CONDITIONS

Peripheral Arterial Disease

OVERVIEW

Peripheral arterial disease (PAD) is a common circulatory problem or vascular disease. One of the most common diseases affecting the arteries is atherosclerosis, which causes hardening and narrowing of the arteries. The arteries most often affected include arteries of the neck, heart and upper and lower limbs. Left untreated, narrowing in the arteries of the neck can lead to one or multiple strokes. Narrowing in the arteries of the heart can lead to chest pain and heart attacks. Narrowing in the arteries of the legs can lead to poor blood flow to the legs and feet.

THIS CAN BE EXPERIENCED AS:

  • Muscle pain and cramps when walking, especially in the calves, which limits your walking distance.
  • Skin colour changes on the lower legs and feet and nail changes can be seen on the toes.
  • Sores or ulcers on the skin of the lower legs and toes are another sign of poor blood flow, especially if they take longer than usual to heal.
  • Pain in the legs and feet, especially at rest or at bedtime.
  • Reduced feeling or numbness in the toes and soles of the feet.

When the arteries are narrowed or hardened the blood flow to vital organs like the brain and heart may be compromised, and thus peripheral artery disease may be a sign of atherosclerosis of the arteries of other vascular beds. Peripheral arterial disease is therefore a significant risk factor and marker of your overall cardiovascular health.

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HOW DOES A VASCULAR SURGEON PERFORM SURGERY ON ARTERIES?

Treatment for peripheral arterial disease involves medical as well as surgical options, to relieve symptoms by restoring blood flow and circulation to the affected area and to reduce your overall cardiovascular risk.

Lifestyle management and cardiovascular risk factor reduction is also a very important part of Dr Moydien's treatment to address the causes and risk factors involved.

Surgical treatment options include open surgery and minimally-invasive endovascular surgery. Endovascular surgery is performed through a small cut in the skin; this is known as minimally invasive surgery. Or if needed, open bypass surgery can be performed through larger skin cuts/incisions, called open surgery.

MINIMALLY-INVASIVE ENDOVASCULAR SURGERY:

This is performed in a specialised theatre called a catheter laboratory (CathLab), patients are under conscious sedation and the entire procedure is done through a small 1cm cut/incision in the groin. The narrowing or blockage in the artery is opened from the inside of the artery using a special balloon (angioplasty) and if needed a stent is placed (metal mesh scaffold) to keep the artery open. This procedure restores the blood flow to your legs. Most patients stay overnight and are discharged the following morning. Because of the minimally-invasive nature, its pain free and allows for a rapid recovery.

OPEN SURGERY:

This is performed in the traditional operating theatre, patients are put to sleep with a general anaesthetic and the procedure involves larger skin cuts/incision. The blockage requires a “bypass” in order to restore blood flow to the leg. We can either use your own leg veins or an artificial tube to bypass your blockage. The recovery period is slightly longer.

While these may seem like complicated surgical procedures, be assured that Dr Moydien is trained and highly skilled. He has extensive experience performing these and many other vascular procedures.

WHAT ARE THE RISK FACTORS FOR PERIPHERAL ARTERIAL DISEASE?

  • A history of high blood pressure, even if well controlled
  • A history of diabetes, even if well controlled
  • A history of high cholesterol, even if well controlled
  • Any history of cigarette smoking
  • If you are over the age of 50
  • Obesity (Body Mass Index of 30 and above)
  • Family history of vascular artery disease
  • Any previous episode of a stroke or heart attack

If you have one or more of the above risk factors, with or without symptoms, it is recommended that you consult with your General Practitioner to assess your risk and if needed, refer you to a vascular surgeon for further management.

While many may dismiss leg pain and numbness as a regular aspect of ageing, it is essential to have your doctor have a closer look to rule out peripheral arterial disease. Left untreated, peripheral artery disease may lead to an increased risk of developing critical limb ischemia with risk of limb loss/amputation, a stroke or heart attack.

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