Peripheral Arterial Disease / Blocked Arteries
Peripheral Arterial Disease (PAD) is a chronic condition caused by fatty deposits (atheroma) in the blood vessels, which cause them to narrow (atherosclerosis) and reduces blood flow to the legs. While many people with PAD have no symptoms, some experience pain or aching in the legs when walking which goes away after resting for a few minutes. This is called intermittent claudication and can affect one or both legs at the same time. Other symptoms can include cramping, numbness, weakness in the legs, a feeling of coldness or colour change, hair loss or shiny skin on the legs, open sores (ulcers) that heal unusually slowly, pain in the legs at night, slow-growing or brittle toenails, and erectile dysfunction in men. If left untreated, it can lead to gangrene or limb loss. You are more likely to be at risk of PAD if you are a smoker, if you have high blood pressure or cholesterol, are diabetic, runs in family and if you are older. If you suspect you may have PAD it is important to see your doctor. In most cases, lifestyle changes and/or medication are the first line of treatment for Peripheral Arterial Disease. In more serious cases, you may be referred for revascularisation procedure. During your initial consultation, Mr Akin Oluwole may order tests to assess your condition, and will be able to advise you on your options.
Treatment Options
Angioplasty / Stenting
During an angioplasty, a catheter is inserted into the affected artery under local anaesthetic. A balloon is then fed through the catheter and inflated to squash the atheroma (fatty deposit) into the vessel wall, which widens it. It is normal to feel some pain during the procedure, but this should go away when the balloon is deflated. It is also common to feel a slight change to your heartbeat while the operation is performed. The whole procedure generally takes between 30 minutes to 2 hours to complete and many patients can go home same day. A wire mesh tube called a stent may be inserted at the same time as an angioplasty, which helps to keep the artery widened. If you have a stent, you will need to take certain medications afterwards to reduce your risk of blood clots.
Risks
It is common to feel tenderness in the area, and to experience some bruising where the catheter was inserted, though over-the-counter painkillers are generally sufficient to deal with any soreness. There is also a risk of bleeding, damage to the artery (occlusion and dissection). Limb loss, heart attack and stroke is possible but very rare. During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.
Exercise Therapy
Exercise therapy is an effective initial treatment option for the easing of pain caused by narrowed arteries (claudication). Peripheral Arterial Disease (PAD) can make it difficult to walk and participate in day-to-day activities which can impact quality of life. A supervised regimen of exercise, if available in your area is the best but if not, walking 30-40mins every day and walking through the pain barrier is a highly effective way of reducing the severity of PAD symptoms and improve mobility and independence. It is recommended that patients also make other lifestyle changes- such as quitting smoking- in addition to undergoing endovascular treatment for the best overall outcome.
Medical Therapy
The use of certain medications in combination with exercise therapy and other lifestyle changes can reduce the need for more invasive treatments. These include statins, which reduce the amount of cholesterol in your blood; anti-hypertensives that reduce your blood pressure; antiplatelets such as aspirin or clopidogrel; and a drug called naftidrofuryl oxalate which can improve the blood flow in your body. Mr Akin Oluwole will formulate a treatment plan with you that is tailored to your situation, considering all of the available options.
Bypass Surgery
When other treatment options are unsuitable or have not been successful, a bypass graft may be performed. A synthetic vessel or a healthy vein from your leg or arm can be grafted (attached) to the diseased artery, which allows the blood to bypass the blockage. This is performed under general or spinal anaesthetic and takes between 2 – 4 hours. For most patients, this surgery will decrease pain, decrease the future risk of amputation of the limb, and improve mobility- particularly when this is complemented with lifestyle changes, such as quitting smoking or improving your diet. Most people will need to recover in hospital for 3 to 5 days after bypass surgery. You should be able to resume normal activities after around 4 to 6 weeks. You will have a follow-up appointment with Mr Oluwole to check the progress of your recovery and to discuss any queries you may have.
Risks
As with any major surgical operation, there is a risk of complications. These include irregular heartbeat, infection of the wound and graft, thrombosis (blood clots), stroke, heart attack and bleeding. Pre-existing conditions such as diabetes or cardiovascular disease (CVD) can increase your chances of developing complications. During your consultation, Mr Oluwole may order tests that will help assess your risk and will discuss the best course of action with you, along with the risks of complications in more depth.
