Peripheral arterial disease (PAD) occurs when there is a cholesterol plaque on the blood vessel walls causing them to narrow resulting in reduced circulation to the upper and more commonly lower limbs.
Who is at risk?
It commonly affects people with type 2 diabetes especially when they have poor diabetic control. According to the American Diabetes Association, about 1 in 3 people with diabetes over the age of 50 have PAD. Other people at risk include smokers, older age, people with high cholesterol, overweight and having sedentary lifestyle with minimum or no exercise.
Symptoms and Signs
The symptoms depend on the extent of narrowing of the blood vessels.
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- Initially, there will numbness or pins & needles in your legs and feet
- Pain in your calf muscle after walking a short distance or even at rest
- Sores on your feet or toes which heal slowly
- Hair loss on the legs with shiny skin appearance
- Cold feet with weak pulse
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- Toes or feet turning blue-black (gangrene)
Claudication pain is a reproducible pain at the calf muscle brought on by walking to a certain distance and relieved with rest but returns once the patient walks to the same distance. The pain occurs when there is not enough blood circulation to the leg during exercise.
How to prevent PAD
You can reduce your risk of developing PAD by changing to a healthier lifestyle and this includes:
- stopping smoking immediately
- controlling your blood sugar level (if you have diabetes)
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- doing around 30 minutes of gentle exercise daily (read our article ‘How much should we exercise daily’)
- lowering both cholesterol and blood pressure by exercise and medication
- eating a healthy diet which is low in fat (read our article on ‘Let nutrition determine the way you age’)
- reducing your weight to a healthy level for your age and height
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It is extremely important to treat the causes of PAD (as well as PAD itself) because if left untreated, there is a very high chance of the person getting a stroke or heart attack in the next 5 years.
How is PAD diagnosed?
1. Measuring the ankle-brachial index which is the ratio of blood pressure in the feet compared to the arm blood pressure.
2. Doppler ultrasound to measure the flow rate in the blood vessels in the feet and toes.
3. CT Angiography.
Treatment of PAD
Treatment of PAD has to achieve 2 goals:
(a) treat underlying risk factors to prevent further cholesterol plaque blockage
(b) treat the leg symptoms to reduce pain and prevent progression to gangrene
1. Angioplasty and stent insertion
This is a minimally invasive procedure to widen the blood vessel narrowing and also to place a stent to prevent the blood vessel from blocking again.
2. Open endarterectomy
Endarterectomy is required to remove the cholesterol plaque if the PAD is severe or the plaque is hard and large. The artery is then closed using stitches or with a patch made of your own vein or synthetic graft.
3. Bypass surgery
In cases where the blockage is long and very hard (calcified), bypass surgery may be required whereby a graft (made up of either your own vein or synthetic graft) is used to create a new passage to flow around the blockage to the feet.
Follow-up foot care
Lifelong close regular follow-up surveillance is essential for all patients with PAD as the disease may recur. In addition to the lifestyle changes, you must also invest time to take of your feet with the help of a podiatrist. This is because any sore or injury heals slowly which increases the risk of infection.
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- Wash your feet daily, dry them thoroughly and moisturise regularly to prevent cracks which can lead to infection
- Wear well-fitting shoes and dry socks to prevent fungus growth
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- Treat any fungal infections of the feet (such as athlete’s foot) quickly
- Take care when cutting your nails
- Never walk barefoot out in the garden or beach