Saving limb and life from PAD

THIS WEEK, I attended the joint meeting of the Asian Pacific Society of Vascular Disease, Philippine Heart Association, Philippine Lipid and Atherosclerosis Society and the Philippine Vascular Society.

The APSVD-PHA-PLAS-PVM meeting focused on peripheral arterial disease (PAD) which, many of the foreign and local lecturers agreed, is a highly prevalent, but sadly underrecognized and undertreated cardiovascular problem in the Philippines and worldwide.

When one develops PAD, the extremities—usually the legs—don’t get enough blood supply to keep up with the oxygen demand. The PAD patient may complain of leg pain when walking (intermittent claudication).

The symptoms may include muscle pain or cramping in the legs or arms that’s triggered by activity, such as walking or running, but disappear after a few minutes of rest. This is similar to the chest pains one experiences when one has clogged arteries in the heart.

The location of the leg pain depends on the location of the narrowed artery in the leg. “Calf pain is most common,” said Australia-based vascular specialist Dr. Edward Janus, former APSVD president.

Claudication

The severity of intermittent claudication varies widely. Some only complain of a mild discomfort while others may have debilitating pain which hinders them from doing any activity. They may be basically disabled because of the pain so they’d rather just rest at home and do nothing.

As it gets worse, the claudication gets worse and happens even at rest. The pain may be so intense to disrupt sleep. Some can feel temporary relief by hanging the legs over the edge of the bed or walking around the room. Soon, bluish discoloration and subsequently blackening of the legs appear, and these are likely to become gangrenous already.

If blood supply is not rapidly restored, the leg muscles and tissues die requiring amputation, or else the infection might creep into the bloodstream and put the patient’s life in peril. So many doctors choose to save the life rather than the limb by cutting off the gangrenous leg, explained Dr. Rene Villanueva, vascular surgeon from the Philippine Heart Center.

Many are walking around with PAD, not realizing they have it. Their symptoms such as leg pains and weakness may be attributed to something else other than PAD. More unfortunately, some only know that they have PAD already when they develop leg gangrene which would require amputation. It can literally and figuratively save one’s limb and life finding out early if he or she has PAD.

Aside from claudication, other symptoms of PAD include: leg numbness or weakness; coldness in the leg or foot, especially when compared with the other leg; sores on the toes, feet or legs that won’t heal; a change in the color of the legs; hair loss or slower hair growth on the feet and legs; slower growth of the toenails; shiny skin on the legs; no pulse or a weak pulse in the legs or feet; and erectile or sexual dysfunction in men.

Smoking is the single most important factor which causes it, and there is an estimated 17 million Filipinos who smoke. Other risk factors are diabetes, hypertension, cholesterol problems and genetic predisposition. Essentially, the same risk factors that cause heart attacks and strokes are contributory in causing PAD.

Coronary artery disease (CAD) in the heart and cerebrovascular disease (CVD) in the brain are basically part and parcel of the same problem in the arteries. The common mechanism is a narrowing of the arteries due to the atherosclerotic deposition of fatty materials leading to poor blood circulation in the area, literally starving that part and causing it to die or develop an “infarction.”

Early diagnosis

Dr. Janus and the foreign speakers in the joint PAD meeting were joined by the local experts including Doctors Rody Sy and Tess Abola, who are recognized authorities on PAD, and they all agreed that early diagnosis of these patients is necessary to prevent worsening of the condition.

Usually, PAD is also associated with significant disease in the heart and brain arteries so knowing that someone has PAD can alert the doctor that this patient is likely to have CAD and CVD as well. In fact, PAD patients die more due to heart attacks and strokes rather than to PAD-related causes such as leg gangrene and amputation.

As in the treatment of diseases of the heart and brain arteries, one can successfully prevent and treat PAD by quitting smoking, exercising and eating a healthy diet.

PAD screening

The important thing to remember is that if one experiences leg pain, numbness or other symptoms, one should not take them lightly or dismiss them as just due to arthritis or as a normal part of aging.

Even in the absence of symptoms, one should be screened for PAD if the following is present:

One is 70 years or older.

One is over 50 years old with a history of diabetes or smoking.

Younger than 50 years but with diabetes and other PAD risk factors, such as hypertension, obesity or cholesterol problems.

An early trip to the doctor could save one’s limb, and possibly one’s life.