Peripheral Arterial Disease
Arteries are blood vessels bringing blood from the heart to the organs and peripheries. These normally have a smooth inner lining which promotes blood flow within.
Peripheral Arterial Disease (PAD) is a condition where cholesterol deposition in the lining of the arteries to the legs causes narrowing of the arteries. This leads to reduced blood flow and decreased blood supply to the peripheries.
- Hypertension, high blood pressure
- Hypercholesterolemia, high cholesterol levels
- Diabetes mellitus
- Tobacco use and smoking
- Vitamin B6 deficiency
- Hereditary factors
- Sedentary lifestyle
In the initial phase of the disease, there are usually minimal symptoms.
- Intermittent Claudication
When the degree of narrowing progresses, patients may notice pain in the calf or foot on walking, usually after walking a fixed distance. The pain is usually relieved once the patient stops to rest.
- Critical Limb Ischaemia
As the disease worsens, patients may have pain even at rest or at night when sleeping. This is an indication for intervention to restore circulation to the legs. Failing to restore the circulation will put the patient at risk of losing the affected leg.
The diagnosis of PAD is made on the basis of the clinical history and physical examination of the patient, most importantly the palpation of pulses in the legs.
Ankle-Brachial Pressure Index (ABPI) is a measurement comparing the blood pressure in the leg against the upper limb. This gives an objective measurement of the severity of ischaemia.
A duplex arterial scan is performed to demonstrate the location, extent and severity of narrowing of the arteries in the legs. This allows the surgeon to assess which treatment modality is most suitable. The advantage of a duplex scan is that it is non-invasive and avoids radiation and contrast exposure.
At Nexus Surgical Vascular and Vein Centre, the Duplex scan is performed at the bedside using a high-end ultrasound scanner during your consultation with the vascular surgeon.
For patients with intermittent claudication, the mainstay of treatment is managing the risk factors and medication.
Risk factor management include:
- Control of blood glucose levels in diabetics
- Control of blood pressure
- Lowering low-density lipoprotein (LDL) and cholesterol levels
- Diet and weight loss treatment
- Smoking abstinence
Medications that have been shown to improve the symptoms of claudication include:
- Antiplatelet agents e.g. aspirin, clopidogrel (Plavix), ticlopidine (Ticlid)
- Statins e.g. simvastatin, rosuvastatin (Crestor), atovarstatin (Lipitor)
In addition to risk factor control and medication, a course of supervised exercise therapy by the physiotherapist has also been shown to significantly increase the walking distance in claudicants. Exercise therapy encourages the formation of new blood vessels (collaterals) into the areas where there is inadequate blood supply.
Critical Limb Ischaemia (CLI)
Patients with critical limb ischaemia require urgent evaluation by a vascular surgeon in order to salvage the leg that is threatened.
Treatment options for revascularization depends on many factors including the patient’s age and functional status, the extent and severity of disease, the availability of a suitable bypass conduit, etc. The options include:
- Bypass surgery
- Balloon angioplasty
- Angioplasty and stenting
Click here for the link to Nexus Surgical Vascular and Vein Centre for information on the range of services and options available