Peripheral Arterial Disease

It is a common circulatory problem in which narrowed arteries reduce the blood flow to your arms and legs.

What are Peripheral Arteries ?

Arteries carry oxygen rich blood and nutrients away from your heart, to your body’s tissues. The main artery arising from the heart is called the Aorta.  It branches and comes to the limbs – upper or lower limbs, these are called Peripheral arteries.

Plastic surgeons and vascular surgeons deal with any abnormality arising out of arteries of the upper or lower limb. The ones above that concerning the heart and aorta go into the realm of cardiac or cardiovascular surgeons.

Acute Peripheral Arterial Disease

Acute problems can be because of a  clot forming or a clot getting transferred from somewhere else.  A clot in the heart can travel and go anywhere to the brain, arteries, hand or feet and that area can become blocked and ischemic. This calls for an acute emergency. Acute obstruction because of clot and obstruction of a major artery of a limb can cause complete de-vascularization of the limb. 

It presents as absolute, severe pain and pale limbs as the blood stops to flow. In contrast with venous obstruction, the artery keeps on pumping the blood but the blood is unable to flow up, so the limb becomes congested and painful which means a high index of suspicion must be raised for an acute arterial obstruction first by confirming the diagnosis and then whether it is an acute thrombus is forming or it is a clot thrown from somewhere else.

Symptoms Of Arterial Obstruction are :

  • Painful cramping in hip, thigh or calf muscles after walking
  • Leg weakness / numbness
  • No pulse or weak pulse in legs / feet.
  • Pale coloured skin
  • Aching pain or cramping in arms when doing manual tasks.

    Peripheral Arterial Disease (PAD), can be Acute or Chronic.

Lymphedema and Vascular clinic

Acute arterial obstruction by a thrombus (clot)

Bypass / reconstruction of the blocked segment using a autologous vein graft

Investigations include

  • Clinical examination – palpation and looking for peripheral arterial pulsations of both the limbs and of the arteries above that, eg the neck and the opposite limb. 
  • Colour Doppler of the concerned limb.
  • 2D Echo of the heart.
  • Abdominal Ultrasound.
  • Whole body CT scan with contrast will screen for any other obstruction happening elsewhere.

Treatments we Offer

Surgical
  1. Arterio arterial bypass surgery to overcome a narrowed arterial segment which is done either with an arterial prosthesis or with an autologous vein from the opposite limb
  2. Fogarty catheter is inserted and the clot is taken out.
  3. Surgical removal of the thrombus or clot – arteriotomy.
  4. Reconstructive procedure for any wounds or ulcers.
  5. Debridement of ulcers especially in diabetic foot and reconstruction
Non Surgical
  1. Decrease in the blood flow poses as a main issue. There are medications that can be used to increase the blood flow.
  2. Minimally invasive interventional radiology procedures like stenting and thrombolysis are used gradually.
  3. Heparinization and monitoring

The prognosis in arterial obstruction depends on how early the problem is diagnosed and the site of the problem. 

Smoking is very harmful for patient with Arterial Disorders. 

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