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Peripheral artery disease (PAD) encompasses diseases involving the arteries supplying the lower and upper limbs, arteries supply the abdominal organs (including the kidney arteries), aortic disease (particularly aortic aneurysms) and carotid artery (artery running along the neck to supply the brain) disease.
This develops when the arteries in the lower limbs become narrowed with cholesterol deposits and limit or completely block blood flow in the legs.
Risk factors for PAD are similar to those for heart disease and include diabetes, hypertension and high cholesterol which are common illnesses in our population. With increasing pain affecting their movements, patients become less active and more sedentary.
Symptoms include intermittent claudication which is an aching pain usually in the calves on exertion.
A simple method of detecting lower limb PAD is to check the ratio of the ankle and arm blood pressures during a clinic consultation (the ankle-brachial index – ABI). Medications may be prescribed for the treatment of diabetes, hypertension and high cholesterol. In patients who have significant lifestyle limiting symptoms or who have rest pain, foot ulceration or gangrene, interventional procedures such as balloon angioplasty (to widen the narrowed artery), or angioplasty with stent placement (to support the artery after ballooning and keep it open) can provide symptomatic relief and save the foot (to avoid foot amputation). Carotid artery stenosis may be detected during the workup of patients presenting with stroke, transient ischaemic attack (very minor stroke that fully recovers) or amaurosis fugax (transient loss of vision in one eye) (i.e. In symptomatic patients, there is a markedly increased risk of recurrent ipsilateral (same side) stroke of approximately 26% over the following 2 years whereas the risk is 12% in asymptomatic patients. In the past 15 years, carotid artery stenting has become a less invasive alternative to carotid endarterectomy. It must be emphasised that medical therapy must be optimised regardless of the interventional technique chosen to treat the carotid artery stenosis. Dr Paul TL Chiam is an interventional cardiologist at The Heart & Vascular Centre, Mount Elizabeth Hospitals.


Oxygen-rich blood supply is reduced resulting in pain in the buttocks, thighs and calves on physical exertion. This predisposes to weight gain and worsens diabetes, high blood pressure leading to increase risks of heart attack and stroke. If PAD is suspected, further tests such as an ultrasound of the lower limb blood vessel can be performed. Also, diabetes, high blood pressure and high cholesterol have to be controlled optimally; these are risk factors of PAD. A blood thinner such as aspirin is usually recommended to reduce the risks of heart attack and stroke. In very severe disease, surgical bypass operation (to re-route blood flow around the blood vessel blockage) may be required. Patients tend to ignore the symptoms or simply bear with it and do not report it to their physicians. Large studies have shown that carotid endarterectomy (surgery to remove the plaque deposit) can significantly reduce the risk of recurrent stroke from 26% to 9% over 2 years in symptomatic patients and from 12% to 6% in asymptomatic patients over 5 years, when compared to medical therapy alone. Studies have shown that carotid artery stenting may be superior to surgery in high surgical-risk patients and is an attractive treatment choice for such patients.
Blood thinners (such as aspirin), medications to control diabetes, hypertension and high cholesterol and smoking cessation are of paramount importance. He is also an Adjunct Associate Professor with the National University of Singapore, Yong Loo Lin School of Medicine.
Content and images are meant for practicing medical doctors, allied health care professionals and other establishments in the medical industry. PAD is also a marker for increased risk for heart attacks and strokes since the same disease process also affects arteries in the heart and brain.


He stops and rests for a few minutes and the pain subsides, and then he can walk for another 100 metres before the pain recurs. Patients are encouraged to practice good foot and skin care to prevent infection and reduce the risk of complications. Also checking the ratio of the ankle to arm blood pressures (ABI) is not commonly practiced. Unlike arteries in the heart or lower limbs, the reduced blood flow usually does not cause symptoms since the carotid artery on the opposite side of the neck and vertebrobasilar arteries (at the back of the neck) can provide collateral blood supply.
In normal risk patients, carotid stenting is equivalent to surgery to and either treatment modality would be of benefit to the patient. He is trained in complex coronary angioplasty, peripheral artery and carotid angioplasty and structural (heart valve) interventions.
In more severe cases, PAD can result in rest pain of the feet, feet ulcers, gangrene and the need for amputation. Exercise or walking therapy helps to improve collateral blood supply (naturally developing small bypass channels) to the lower limbs and improves walking distance.
Early detection and treatment can halt disease progression, keep patients active, prevent limb (foot loss) and ultimately reduce disability and death.
The main problem arising from carotid artery stenosis is that it can be the cause in 10% to 20% of large artery strokes.
He performed the first Transcatheter (percutaneous) Aortic Valve Replacement in Asia in 2009.



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