Health Tips

What is peripheral arterial disease (PAD)?

  PAD occurs when atherosclerosis occurs in the arteries supplying the lower limb. Atherosclerosis (Athero means “fatty-like”, sclerosis means “hardening”) means hardening and narrowing of arteries due to fat deposit, causing insufficient flow to the artery. Atherosclerosis can happen in any arteries of the body. If the narrowing of arteries occurs in blood vessels supplying the brain, it causes stroke. If it occurs in arteries supplying the heart, it may cause a heart attack. When arteries supplying the lower limb are affected, the condition is called peripheral arterial disease (PAD), also known as chronic lower limb ischemia. The symptoms of PAD are due to insufficient blood flow to lower limbs.

Who is more likely to have the condition?

• Diabetic patient

• People with high cholesterol level

• Obese individuals 

• Smoker

• People with family history of heart disease

• Hypertensive

• Had previous heart attack or stroke

• Physically inactive people

• Older people (>50 years)

What symptoms will you experience if you have PAD?

1. Cramping leg pain on walking, relieved by rest (intermittent claudication). The location of pain depends on the area of artery affected

2. Numbness, tingling sensation of lower limb

3. Rest pain (severe claudication pain), patients often have to hold their legs or hang them by the bed to slightly relieve the pain

4. Non-healing ulcers, sores

5. Loss of arterial pulse, or weak pulse in legs or feet

6. Loss of hair on legs

7. Coldness of legs, change in colour (pale/ bluish/ dark red)

8. Impotence in male

How do doctors diagnose the condition?

  Your doctor will do a complete physical examination including examination of your pulse. They will also check your ankle-brachial pressure index (ABPI), which compares blood pressure at your ankle to that at your arm. Normally ankle pressure is higher. If your ankle pressure is lower than pressure measured at arm, you may be diagnosed with peripheral arterial disease.

  Other diagnostic methods may also be done. For example magnetic resonance angiography to visualise the arterial system, Doppler ultrasound to detect the blood flow across the artery. Electrocardiography (ECG) may be performed to rule out any problem of blood supply to the heart.

Treatment of PAD

Basic treatment consists of lifestyle modification and medication. In critical cases, surgery may be the option, including vascular stenting, angioplasty or bypass graft surgery.

For many patients with claudication pain, a structured exercise programme of at least 2 hours of exercise per week for 3 months, in combination with smoking cessation, will lead to improvement of the symptoms and reduced cardiovascular risk.⁴

Lifestyle modification:

1. Quit smoking

2. Eat a healthy, well balanced diet to control weight and blood sugar level

3. Do moderate exercise as recommended by your doctor

4. Control underlying medical conditions, e.g Diabetes, dyslipidemia, hypertension

Medication:

1. Diabetes, hypertension and dyslipidemia medications, to lower the risk and progression of atherosclerosis throughout the body

2. Antiplatelet drugs (Aspirin, clopidogrel)

3. Anticoagulant drugs (Heparin, Warfarin)

4. Pentoxiphyllin, cilostazol

What is the outlook of patients with Peripheral Arterial Disease?

Peripheral Arterial Disease increases the risk of developing heart attack and stroke. According to research published in the Journal of the American Medical Association (JAMA), “PAD is a powerful predictor of heart attack, stroke, and death due to vascular causes.” If left untreated, it may also progress to critical limb ischemia, where there is minimum blood supply to the lower limb, leading to tissue death (gangrene), requiring amputation of the affected leg. Hence, it is very important to diagnose and treat the condition early. 

As prevention, people who have risk factors of developing PAD should stop smoking, eat a healthy diet, control blood sugar, blood pressure and cholesterol level. Regular exercise is also a key to prevent one from this condition.

Cover image credit: http://pendidikanpesakit.myhealth.gov.my/en/peripheral-vascular-disease-pvd-in-diabetics/

Image credit:

1. https://www.ciccenters.com/peripheral-artery-disease-vs-peripheral-vascular-disease-whats-the-difference/
2. https://health.veininstitutenj.com/blog/what-is-claudication
3. http://www.accessmedicalsystems.com/diabetology.php

Sources:

1. Healthline. What to know about peripheral arterial disease (PAD). https://www.healthline.com/health/type-2-diabetes/peripheral-arterial-disease

2. MyHealth. Peripheral vascular disease in diabetics. http://pendidikanpesakit.myhealth.gov.my/en/peripheral-vascular-disease-pvd-in-diabetics/

3. Graeme J. Hankey, MD; Paul E. Norman, DS; John W. Eikelboom. Medical treatment for peripheral arterial disease. JAMA. 2006;295(5):547-553. https://jamanetwork.com/journals/jama/fullarticle/202271

4. Bailey and Love’s short practice of surgery, 27th edition

5. Mayo clinic. Peripheral artery disease (PAD) https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/symptoms-causes/syc-20350557

Written by

Chen Wen Hao