Peripheral artery disease: A very common cause for leg amputation

Peripheral artery disease is a condition in which there is narrowing of the lumen of blood vessels that supply blood to the extremities (arteries), usually to the legs. For every body part to function well, it must have constant adequate blood supply all the time and the blood supply should be able to increase accordingly when a body part is in use than at rest. People with peripheral artery disease are unable to increase blood supply to the affected structures (usually the legs) due to the narrowed blood vessels. This commonly causes leg pain that is worse with activity. Muscle pain that is worse with activity and gets better with rest is usually the first symptom. The global prevalence of peripheral disease increased by 24% from 2000 to 2010, from 164 million to 202 million and nearly 70% of the affected individuals living in low to middle income regions. Being a disease common in the elderly lies, the increase in life expectancy could be responsible for the increase in the peripheral artery diseases cases. Worldwide, peripheral artery disease affects approximately one in 10 people at the age of 70 years or more and one in 6 people after the age of 80. Peripheral artery disease is commonly caused by deposition of fatty plaques inside the walls of arteries, narrowing their lumens, hence presence of peripheral artery disease can mean that there is fat deposition in other arteries of the body, including but not limited to the heart and the brain which can eventually develop into a heart attack and a stroke respectively! Symptoms of peripheral artery disease can be mild or severe, depending on; which arteries are affected, how narrow the arteries are, and how much activity a person does. Peripheral artery disease often causes pain in the back of the lower leg. The pain is usually worse with walking and exercise, and gets better with rest. Peripheral artery disease can also cause pain in the feet, thighs, or buttocks. The person might also notice trouble walking up stairs, leg numbness or weakness, coldness in one leg compared to the other, change in color of the leg or foot (usually becomes darker in advanced condition), trouble getting an erection (in men) or trouble with sexual arousal (in women). Some people might actually not experience any initial symptoms, and only present with late complications of long standing disease. Some people are at more risk of getting peripheral artery disease than others, and these include; cigarette smokers, poorly controlled diabetes, people with high blood cholesterol and those with poorly controlled high blood pressure, obesity, history of a family member who suffered from the disease and elderly age (common after the age of 50 years). Your doctor will usually diagnose the condition through listening to the history of your symptoms, physical body examination and do some investigations to confirm the condition. These examinations might involve taking the blood pressure flow in the legs compared to the arms. Investigations such as ultrasound scan, CT scan of the leg to look at the blood flow in the arteries of the leg and look out for any narrowing in the vessels can be done. Blood tests to test for the possible risk factors such as sugar levels, cholesterol levels can be done too. Once diagnosed with peripheral artery disease, measures should be taken to prevent it from worsening. In its worse stages when there is significant blood occlusion to the affected part of leg, the leg/ foot begins to ‘die’ off and once major arteries to the affected part are damaged, the ‘dead’ part of the limb will need to be amputated. Life style modifications can reduce ones risk of suffering from peripheral artery disease and help in preventing the progression of the disease for those already with the disease. These include; cessation of cigarette smoking, controlling diabetes or cholesterol and high blood pressure well with medicines as prescribed, regular exercises, cutting weight if obese. In addition to the medicines to keep the risk factors for the peripheral artery disease in check, lifestyle modification, and pain killers to overcome the pain during exercises, there are surgical procedures that can be done to help restore normal blood circulation to the affected leg part depending on the stage at which the condition is detected and other patient factors including age. Surgery can be done to re-open or bypass the narrowed artery to restore blood supply to the affected part. Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital E-mail: iangashugi@gmail.com

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Peripheral artery disease: A very common cause for leg amputation