PERIPHERAL ARTERIAL DISEASE

Peripheral arterial disease (PAD) is a common circulatory condition in which narrowed or blocked arteries reduce blood flow to the limbs — most often the legs. It is caused by a build-up of fatty deposits (atherosclerosis) inside the artery wall, progressively restricting the passage of blood.

PAD affects approximately 20% of people over the age of 60 in the UK and is a marker of cardiovascular risk. People with PAD are at substantially higher risk of heart attack and stroke, making early diagnosis and management particularly important.

Intermittent claudication (mild to moderate PAD)

The most common symptom is intermittent claudication — a cramping pain, tightness, or aching in the calf, thigh, or buttock that comes on during walking and is relieved by rest. The distance a person can walk before pain starts (claudication distance) is a useful indicator of severity.

Critical limb ischaemia (severe PAD)
In more advanced cases, blood flow may be insufficient even at rest. This is known as critical limb ischaemia and requires urgent assessment. Symptoms include:

•    Rest pain in the foot or toes — often worse at night
•    Non-healing wounds or ulcers on the foot or leg
•    Blackening or gangrene of the toes or foot
•    Coldness, pallor, or a blue-grey discolouration of the leg

Critical limb ischaemia is a vascular emergency. If you or someone you know has these symptoms, please seek urgent medical attention.

Professor Zayed uses a combination of clinical examination and non-invasive investigations to assess the severity of PAD and plan treatment. Common tests include:

•    Duplex ultrasound — to visualise the arteries and identify the location and extent of blockages
•    CT angiography or MR angiography — detailed imaging to map the arterial anatomy before any intervention

Lifestyle modification and medical management
For mild to moderate PAD, the most important steps are stopping smoking, life-style modifications and undertaking a supervised exercise programme, and optimising cardiovascular risk factors (blood pressure, cholesterol, and blood glucose). Antiplatelet medication (such as aspirin or clopidogrel) and cholesterol tablets (Statins) are usually prescribed to reduce the risk of heart attack and stroke. 

Endovascular (keyhole) treatment — angioplasty and stenting
Professor Zayed has extensive experience in minimally invasive endovascular techniques. A fine catheter is passed into the artery under X-ray guidance; a small balloon is then inflated to open the narrowed segment (angioplasty), and a metal stent may be inserted to keep the artery open.This approach, commonly performed under local anaesthesia, avoids major surgery and is associated with a short hospital stay and rapid recovery.

Surgical bypass
Where the pattern of arterial disease is not suited to an endovascular approach — or where previous procedures have failed — surgical bypass may be required. Professor Zayed specialises in femoropopliteal and femorodistal bypass, using either a vein graft (taken from the patient's own leg) or a synthetic graft to route blood around the blocked segment.