PERIPHERAL ARTERIAL DISEASE
Peripheral arterial disease (PAD) is the narrowing of arteries that supply blood to the limbs due to the hardening of arteries caused by cholesterol and/or calcium deposits within the arterial wall over time. When this happens, your limbs are unable to receive the necessary nutrients and oxygen that they need, often causing pain in those areas.
Common symptoms include:
- Difficulty walking is one of the earliest signs, also known as intermittent claudication.
- Pain when you begin walking and relieved when you stop.
- Constant pain as the condition progresses.
- Development of ulcers or gangrene in the legs when left untreated. This may lead to amputations and can potentially be life-threatening.
Risk factors include:
- Diagnosis of other cardiovascular diseases (including stroke and hypertension)
- High cholesterol
- Chronic Smokers
- Renal failure
- Ankle Brachial Index (ABI) measurement – Doctors utilise this treatment for patients with an early stage of PAD. This treatment measures the blood pressure in the arms and legs simultaneously to check for any inconsistencies between the two.
- Ultrasound scan of arteries – this will help the doctor determine how severely the artery has been narrowed and the obstruction of the blood flow.
- CT or MRI scans
We provide a minimally invasive endovascular treatment which includes angioplasty and/or stent placement. For a significant number of patients, this can be done as a day procedure with discharge from the hospital on the same day. Some patients may require an open surgical bypass surgery when angioplasty/ stenting is unsuccessful.
A chronic wound is usually a break in the skin with an ulcer over any part of the body. Some of these wounds may have been present for over one month and have been unable to heal on their own. The wound may also have secondary bacterial infections resulting in pus discharge, bad odours, surrounding redness and pain.
Chronic wounds are usually found at sites where:
- There is persistent pressure on the skin (e.g. lower back, buttocks, heel of the foot), especially in patients who are not mobile and laying down for long periods
- The arterial blood supply is poor (e.g. lower limbs, foot and toes of patients with peripheral artery disease)
- There is an infection underlying the wound (e.g. chronic bone infections resulting is a wound on the surface and discharge)
CAUSES/ RISK FACTORS
Patients with PAD or diabetes or are immunocompromised are at risk of developing chronic, non-healing wounds.
The aim of these investigations is to determine the cause of the wound as well as to guide treatment of the wound. They include:
- Wound bacterial swabs and cultures are usually taken to determine the presence of bacteria in the wound as well as to guide antibiotic therapy
- Some patients may require x-rays, CT scans or MRI scans to assess underlying bone and/or soft tissue infections
Wound assessment: For a chronic wound to heal, we must treat two key components – the underlying cause and the wound itself. For example, suppose there is underlying peripheral artery disease causing the poor blood supply to the region of the wound. In that case, the patients should undergo surgery to treat the artery disease to improve the blood flow to the wound. If there is an underlying infection, then the wound may need to be cleaned surgically, and antibiotics started.
We then use different techniques with various types of dressing preparations to treat the wound itself. The dressings range from simple gels applied to the wound to complex types like Vacuum-Assisted Closure (VAC) or maggot therapy. We aim to have complete healing of these wounds with the return of functionality.