Peripheral arterial disease (PAD)

You are probably familiar with the terms angina and heart attack, which are related to a blockage of blood flow to the heart. The same sort of blockage can occur elsewhere in the body, depriving the limbs (the peripheral parts of the body and organs) of blood flow. If left untreated, PAD can lead to amputation or organ dysfunction.

Healthy peripheral arteries are smooth and unobstructed, allowing blood to flow freely to provide the legs with oxygen, glucose and other nutrients. As we age, peripheral arteries build up plaque, a sticky substance made up mostly of fat and cholesterol. Plaque narrows the passageway within the arteries and causes them to become stiff.

A moderate blockage in one of the arteries in a major leg muscle, such as the calf or thigh can cause pain when walking. This pain may ease with rest; however it will increase again with more walking or activity. Lower extremity pain, similar to angina is called claudication by medical practitioners. The pain itself is not limb-threatening but is a sign that the person should make lifestyle changes and see a vascular surgeon.

The main cause of PAD is the build-up of fatty deposits inside your arteries called ‘atherosclerosis’. Other things that can make it more likely for you to develop PAD include:

Smoking is a major risk factor for PAD because the harmful chemicals in cigarettes can damage your blood vessels.

Diabetes results in high blood sugar levels which can harm your blood vessels and increase your risk of PAD.

If you have uncontrolled high blood pressure, it can damage your arteries and make PAD more likely.

The fatty deposits that build up in your arteries contain cholesterol. Having high levels of cholesterol in your blood can contribute to the development of PAD.

Homocysteine is an amino acid found in the bloodstream. A blood test showing a high level of homocysteine is a risk factor for PAD.

PAD is more common in people who are aged 50 or older because the risk of fat build-up in the arteries increases with age.

If other people in your family have had PAD, you may be more likely to develop it too.

Being overweight can put extra pressure on your blood vessels, increasing your risk of PAD.

PAD can develop slowly, and you may not notice any symptoms at first. But as it progresses, you might experience:

Early diagnosis of PAD is essential for effective management. Your doctor may use various methods to diagnose the condition, including:

The ankle brachial pressure index (ABPI) is a simple and painless test that compares the blood pressure in your arms and ankles. Measuring ankle brachial pressure helps your doctor assess how well blood is flowing to your legs. A lower ABPI value indicates more blockage in your leg arteries.

Duplex ultrasound combines traditional ultrasound with Doppler technology to create clear images of how blood is flowing within your arteries. It helps your doctor precisely pinpoint blockages or obstructions.

Angiography is a more invasive procedure that involves injecting a special dye into your arteries and then taking X-ray images. It provides detailed information about the location and severity of arterial blockages.

These are advanced techniques that provide clear images of your blood vessels, helping your doctor diagnose and assess the extent of PAD.

If left untreated, PAD can lead to serious complications, including:

Effective PAD treatment aims to reduce symptoms, improve blood flow, and lower the risk of complications. The PAD treatment your doctor recommends will depend on the severity of your condition, what treatments you’ve already tried and your individual health factors.

For mild PAD, treatment involves making lifestyle changes to manage the condition. These changes can include:

This is a minimally invasive PAD treatment. Dr Theivendran uses various techniques to the narrowed artery. This is often required.

Read more about angioplasty

a. Balloon angioplasty

b. Stent

c. Atherectomy