Peripheral Arterial Disease

The symptoms of PAD can vary from mild to severe. Common symptoms include:

1. Pain felt during walking or during physical activity, which is relieved after rest (intermittent claudication)
2. A tingling sensation, or numbness, in the legs
3. Slow-healing wounds on the legs
4. Constant pain as the condition progresses
5. Ulcers and gangrene can develop if the condition is left untreated, which can be life threatening, and lead to amputations

Several factors can increase the likelihood of developing PAD, including:

1. Diabetes: High blood sugar levels may damage blood vessels
2. Chronic smoking: Damages the blood vessels and promotes the formation of atherosclerotic plaque.
3. Other factors include high blood pressure, high cholesterol, a family history of PAD or other cardiovascular diseases, or being over the age of 60

Ankle Brachial Index (ABI) measurement: This treatment simultaneously measures the blood pressure in the arms and legs to check for any inconsistencies, and is capable of picking up PAD in the early stages

Ultrasound scanning: CT or MRI scans help the doctors to determine the extent of the obstruction of blood flow and narrowing of the artery.

We provide a minimally invasive endovascular treatment which includes angioplasty and/or stent placement. For many patients, this can be done as a day procedure with same-day discharge. Some patients may require an open surgical bypass surgery when angioplasty/stenting is unsuccessful.

Patient has a history of long-standing diabetes and presented with right leg critical ischaemia with non-healing right big toe amputation wound as well as lateral foot dry ulcer.

The right common femoral artery was accessed with an ultrasound guide but the lesion antegrade could not be crossed. Access was carried out through the right ankle posterior tibial artery and a bi-directional approach was used to cross the lesion with wires. Percutaneous old balloon angioplasties were performed on the proximal tibial artery(PTA) and the superficial femoral artery(SFA). Stents were placed in the tp trunk, proximal PTA and SFA.

Patient’s wounds healed within 1 month and he is now ambulant. We managed to save his leg.

Patient presented with bilateral PAD and rest pain and weeping from a previous left big toe amputation. He has a background history of diabetes mellitus, hypertension and hypercholesterolaemia.

An angioplasty with a drug coated balloon was performed. Multiple wires were used due to tight stenosis and calcifications in the patient’s blood vessels and percutaneous old balloon angioplasty was done to widen the affected blood vessels.

Good blood flow restored as the previously blocked arteries were re-opened. The patient’s wound healed in 4-6 weeks and his lower limb was salvaged.

Peripheral arterial disease (PAD) in the legs results from the narrowing and hardening of arteries supplying blood to these areas. When this happens, the legs are unable to receive the necessary nutrients and oxygen that they need, often causing pain. The symptoms of PAD can vary from mild to severe.

We provide a minimally invasive endovascular treatment which includes angioplasty and/or stent placement.

In this case, a catheter was inserted into the femoral artery, and a guide wire was threaded through. Sirolimus and Paclitaxel drug-coated balloon catheters were inserted into the [vessel of interest], and inflated. The lumen of the artery was hence widened, increasing blood flow. Peripheral stents were also inserted to provide additional support.

Following the procedure, good inline flow was restored to both feet, thus saving the leg.

Chronic wounds commonly occur at sites where there is constant pressure on the skin (e.g., lower back, buttocks, heel), especially in immobile patients. They are also associated with poor arterial blood supply (e.g., lower limbs in peripheral artery disease) and underlying infections.

Risk factors for chronic, non-healing wounds include peripheral artery disease (PAD), diabetes, and immunocompromisation.

Diagnostic investigations are carried out to determine the cause of the wound and guide treatment. They involve wound bacterial swabs and cultures to identify bacteria and guide antibiotic therapy. Some cases may require imaging scans (x-rays, CT scans, or MRI scans) to assess bone and soft tissue infections.

Our treatment plan:

Wound assessment: This addresses both the underlying cause and the wound itself. For instance, patients with peripheral artery disease would have to undergo surgery to improve blood supply. Infected wounds may require surgical cleaning and antibiotics.

Various dressing techniques: The techniques we employ range from simple gels to Vacuum-Assisted Closure (VAC) or maggot therapy. We aim to have complete healing of these wounds with the return of functionality.

Patient presented with a non-healing wound with sloughy edges after the amputation of the fourth toe of the right foot.

The underlying Peripheral Artery Disease was treated with angioplasty and stenting of the superficial femoral artery then the main foot wound was debrided and had twice weekly dressings and cleaning.

Recovery progress

The wound has healed after angioplasty and stenting with careful wound dressings over a period of 4-6 weeks.