Staying in circulation and avoiding heart-attacks
at the Endovascular & Interventional Radiology Unit, Bangkok Heart Hospital.
One of the biggest problems with Peripheral Artery Disease is that most people don’t even know they have got it until life and limb are already at risk.
“Peripheral Artery Disease develops slowly over many years. In the early stages, only about one in three people would feel any symptoms. And yet, their arteries may already be seriously clogged or hardened,” says
Assoc. Prof. Komgrit Tanisaro MD Endovascular & Interventional Radiology Unit at Bangkok Heart Hospital.
Another problem is that Peripheral Artery Disease (PAD) isn’t common knowledge. “While most people know about coronary artery disease, they haven’t heard about PAD - and yet, it’s all part of the same disease,” the doctor adds.
PAD is definitely worth knowing about, apart from potentially leading to limb amputation in itself, it provides early warning signs of cardio-vascular disease. And as Dr. Komgrit points out: “Cardio-vascular disease is the No. 1 killer in the West and No. 3 in Thailand and increasing all the time.”
Inside PAD
So what exactly is PAD? Essentially, it develops when the arteries in the legs become narrowed or clogged with fatty deposits, or plaque. The plaque causes the arteries to harden and narrow, resulting in the disease known as atherosclerosis. When leg arteries are hardened and clogged, blood flow to the legs and feet is reduced, resulting in poor circulation.
Although PAD occurs most often in the arteries in the legs, it can also affect arteries that go to the brain, the kidneys, the stomach and the aorta.
Furthermore, the hardened and narrowed periphery arteries are likely signs of hardened and narrowed mainline arteries to the heart and brain. Left untreated, the arteries inside the heart harden and narrow and you end up with coronary artery disease or cardiovascular disease.
“Once the disease is detected in any part of the body it is an indication of a problem throughout the body. If it appears in the leg, soon it will appear in the heart or brain,” Dr. Komgrit stresses.
The good news is that by making lifestyle changes, taking medicines, or having intervention or surgery can head off the most serious consequences, so people who are diagnosed with PAD can still live long and well.
Early warnings
Fortunately, early signs of PAD can be detected with a simple ABI (Ankle Brakial Index) test which uses sound waves to find out if there is reduced blood flow in the arteries. This “very smart test” also compares the blood pressure in your ankles with the blood pressure in your arms. A good idea might be to check whether an ABI is included in your annual medical check-up.
Then if any abnormality is detected, it should be followed up by a CT scan, a Magnetic Resonance Imaging (MRI) scan or an angiogram, a special kind of X-ray for arteries, to get clearer pictures of the problem.
The most common symptoms of PAD you will feel include claudication or fatigue, tiredness or pain in your legs, thighs or buttocks. You probably feel it most when you walk and it goes away when you sit down. Another common symptom is foot or toe pain which may be experienced even when at rest. It is the kind of thing that may also disturb your sleep. The third main symptom consists of skin wounds or ulcers on the feet or toes that are slow to heal.
Unfortunately, a lot of people still just put it all down until getting older and remain unaware that they are suffering from a potentially serious medical condition. But if untreated, PAD at this stage may cause other problems that can lead to amputation of a toe, foot or a leg. People with PAD may become disabled and not be able to go to work. As time goes on, their quality of life will deteriorate noticeably.
“It is important to discuss any leg or thigh pain with a doctor,” says Dr. Komgrit. “It may be a warning sign.”
Check-ups aside, you can decide, with the help of a doctor if necessary, if you fall into any of the risk groups and, if so, seek out an initial ABI test. The chance of anyone having PAD increases as you get older, especially among people over 50. The risk is also increased if you smoke or used to smoke or have diabetes, high blood pressure or abnormal blood cholesterol levels. If you or someone in your family
history has had heart disease, a heart attack or a stroke, you are also in a higher risk group.
Managing risk factors
Obviously, the earlier you get treatment, the better your chances of arresting the disease.
Treating PAD includes making lifestyle changes, taking medicines and undergoing special procedures, if needed.
Since people with PAD are at high risk for heart attacks and strokes, it is very important for you to take charge of controlling the risk factors related to cardiovascular disease.
Potentially life-saving steps to prevent and control PAD, include obvious things like stopping smoking and lowering your LDL (bad) cholesterol to less than 100 mg/dl or to less than 70 mg/dl if you are at very high risk for a heart attack or stroke, such as if you smoke, have diabetes or have chronic kidney disease. Another target would be to lower your blood pressure to less than 140/90 mmHg or less than 130/80 mmHg if you have diabetes or chronic kidney disease. Those with diabetes are further advised to manage your blood glucose to reach an AIC level of less than 7 and practice proper foot care.
It may also be advisable to talk to your doctor about taking anti¬platelet medicines to prevent clotting such as aspirin or clopidogrel.
Some of the other preventive advice pretty much applies whether you have PAD or not such as following a healthy eating plan to control your blood pressure, cholesterol and, if you are diabetic, your blood glucose. Also, get regular exercise such as walking for 30 minutes at least three times a week. If you’re experiencing discomfort when doing that, consult your doctor about now to improve your walking ability.
Convenient treatments
Most people with early-stage PAD will find that these life saving steps will be enough to control the disease and even improve the symptoms. However, if your arteries remain severely blocked, your doctor can refer you to a specialist for procedures or surgery.
The good news is that even if that happens, today’s treatments are relatively straightforward and a lot less uncomfortable and inconvenient than before.
“The biggest development in terms of PAD treatments in recent years has been the move from surgical to non-surgical solutions,” says Dr. Komgrit. “Today, we don’t need to open up the abdomen to make the necessary corrections. The patient only spends 1 or 2 days in hospital and can go straight back to work.”
Common procedures include minimally invasive endovascular angioplasty and stent procedures. Angioplasty is the mechanical widening of a narrowed or totally-obstructed blood vessel whereas a stent is an expandable wire form or perforated tube that is inserted into the artery to prevent constriction. Obviously, these are still specialised procedures and it is recommended to consult experts. Hospitals with all the relevant specialists, including vascular surgeon, vascular radiologists, cardiologists, diabetes doctors, rehabilitation doctors and all the very high-tech equipment such as CT scan, and MRI, are the only places treating peripheral vascular disease today that can perform all the treatment options available.
“You need an all-round team for the best results - not just a surgeon,” says Dr. Komgrit.
Ideally, he adds, the medical staff will also follow Western-standard Clinical Practice Guidelines which take all eventualities into consideration.
“The main thing to remember is that finding and treating PAD early can help keep your legs healthy, lower your risk for heart attacks or stroke. But if you do get beyond that point, there is still a lot that can be done to save your life and limbs”