‘There is a recent trend whereby many young patients are coming in with PAOD. Those in their 40s are considered young while those in their 30s are abnormally young to have PAOD,’ says Dr Tan.
A possible sign of artery blockage causing lower blood flow leading to organ or tissue damage
MANY have experienced the pins and needles sensation taking over one or both legs after sitting in a position for too long, while others may have experienced leg pain after completing “leg day” in the gym or even when an old injury creeps up and catches us off guard.
Oftentimes leg pains are seen as fleeting sensations, not a cause for concern since we may have experienced these feelings at some point in our lives.
However, leg pain while walking is not something for us to take lightly.
According to Cardiac Vascular Sentral Kuala Lumpur (CVSKL) consultant vascular and endovascular surgeon Dr Tan Kia Lean, this can be a sign of claudication in the leg and a symptom of peripheral artery occlusive disease (PAOD), also known as peripheral artery disease.
Severe symptoms of PAOD include leg pain when walking short distances, according to Dr Tan.
“The shorter your walking distance, the more serious your disease. Intervention or surgical management is recommended when your walking distance (while experiencing pain) is less than 100m.
“More severe signs include skin discoloration when it turns grey or purplish. Some may experience pain while resting (also known as rest pain).
“When rest pain sets in the medical diagnosis changes. It’s no longer PAOD; instead, it becomes critical limb ischemia (hypoxic injury that causes tissue to die),” he says.
Although symptoms present themselves when the occlusion is severe, he says, early signs can go unnoticed.
“Some patients might not show early signs if the blockage is not total. If there are some forms of cholesterol plaque that cause 50%-70% atherosclerosis – the hardening or narrowing of arteries – you might not show any signs especially if you are not active and lead a sedentary lifestyle.
“When the obstruction becomes more severe some of the (early signs) changes include muscle dystrophy, whereby the muscle on the calf and thighs become smaller and is more obvious if it occurs only on one leg. Some skin changes may happen such as shiny skin and hair loss, too,” he says.
Atherosclerosis is the hardening or narrowing of arteries. You may not see early signs of this affecting your body especially if you lead a sedentary lifestyle.
Younger patients
PAOD is an occlusion in the artery causing diminished or reduced blood flow leading to organ or tissue damage. This typically occurs in the limbs, generally in the lower body – calf, thighs, and even the rear – with more severe occlusion affecting the arms.
Moreover, its risk factors are akin to cardiac cardiovascular diseases (CVDs) including family history of PAOD, heart disease or stroke, high blood pressure, high cholesterol, diabetes, physical inactivity, and obesity.
“People who have CVD will develop PAOD and vice versa. Arterial disease is systemic and, on a spectrum, it boils down to which one will manifest first,” he says.
“There is a recent trend whereby many young patients are coming in with PAOD. Those in their 40s are considered young while those in their 30s are abnormally young to have PAOD.”
Dr. Tan adds that young patients are being treated for PAOD with many of them being diagnosed with diabetes and have shown sensitivity towards cigarette smoking, also known as Buerger’s disease.
“Sensitivity towards cigarettes causes the blood vessels to change whereby their small blood vessels become occluded, manifesting in young patients between 20 and 30 years.
“Normally the outcome is quite poor where you can’t even place in a wire or balloon to open up the occluded artery.
“This leads to creeping amputation whereby we would remove toes or fingers one by one before resorting to major amputation,” he says, adding that the artery disease progresses more aggressively for younger patients.
“With some medication, we can prolong the effects. But usually, patients struggle to control their lifestyle habits.
“I had a patient where we had to amputate their fingers, leave the thumb and pinky but they still choose to continue smoking even with the two fingers,” he says.
Young patients are being treated for PAOD with many being diagnosed with diabetes and have shown sensitivity towards smoking cigarettes also known as Buerger’s disease.
Feel the pulse
Dr Tan says that diagnosing PAOD is very simple. One way to diagnose PAOD is to feel the pulse.
“For the wrist, there are two pulse points to check in the inner and outer parts. If the pulse is present the blood supply should be good.
“Similarly in the foot, there are two pulse points including the heel and dorsum of the foot,” he says, adding that while the pulse is present, he cannot say that PAOD is not present as there might be some narrowing.
However, should there be no pulse, he says, the next course of action is to use the Doppler machine to gain the ankle-brachial index (ABI).
“If the ABI reading is above 0.9 it is considered normal. If the reading is between 0.6-0.9 there is a cause of arterial disease or PAOD while below 0.6 is considered critical.
“Those who do regular health checks might be able to detect how severe their occlusions are even if they are asymptomatic,” he says.
“Those who need to come in for PAOD checks are people above the age of 60, diabetes, and smokers.
“Those who are above 65 and do not have symptoms ought to come in for PAOD screening,” he says.
Once diagnosed with either an ultrasound or an angiogram to find out where the blockages are and how severe they are, Dr Tan says, proposed medication to manage PAOD will be prescribed or even surgery where necessary.
One of the best ways to avoid leg pain due to PAOD is to lead a healthy lifestyle.
The best way to prevent leg pain due to peripheral artery disease is to maintain a healthy lifestyle, which includes not smoking, controlling, being physically active, maintaining a healthy weight, controlling diabetes, and managing blood pressure and cholesterol.
KKLIU No. 1794/2022
Expiry: Dec 31, 2024
