Chronic arterial occlusive disease

This is also called smokers disease and involves all the arteries of the body except the heart. It is more common in the legs and is due to narrowing of the arteries causing a reduction of the blood supply to the part it supplies. Over time if the patient continues to smoke the narrowing progressively increases till the artery is totally blocked. The narrowing is due to atherosclerosis, which is the deposition of fat within the walls of the artery called plaque. It is the hardening of the arteries. It is an ageing disease.

Arteries Of A Leg
Picture 1- Showing the narrowing the artery due to plaque

Picture 2 – Blood flow through the narrow artery

How do I know I have a narrowed or a blocked artery?

The patient experiences pain on walking – first on climbing up the stairs or walking uphill. He has to stop and rest for about a minute before the pain disappears and allows him to walk an identical distance before stopping again due to similar pain. This is called ‘claudication’ in technical terms.

High Pain In Vien
Picture 3 – Common site of pain

Over time if the patient continues to smoke the narrowing worsens leading to total blockage. The pain also progressively worsens until he gets pain all the time – day and night. This is called rest pain.

 Patient Taking Rest
Picture 5 – Rest pain patient sleeping with legs dangling

This rest pain is a warning sign that your leg is now in danger if you continue to smoke or do not seek medical help.

As the blood supply continues to reduce to the leg the patient may have ulcers that do not heal or blue toes. This is the progression of the disease to Gangrene. You are in danger of getting your leg amputated should you not seek medical help from a specialist Vascular Surgeon.

Healing In Toes
Picture 6 – Ulcers on toes that do not heal

Blue Toes
Picture 7 – blue toes – pre-gangrenous state


What happens when we come to the vascular surgeon?

  • The specialist vascular surgeon will note the history of ‘caludication’, ‘rest pain’, non-healing ulcers and blue toes with their duration.
  • Then he will examine you from head to toe because atherosclerosis involves the arteries throughout your body – brain, neck, heart, abdomen and limbs.
  • He would examine all your pulses and record the pressures in your limbs using a small handheld Doppler.
Checking Pressure In Human Body
Picture 8 – recording the ankle-brachial index (ABI) using a bedside hand-held Doppler

Having reached a provisional diagnosis your doctor would confirm his diagnosis by ordering a few tests.

What tests would be needed?

  • Blood tests
  • ECG
  • Echocardiogram to evaluate the condition of your heart
  • Colour Doppler study of the carotids to see narrowing in the neck
  • CT Angiogram to know the site and the extent of blocked artery

Would I need surgery?

Surgery is not mandatory. A minority of patients go under the knife. Most are treated without surgery. You may be advised to:
Stop Smoking. This is a must and there is no compromise. It is no good to reduce smoking but it is important to totally stop smoking.
Walking program. You may be asked to walk daily for up to 30 minutes including stoppages for pain.
Dietary restrictions – You will be asked to have a healthy diet of fruits and fresh vegetables and avoid fatty greasy fried foods and junk food.
Medication – You may be prescribed blood thinning drugs like Aspirin and clopidogrel along with pain killers if needed.

When is surgical intervention advised?

This could be:

  • Minimally invasive – Peripheral Angioplasty
  • Bypass surgery

What is peripheral Angioplasty?

This is a minimally invasive puncture hole technique performed from the groin or the arm. It is performed under local anaesthesia. It is done mostly when there are narrowing of the arteries preferably involving short distances.

When is surgery needed?

It is mostly indicated when the artery is totally blocked and calcified (more common in diabetics) preventing the guide wire from entering the blocked artery.

How is peripheral bypass surgery performed?

    • It is performed under anaesthesia – spinal or general
    • It needs hospital admission
    • There are incisions on the body which would need time to heal
Human Artery
Picture 9 – the bypass grafting of a blocked artery

Who is more prone to arterial disease?

It is commoner in Smokers, diabetics, hypertensive, people with increased cholesterol levels and those with renal disease.

Can lifestyle changes increase the risk?

It is commoner in obese people who lead a sedentary life continue to smoke and eat unhealthy foods.

Can the arterial disease be prevented?

This is possible by having a healthy lifestyle that includes:

  • Stop Smoking
  • Control of diabetes
  • Exercise 30 minutes a day thrice a week
  • Keep blood pressure and cholesterol under check
  • Eating a healthy diet lower in saturated fats
  • Keeping weight at a healthy level.