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Home > Our Services > Conditions and Treatments > Peripheral Arterial Disease

Peripheral Arterial Disease



What is it?


Lower limb Peripheral Arterial Disease (PAD) occurs when

  • An artery is affected by atherosclerosis (narrowing/hardening of arteries by fatty deposits)
  • Its lumen will get narrowed or occluded
  • Blood supply to the corresponding organ will be diminished


Sites of arteries that are frequently affected by atherosclerosis include

  • Heart (coronary)
  • Lower Limb
  • Neck (Carotid)


The reduction in blood supply caused by atherosclerosis to the lower limb may cause deterioration in walking capacity, pain in the foot and toes, ulcer or gangrene, and even limb loss depending on the severity of the disease.


Lower limb PAD signifies that:

  • You have higher cardiovascular risks throughout the body (e.g. heart attack and stroke)
  • Your walking capacity and quality of life may be adversely affected
  • You may suffer from chronic pain and even limb loss


The following are people at risk of PAD:

  • People aged more than 50
  • Smokers
  • People with diabetes, hypertension or hyperlipidaemia


What are the symptoms?


  • Early disease could be totally without symptoms (asymptomatic).
  • More severe disease can present as
  • Intermittent claudication
      •  tightness or soreness of the calf muscle after certain period of walking
      •  muscles responsible for walking do not get enough blood supply during exercise
      •  discomfort will go away after a period of resting
  • Rest pain
      •  Pain over the extremities, usually toes and foot
      •  Usually gets worse at night and may even wake the patient up.
      •  Due to a constant insufficient oxygen supply to the furthest parts of the lower limbs
  • Ulcer/gangrene of the foot and toe
      •  Blood supply to the extremities further deteriorate, worsening the healing ability
      •  Very minor injury to the toe or foot can result in a persistent wound
      •  Ulcer or gangrene (localized tissue death) may develop even without any injury



How is it Diagnosed?


  • Diagnosis of PAD is not difficult
  • The doctors will look at the symptoms and the history of the patient
  • Lower limb pulses will be examined at various positions
  • Clinical assessment of foot and toe
  • Ratio between highest ankle arterial pressure and brachial artery pressure (Ankle-Brachial Index) will be taken. Normal ratio would be >1.0 but narrowing of lower limb artery will result in diminished Ankle-Brachial Index
  • Depending on the severity of the disease and other clinical findings, further investigations may be needed



What is the treatment?


There are 3 treatment  goals:

  • Reducing cardiovascular risk
  • Preventing lower limb loss
  • Restoring walking capacity and improving quality of life


To control atherosclerosis

  • Risk factors screening and control
  • Change of life style - quit smoking, low cholesterol diet, moderate exercise
  • Anti-platelet agents - long term anti-platelet agents reduce the risk of all cardiovascular disease (eg. aspirin, plavix, ticlid)


Non-surgical treatment

  • Walking exercise - regular walking exercise of at least 50 minutes, 3 or more times per week can improve most people who have intermittent claudication.
  • Medications to reduce intermittent claudication symptoms are available.


Surgical treatment

It is only indicated for certain inpatients with significant symptoms. It aims to improve the blood supply to the affected tissues. However, if ulcer or gangrene is already set in, surgical debridement (removal of dead, damaged, or infected tissue to promote healing) will be needed


  • Minimally invasive endovascular intervention
  • Arterial Bypass surgery
  • Combination of endovascular intervention and bypass surgery
      •  This combination is used to treat patients with more complicated arterial occlusive disease
  • Endarterectomy
      •  The removal of antherosclerotic plaques by making an incision over the particular segment of the artery to improve blood flow
  • Minor amputation and wound debridement
      •  If ulcer or gangrene of the toe and foot has already set in, minor amputation or wound debridement may be necessary to ensure rapid recovery and also to restore the walking ability of the individual. The need for this surgery very much depends on the site and severity of tissue loss.
  • Multi-disciplinary approach
      • Besides Vascular specialists, we provide a comprehensive care to PAD patients by teaming up with





 -Wound-care nursing specialist

 -Rehabilitation specialists

      • With proper treatment and care, the majority of PAD patients with tissue loss will be able to heal up the ulcer/gangrene, avoid limb loss and walk again.



Peripheral Arterial Disease

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Vascular Doppler Ultrasonography