Dialog Devices - development and commercialisation of non-invasive biomedical health technology

P A D - for Professionals

Diagnosing PAD

After checking patient history the following tests may be performed:

	•	Ankle-Brachial Pressure Index (ABPI), which compares the blood pressure in the arms and legs. - This test takes 20 minutes to perform, can cause some pain and discomfort to the patient, is highly subjective, unreliable on diabetics and difficult to perform in Primary Care.
	•	Blood tests for cholesterol or other markers for artery disease

To better understand the extent and location of the obstruction, advanced hospital tests may be recommended:

	•	Duplex Ultrasound uses high-frequency sound waves to measure real-time blood flow and detect blockages or other abnormalities in the structure of the blood vessels
	•	Pulse volume recording measures the volume of blood at various points in the legs using an arm blood pressure cuff and a Doppler probe
	•	MRI uses magnetic fields and radio waves to show blockages inside the arteries
	•	Angiography produces x ray pictures of the blood vessels in the legs using a contrast dye to highlight the arteries. Physicians usually reserve angiography for people with more severe forms of leg artery disease.

Treating PAD

Medication

Medication include cholesterol- or blood pressure-lowering drugs. Anti-clotting medication to prevent clots blocking narrowed arteries may also be administered. If the patient does not have a disqualifying medical condition, such as heart failure, the physician may also prescribe cilostazol (Pletal), which can improve walking distance without discomfort or pain. Other drugs prescribed include aspirin and clopidogrel (Plavix), either of which can decrease the chances of developing blood clots.

Walking exercise

Exercising and walking regularly, for instance walking at least 30 minutes 3 times each week, may help improve the symptoms. This is done in order to simulate the creation of alternative blood pathways to the lower limbs.

In severe cases of PAD, lifestyle changes and medication may not be enough. Surgery may be the only solution:

Angioplasty and Stenting

This is a minimally invasive procedure. The physician inserts a long, thin, flexible tube called a catheter into a small puncture over an artery in the groin. The catheter is guided through the arteries to the blocked area. Once in place, a special balloon, which is attached to the catheter, is inflated and deflated several times. The balloon pushes the plaque against the artery walls, widening the vessel. In some circumstances, the surgeon may then place a tiny mesh-metal tube, called a stent, into the narrowed area of the artery to keep it open. The stent remains permanently in the artery.

Endarterectomy

An endarterectomy is a way of removing plaque from the artery. To perform an endarterectomy, the surgeon makes an incision in the leg and removes the plaque contained in the inner lining of the diseased artery. This helps to restore blood flow through the artery.

Bypass Surgery (Vascular Grafts)

Bypass surgery creates a detour around a narrowed or blocked, section of a leg artery. To create this bypass, the vascular surgeon uses one of the veins or a synthetic tube. The surgeon attaches the bypass above and below the area that is blocked. This creates a new path for blood to flow to the leg tissues.

Amputation

In extreme cases, especially if the leg has gangrene, the surgeon may recommend amputation of the lower leg or foot. Amputation is a treatment of last resort. It is only performed when circulation in the leg is severely reduced and cannot be restored.