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Peripheral Arterial Disease

Peripheral Arterial Disease: Symptoms, Causes and Risk Factors, Diagnosis, Treatments | National Heart Centre Singapore

Peripheral Arterial Disease - What it is

​Peripheral arterial disease (PAD) occurs when narrowed arteries restrict blood flow to the limbs. It is a major cause of limb loss in Singapore. However it does not receive as much attention as diseases involving the other vascular beds: namely, coronary artery disease and cerebrovascular disease. Yet, it is a good predictor of heart attack and stroke risk.

Peripheral Arterial Disease - Symptoms

Symptoms include intermittent claudication, or momentary limping because of pain. For example, when a patient with a blockage in his leg walks 100 metres, he starts developing pain in the calf muscle of the affected leg. He stops and rest for a few minutes; the pain goes away and he can go another 100 metres before it comes on again.

In the most extreme cases, if left unchecked, it can cause ulcers, gangrene, and amputation.

Peripheral Arterial Disease - How to prevent?

Peripheral Arterial Disease - Causes and Risk Factors

Causes

PAD develops when arteries in the legs become clogged with plaque – such as fatty deposits and cholesterol – that limits or completely blocks blood flow in the legs. This causes muscle pains in the calves, thighs, and buttocks.

Like atherosclerosis, PAD is caused by the accumulation of fatty deposits — called plaque — in the arteries. Having blocked arteries can prevent oxygen-rich blood from reaching the muscles when the muscles need it most. This lack of oxygen causes the pain. PAD can increase your risk of heart attack and stroke. But the good news is that PAD can be easy to diagnose and is treatable.

With pain limiting their movements, the patients move gradually from an active lifestyle to a sedentary one. This results in immobility and a shorter life expectancy due to the increased risk of high blood pressure, heart attack, and stroke.

Risk factors
The risk factors for PAD include hypertension, high cholesterol, and diabetes – all of which are common illnesses in our population. One-third of diabetics over the age of 50 develop the disease. 

Another high-risk activity, such as smoking, brings on the disease much sooner. So PAD patients, who otherwise would be in their late 70s or 80s, could start to feel symptoms as early as their 50s or 60s.

Peripheral Arterial Disease - Diagnosis

​Doctors may prescribe imaging tests to verify the condition. These may include an echocardiogram, computerised tomography (CT) and magnetic resonance imaging (MRI) scans.

Peripheral Arterial Disease - Treatments

One way to prevent PAD is by checking ankle and arm pressures during routine clinic consultations, which should be the same. The ankle-brachial index (ABI) is calculated by dividing ankle pressures by arm pressures. A value of 0.9 to 1 is normal. If it comes back as 0.5, then that implies that the patient has significant disease.

Specific management of PAD involves:

1. Lifestyle changes
These include smoking cessation; eating a balanced diet that is high in fibre and low in cholesterol, fat and sodium; and exercise.

2. Management of other related health problems, such as high blood pressure, diabetes or high cholesterol.

3. Practise good foot and skin care to prevent infection and reduce the risk of complications.

4. Medications
Medications may be recommended to treat conditions such as high blood pressure (anti-hypertensive medications) or high cholesterol (statin medications). An antiplatelet medication such as Aspirin or Clopidogrel (Plavix) may be prescribed to reduce the risk of heart attack and stroke.

5. Intervention 
More advanced PAD can be treated with interventional procedures such as angioplasty (to widen or clear the blocked vessel), angioplasty with stent placement (to support the cleared vessel and keep it open), or atherectomy (to remove the blockage). In some cases, surgical procedures such as peripheral artery bypass surgery may be performed to re-route blood flow around the blood vessel blockage.

Despite the availability of healthcare in Singapore, PAD is still “under-diagnosed” for several reasons. One being that checking the arm and ankle pressures is not as routine as it should be.

The goal of therapy is to improve blood supply to the leg muscles so that patients maintain their functional level of activity. Once patients become used to sedentary lifestyles, it is hard to get them active. They need to be constantly kept active to maintain their health.

Peripheral Arterial Disease - Preparing for surgery

Peripheral Arterial Disease - Post-surgery care

Peripheral Arterial Disease - Other Information

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