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 Peripheral vascular disease (PVD), a condition characterised by the narrowing or blockage of the arteries, could cost you an arm or a leg, quite literally.
Blame it on the build-up of fatty deposits – called plaque – on the walls of the arteries. When this happens, the artery walls harden or narrow. This in turn causes the blood flow in the legs to become severely limited or completely blocked.
Dr Manish Taneja, Consultant at the Interventional Radiology Centre, Singapore General Hospital explains: “Narrowed arteries mean that the necessary oxygen and nutrients cannot reach the muscles. This leads to muscle pains in the calves, thighs and buttocks depending on the artery blocked, especially when more blood flow is required as during walking or exercise.”
This pain is called intermittent claudication. As the narrowing increases with time, the pain becomes constant, even at rest. It can eventually progress to ulcers and gangrene of the toes, feet or the whole leg.
“In Singapore, 4-5 per cent of the population is suffering from PVD”, says Dr Taneja. “It is more common in individuals over 70 years of age. A significant subgroup of patients presenting with PVD in our population are diabetics.”
Watch out for clogged arteries
 When PVD is left untreated, amputation may become inevitable. Locally, PVD is a major cause of limb loss. Sadly, a significant proportion of patients who undergo amputation die within two years. Dr Taneja explains: “Our local studies have shown that over 60 per cent of patients die within four years of amputation. This is due to combination of other associated disease, lack of mobility and poor general health.”
But here’s the good news. PVD is easily diagnosed and treatable. Do you have any of the risk factors?
- Regular smoking
- Age over 50 years old
- A diet high in fat and low in antioxidant vitamins C and E
- High blood pressure, high cholesterol and diabetes
- Excess body weight or obesity
- A sedentary lifestyle
DID YOU KNOW? Smokers face the biggest risk of contracting PVD. Dr Taneja explains: “Atherosclerosis, or narrowing of the arteries, has been observed after only six months of regular smoking. When this happens, it brings on PVD much sooner.”
Are you suffering from PVD?
These are signs and symptoms of PVD:
- Muscle pain or cramps, or intermittent claudication, made worse with exercise. For instance, when a PVD patient starts to jog, he or she will feel the pain shortly after. The pain will steadily increase with continued movement until it forces the patient to stop.
- Pain at rest: In more serious cases, a PVD patient can feel severe pain in the feet even at rest. This pain usually occurs at night.
- Ulcers/gangrene: In extreme cases, a PVD patient may see painful ulcers or gangrene setting in, usually in the toes.
Get diagnosed
In Singapore, PVD is under-diagnosed due to limited awareness, as well as a lack of routine ankle-brachial check-ups. During clinical examinations, doctors will use various methods to look for signs of PVD. This includes:
- Listening to specific sounds (known as bruits) in the arteries using a stethoscope
- Checking for changes in blood pressure in the limbs during rest and exercise
- Using imaging tests like the Doppler ultrasound (this detects and measures blood flow) and angiography (the most accurate test to detect the location and severity of artery occlusion)
Lifestyle changes are key
Treatment for PVD is straightforward – it’s about relieving the pain in the limbs, as well as avoiding any potential complications like gangrene.
Dr Taneja explains: “We may prescribe medications to treat the risk factors of PVD, such as high blood pressure, diabetes and high cholesterol. As PVD patients are more susceptible to heart attack and stroke, we may also prescribe an antiplatelet medication like aspirin or clopidogrel (Plavix).”
In addition, doctors will encourage PVD patients to make certain lifestyle changes to manage their condition. These changes may include:
- Quitting smoking: When you quit smoking, build-up of plaque in the arteries is less likely to happen.
- Eating a low-fat diet: A diet rich in fruits and vegetables will help keep the blood vessels healthy.
- Exercising: Supervised exercise (inasmuch as the patient can tolerate the pain) promotes the growth of smaller new blood vessels, which will in turn improve blood flow to the muscles.
- Practising good foot and skin care: This prevents infections and reduces the risk of complications
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