Peripheral Arterial Disease in Singapore

Peripheral Arterial Disease in Singapore

What is Peripheral Arterial Disease?

Peripheral arterial disease (PAD) is a common and serious condition affecting the arteries or blood vessels outside the heart and brain, leading to reduced or blocked blood flow. The lower limb (leg and feet) are most commonly affected and can lead to amputations.

People with diabetes have a higher risk of developing PAD because the high blood sugar levels damage blood vessels and impair blood flow. As a result, people with diabetes must manage their condition effectively and be vigilant about potential PAD symptoms.

Peripheral Arterial Disease in Singapore

Symptoms of Peripheral Arterial Disease

Symptoms of PAD may include:

  • Leg pain or cramping (especially during physical activity), 
  • Numbness or weakness
  • Coldness in the lower extremities
  • Colour changes in the skin (dull and purplish skin)
  • Non-healing wounds or ulcers. 

Suppose you have any of the above symptoms or have a history of diabetes. In that case, you should consult a podiatrist or medical professional for further evaluation.

Diagnosing Peripheral Arterial Disease

To diagnose PAD, we need to perform a comprehensive examination, which includes the following:

  • Checking your pulses
  • Inspecting your legs and feet for signs of PAD. 
  • Clinical diagnostic tests like the ankle-brachial index, doppler ultrasound

If PAD is suspected, your medical professional may refer you for further imaging, such as CT angiography and magnetic resonance angiography.

Treatment and Management

The treatment for PAD varies depending on the severity of the condition, which the imaging scans can determine. Restoring blood flow is urgently needed if there is the presence of a non-healing wound or when the patient is in severe pain. 

Treatment options for PAD in Singapore include:

  • Lifestyle Changes: Healthy habits can improve PAD symptoms and slow progression. Quit smoking, exercise regularly, and maintain a balanced diet.
  • Controlling Your Sugar Levels: You should maintain healthy blood sugar levels. If you have diabetes, you must regularly check with your doctor to monitor your condition.
  • Medications: Your doctor may prescribe medications to control blood sugar, blood pressure, and cholesterol levels. Additionally, they may recommend medications to prevent blood clots and alleviate pain associated with PAD.
  • Surgical and Nonsurgical Procedures: In more advanced cases, procedures like angioplasty, stenting, atherectomy, or bypass surgery by a vascular surgeon may be necessary to restore blood flow and relieve symptoms.
Symptoms of peripheral arterial disease in Singapore.

PAD on Wound Healing

Peripheral Arterial disease can significantly impact wound healing, particularly in people with diabetes. When blood flow to the extremities is reduced or blocked, it leads to impaired delivery of oxygen and essential nutrients, resulting in slower wound healing and an increased risk of infection.

PAD’s Impact on Wounds:

  • Delayed Healing: Due to reduced blood flow, wounds may take longer to heal, increasing the likelihood of complications such as infections.
  • Increased Risk of Infection: Reduced blood flow makes wounds more susceptible to bacterial infections, further delaying healing and increasing the risk of serious complications.
  • Gangrene and Amputation: In severe cases of PAD, blood flow to tissues can be so limited that it leads to tissue death or gangrene. If the gangrene becomes extensive beyond treatable, amputation of the affected limb may be necessary.

Managing Wounds with PAD

Wounds with underlying PAD, especially diabetic foot wounds, should be handled with adequate care to prevent serious complications. Your podiatrist or healthcare professional should help you with the following:

  • Appropriate Wound Care: Proper wound care promotes healing in individuals with PAD. Wounds must stay clean, dry, and covered with dressings prescribed by your podiatrist or healthcare professional.
  • Offloading Pressure: High pressure stops wounds from healing. Your podiatrist will typically prescribe specialized footwear, cushions, or orthotic devices to help redistribute the pressure. 
  • Infection Control: Be vigilant about any signs of infection, such as increased pain, redness, swelling, or foul-smelling discharge. If you suspect an infection, seek medical help immediately.
  • Vascular Treatment: Addressing the underlying vascular issues is crucial for promoting wound healing. Your podiatrist should work closely with a vascular surgeon to develop your treatment plan.
  • Regular Check-ups: A regular weekly review of your wound is necessary. Regular reviews allow podiatrists or medical professionals to intervene promptly if complications arise.

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You should seek medical attention for peripheral arterial disease (PAD) if you experience any related symptoms or signs, especially if you have diabetes, high blood pressure, high cholesterol, or smoking history. Related symptoms of PAD include:

  1. Persistent leg pain or cramping, especially when walking or doing physical activity
  2. Numbness, weakness, or tingling in the legs or feet
  3. Frequent leg cramps or burning pain at night
  4. Coldness, colour changes, or shiny skin on the legs or feet
  5. Non-healing leg or foot wound for more than two weeks

You should maintain a balanced diet and aim for at least 150 minutes of moderate-intensity exercise. If you have diabetes, you should also closely monitor your blood sugar levels, take your medications as prescribed, and have regular follow-up reviews with your doctor. Lastly, check your feet daily for any skin breaks or appearance changes. You should seek medication immediately if you notice any unusual skin changes.

Unfortunately, PAD can potentially recur. If you have a history of PAD, you must monitor your condition and have regular reviews with your podiatrist or healthcare professional. Prompt medical attention can help you prevent complications such as tissue damage, infection, or amputation.

Wounds most commonly associated with PAD are leg and foot arterial ulcers, particularly in individuals with diabetes. These ulcers result from reduced arterial blood flow and, if left untreated, can lead to tissue death or amputations.

Gangrene is the end-stage of PAD, where the reduction in blood flow causes tissue to die extensively. Gangrene typically begins from the toes. If the PAD remains untreated, it will progressively spread towards the foot and ankle.

Your medical professional will guide you on follow-up care, which generally includes regular check-ups, blood tests, and imaging studies to monitor your condition. Long-term management usually involves lifestyle modifications, medication adjustments, and ongoing collaboration with your healthcare team to address all underlying risk factors and prevent complications.