise
discomfort will go away after a period of resting
Pain over the extremities, usually toes and foot
Usually gets worse at night and may even wake the patient up.
Due to a constant insufficient oxygen supply to the furthest parts of the lower limbs
Ulcer/gangrene of the foot and toe
Blood supply to the extremities further deteriorate, worsening the healing ability
Very minor injury to the toe or foot can result in a persistent wound
Ulcer or gangrene (localized tissue death) may develop even without any injury
How is it Diagnosed?
Diagnosis of PAD is not difficult
The doctors will look at the symptoms and the history of the patient
Lower limb pulses will be examined at various positions
Clinical assessment of foot and toe
Ratio between highest ankle arterial pressure and brachial artery pressure (Ankle-Brachial Index) will be taken. Normal ratio would be >1.0 but narrowing of lower limb artery will result in diminished Ankle-Brachial Index
Depending on the severity of the disease and other clinical findings, further investigations may be needed
What is the treatment?
There are 3 treatment goals:
Reducing cardiovascular risk
Preventing lower limb loss
Restoring walking capacity and improving quality of life
To control atherosclerosis
Risk factors screening and control
Change of life style - quit smoking, low cholesterol diet, moderate exercise
Anti-platelet agents - long term anti-platelet agents reduce the risk of all cardiovascular disease (eg. aspirin, plavix, ticlid)
Walking exercise - regular walking exercise of at least 50 minutes, 3 or more times per week can improve most people who have intermittent claudication.
Medications to reduce intermittent claudication symptoms are available.
It is only indicated for certain inpatients with significant symptoms. It aims to improve the blood supply to the affected tissues. However, if ulcer or gangrene is already set in, surgical debridement (removal of dead, damaged, or infected tissue to promote healing) will be needed
Combination of endovascular intervention and bypass surgery
This combination is used to treat patients with more complicated arterial occlusive disease
The removal of antherosclerotic plaques by making an incision over the particular segment of the artery to improve blood flow
Minor amputation and wound debridement
If ulcer or gangrene of the toe and foot has already set in, minor amputation or wound debridement may be necessary to ensure rapid recovery and also to restore the walking ability of the individual. The need for this surgery very much depends on the site and severity of tissue loss.
Besides Vascular specialists, we provide a comprehensive care to PAD patients by teaming up with
-Wound-care nursing specialist
With proper treatment and care, the majority of PAD patients with tissue loss will be able to heal up the ulcer/gangrene, avoid limb loss and walk again.