Peripheral Arterial Disease

One way to prevent PAD is by checking ankle and arm pressures during routine clinic consultations, which should be the same. The ankle-brachial index (ABI) is calculated by dividing ankle pressures by arm pressures. A value of 0.9 to 1 is normal. If it comes back as 0.5, then that implies that the patient has significant disease.

Specific management of PAD involves:

These include smoking cessation; eating a balanced diet that is high in fibre and low in cholesterol, fat and sodium; and exercise.

Medications may be recommended to treat conditions such as high blood pressure (anti-hypertensive medications) or high cholesterol (statin medications). An antiplatelet medication such as Aspirin or Clopidogrel (Plavix) may be prescribed to reduce the risk of heart attack and stroke.

More advanced PAD can be treated with interventional procedures such as angioplasty (to widen or clear the blocked vessel), angioplasty with stent placement (to support the cleared vessel and keep it open), or atherectomy (to remove the blockage). In some cases, surgical procedures such as peripheral artery bypass surgery may be performed to re-route blood flow around the blood vessel blockage.

Despite the availability of healthcare in Singapore, PAD is still “under-diagnosed” for several reasons. One being that checking the arm and ankle pressures is not as routine as it should be.

The goal of therapy is to improve blood supply to the leg muscles so that patients maintain their functional level of activity. Once patients become used to sedentary lifestyles, it is hard to get them active. They need to be constantly kept active to maintain their health.