Peripheral arterial disease (PAD) in the legs or lower extremities: What is the definition and causes of the disease? What are the guidelines of diagnosis and treatment of the Ministry of Health of Vietnam?
- The Ministry of Health of Vietnam: What is PAD in the legs or lower extremities?
- The Ministry of Health of Vietnam: What are the causes of PAD in the legs or lower extremities?
- The Ministry of Health of Vietnam: What are the symptoms of PAD in the legs or lower extremities?
- The Ministry of Health of Vietnam: How to treat PAD in the legs or lower extremities?
On September 9, 2022, the Ministry of Health issued Decision 2475/QD-BYT in 2022 guiding the diagnosis and treatment of Peripheral arterial disease (PAD).
The Ministry of Health of Vietnam: What is PAD in the legs or lower extremities?
Pursuant to the provisions of Section 1 of the Guidelines promulgated together with Decision 2475/QD-BYT in 2022 of the Ministry of Health guiding the diagnosis and treatment of Peripheral arterial disease, the explanation is as follows:
- Peripheral arterial disease (PAD) in the legs or lower extremities is a pathological condition of the arteries of the lower extremities in which the lumen of the artery is narrowed and blocked, causing reduced blood flow to organs and related organs (skin, nerves) downstream.
Peripheral arterial disease (PAD) in the legs or lower extremities: what is the definition and causes of the disease? What are the guidelines of diagnosis and treatment of the Ministry of Health of Vietnam? (Image from the Internet)
The Ministry of Health of Vietnam: What are the causes of PAD in the legs or lower extremities?
Section 1 of the Guidelines issued together with Decision 2475/QD-BYT in 2022 outlines the main causes of PAD in the legs or lower extremities as follows:
The cause of PAD in the legs or lower extremities is atherosclerosis. The main risk factors are cigarette smoking, pipe tobacco, diabetes, dyslipidemia, hypertension and hyperhomocysteinemia, which increase the risk of developing lower extremity artery disease and other atherogenesis.
In addition, the causes of PAD in the legs or lower extremities are also the causes of PAD in the upper extremities. Symptoms in PAD in the upper extremities are similar to those in PAD in the legs or lower extremities but in other locations, such as hand fatigue, brachial claudication, pain at rest, or extremity necrosis when the disease is advanced, and some other symptoms such as balance disorder, dizziness, syncope, ataxia, loss of facial sensation when the patient performs strenuous movements. An occlusion of the brachial artery can cause a stroke or transient ischemic attack.
The Ministry of Health of Vietnam: What are the symptoms of PAD in the legs or lower extremities?
According to the instructions in subsection 2.1, Section 2 of the Guidelines issued together with Decision 2475/QD-BYT in 2022 of the Ministry of Health, the symptoms of PAD in the legs or lower extremities are intermittent lower extremity pain when moving or walking and will relieve pain when resting. However, it will become a constant pain when it reaches the severe stage. As follows:
Physical symptoms:
Intermittent claudication (pain during movement, walking, relief when resting) lower extremities, in severe stages, patients have symptoms of continuous pain, pain at rest.
- Other symptoms: difficult-to-heal extremity ulcers, toe necrosis, etc.
Patients with a history of atherosclerotic artery disease such as coronary artery disease, carotid artery disease, renal artery disease, aortic aneurysm, etc.
Physical symptoms
Lower extremity claudication may be in one or both legs, in one or more locations. Examination of the pulse (pulse) and based on the location of pain can help detect and localize arterial damage:
- Hip and buttock claudication: Injury to the iliac aorta. Bilateral inguinal pulses are difficult or impossible to capture.
- Femoral claudication: Injury to the common iliac and/or femoral aorta. Inguinal pulse is not captured or weak, popliteal pulse is not captured.
- Calf claudication: This is the most common and recognizable pain site. Upper 2/3 calf pain is usually due to superficial femoral artery injury, lower third calf pain is usually due to popliteal artery injury.
- Palate claudication: Injury to the lower leg artery.
Symptoms associated with claudication:
- Weak pulse or not able to catch the pulse.
- Ulcers are difficult to heal.
- Change skin color.
- Head necrosis.
The Ministry of Health of Vietnam: How to treat PAD in the legs or lower extremities?
According to Section 3 of the Guidelines issued together with Decision 2475/QD-BYT in 2022, the treatment goals of lower extremity artery disease are as follows:
Treatment of PAD in the legs or lower extremities consists of 3 main goals:
- Reduce major cardiovascular events (MACE): reduction of death, myocardial infarction (MI), stroke and cerebral infarction (MI). Proven effective treatments include: antithrombotic agents (antiplatelets and anticoagulants), statins, ACE inhibitors, and blood sugar and blood pressure control.
- Reduce the rate of amputation and major limb events (MALE). Treatment measures include: Optimal revascularization, foot care, antithrombotic therapy.
- Improve quality of life for patients: walking, rehabilitation, lifestyle changes, quitting smoking, taking care of foot ulcers.
This decision also provides guidance on several measures to regulate cardiovascular risk due to atherosclerosis such as regular physical activity, weight loss in overweight patients, especially smoking cessation (and similar patterns) problems that are recommended by clinical experts as well as cardiovascular scientists in Vietnam.
Peripheral artery disease in general and lower extremity artery disease in particular is a fairly common disease and also very dangerous, so when symptoms appear on the patient, it is necessary to go to a medical facility for a doctor to determine the most appropriate treatment.
Look up Decision 2475/QD-BYT in 2022 for detailed instructions.
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