One way to prevent that is by checking their 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:
1. Lifestyle changes
These include quit smoking; eating a balanced diet that is high in fibre and low in cholesterol, fat and sodium; and exercise.
2. Management of other related health problems, such as high blood pressure, diabetes or high cholesterol.
3. Practise good foot and skin care to prevent infection and reduce the risk of complications.
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.
In the US, the determination to increase awareness has recently led to increased training for vascular medicine specialists for routine ankle-brachial check-ups and early detection for treatment.
The goal of therapy is to improve blood supply to their leg muscles so that patients maintain their functional level of activity. Once patients become couch potatoes it’s hard to get them off the couch. They need to be kept active to maintain their health.