Atherosclerosis is the narrowing or hardening of arteries by fatty deposits.
The reduction in blood supply caused by atherosclerosis to the lower limbs may lead to the following problems:
Diagnosis of PAD is not difficult. First, your doctor will identify the symptoms and the medical history. Your lower limbs and pulse will be examined at various positions. Then, a clinical assessment of your feet and toes will take place. Through this, the ratio between highest ankle arterial pressure and brachial artery pressure (Ankle-Brachial Index) will be taken. A normal ratio would be >1.0, however, a narrowed 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.
Early disease could be totally without symptoms (asymptomatic).
More severe disease can present as:
Ulcer/gangrene of the foot and toe
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.
Coronary artery narrowings may be treated using either medications that reduce the heart's demand for blood, or by procedures aimed at increasing the heart's blood supply. One of the two most common methods to increase the blood supply is coronary angioplasty, sometimes abbreviated as PTCA (Percutaneous Transluminal Coronary Angioplasty). PTCA offers a non-surgical alternative to Coronary Artery Bypass Surgery.
In PTCA, a balloon mounted on a thin tube (a catheter) is advanced into your coronary artery until it lies within the narrow area. The balloon is then inflated at high pressure, often a few times, to dilate the narrowing. Upon balloon deflation, the arterial narrowing is often significantly reduced.
A stent is a small metal coil to provide support to the narrowed segment of the coronary artery after angioplasty, preventing the artery from collapsing and reducing the likelihood the narrowing will recur. Modern stents are made of stainless steel or a cobalt chromium alloy and are inert to the body. Some stents also have a medication coating and these may be preferred in certain situations to further reduce the chance of repeat narrowing of the heart arteries. Nowadays, stents are frequently placed directly over the narrowed segments (direct stenting) without prior balloon dilatation.
A stent is a small metal coil that provides support to the
narrowed segment of the coronary artery after angioplasty.
Before going through a PTCA, a coronary angiogram is done first to provide a 'roadmap'. Undergoing PTCA is also very similar to having a coronary angiogram procedure.
First, you will be injected with local anaesthetic. A plastic tube known as sheath is inserted in a large artery in the groin or wrist. Through this sheath, a catheter is advanced to the mouth of the narrowed coronary artery. A thin wire is then threaded through the catheter and positioned in the coronary artery. Over this wire, the balloon catheter is pushed into the artery and the balloon is positioned over the area of narrowing.
During balloon inflation, you may experience some chest discomfort, and you should report this to your attending cardiologist. Stenting is carried out in a similar manner. The procedure may take 1 to 2 hours or more depending on the complexity of the diseased artery. Following the successful PTCA, you will be monitored in a special monitoring ward. During this period, the sheath may be kept in your groin artery for 4 to 5 hours. However, the sheath may be removed immediately after the procedure if the situation allows. After the sheath is removed, the puncture site will be compressed for about 30 minutes to ensure that there is no bleeding. You will have to remain in bed for several hours or until the following day to ensure the puncture site is sufficiently healed before walking. Your cardiologist will determine how long you need to stay in bed before you can walk around. Following that, some blood tests and ECGs will be performed to monitor your condition. If there are no complications, most patients can be discharged on the same day or the day after.
The success rate of coronary angioplasty is usually about 95%, depending on the nature of your coronary narrowing. However, in about 5% of cases, the procedure may be unsuccessful and the artery remains narrowed. In very few patients (about 1%), urgent bypass surgery may be required if the procedure is complicated. There is a possibility of a recurrence of the narrowing of the coronary artery in the 6 months following the initial successful angioplasty or stenting, and you would usually feel a chest discomfort should it happen. If you feel a chest pain, you should seek medical attention immediately and inform your doctor.
Major complications like heart attacks, abnormal heart rhythm, stroke and death occurs in less than 1% of the patients undergoing PTCA. Less serious complications like bleeding from the puncture site, bruising and swelling of the puncture site, and blood clot formation in the artery where the sheath is insert occurs in 1-3% of the patients. Overall, the procedure is very safe and well-tolerated.
As a patient:
Coronary Artery Bypass Surgery is an operation that is carried out to improve the flow of blood to the heart muscle in people with coronary heart disease where the coronary arteries are severely narrowed or blocked. The operation involves taking blood vessels from other parts of the body and attaching them to the coronary arteries past the blockage. The blood is then able to flow around, or "bypass" the blockage. If more than one artery is blocked, you may need more than one bypass.
Call the doctor right away if:
Call the doctor during office hours if:
This combination is used to treat patients with more complicated arterial occlusive disease.
The removal of atherosclerotic plaques by making an incision over the particular segment of the
artery to improve blood flow.
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.
Besides vascular specialists, we provide a comprehensive care to PAD patients by teaming up with:
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
Vascular Doppler Ultrasonography