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Imagine starting your day and noticing your big toe turning black after weeks of pain. A visit to your doctor leads to an urgent referral to a specialist, who informs you that bypass surgery on a blocked artery in your thigh is necessary to save your foot. This alarming scenario is a reality for thousands of people suffering from peripheral artery disease (PAD)—a condition many have never heard of, yet one responsible for over 3,500 amputations in the UK alone in 2023.
Efforts are underway across the NHS to reduce these numbers. At Glenfield Hospital in Leicester, a streamlined referral-to-treatment process has shown promising results. A recent study co-authored by researchers there suggests that focusing on speed of care may cut the risk of amputation in half.
What Is Peripheral Artery Disease?
PAD is caused by the narrowing or blocking of arteries in the legs, a process similar to that behind heart attacks and strokes. Yet while the symptoms of these cardiovascular events are widely recognized, PAD remains largely unknown.
More than one in ten people over 65 in the UK have PAD, with its prevalence rising due to aging populations and increasing rates of diabetes. Early stages often go unnoticed, but the first sign is usually intermittent claudication, or pain in the calf during walking.
Treatment at this stage typically involves blood thinners, cholesterol-lowering drugs, and lifestyle changes like quitting smoking, exercising, and managing conditions such as diabetes or high blood pressure.
The Devastating Progression of PAD
If untreated, PAD can progress to chronic limb-threatening ischemia (CLTI), characterized by pain at rest, non-healing ulcers, or gangrene. CLTI survival rates are grim, with fewer than 50% of patients living five years post-diagnosis—worse than many cancers.
For individuals with diabetes, the situation is even more dire. Nerve damage often masks early PAD symptoms, leading to unnoticed foot ulcers that may require surgery and intensive wound care. The financial burden of treating advanced PAD in the NHS is staggering—estimated at nearly £1 billion annually a decade ago and likely higher now.
Addressing the Challenges
Public and professional awareness of PAD remains low, leading to delays in symptom recognition, specialist referral, and treatment. These delays often result in unnecessary amputations. To combat this, the NHS has introduced rapid-access clinics and adopted advanced surgical technologies, including minimally invasive procedures to restore blood flow.
UK guidelines now recommend that surgeries to restore blood supply should occur within two weeks of referral. A study comparing patients treated under older versus newer protocols found that amputation rates dropped from 25% to 11% after the introduction of rapid-access clinics and advanced surgical techniques—representing a 57% reduction in amputation risk.
The Way Forward
Despite progress, more work is needed to prevent PAD from reaching its advanced stages. Raising public awareness about PAD and its warning signs—such as constant pain in the toes, non-healing foot wounds, or darkened toes—is critical. Timely intervention can save not just feet but lives.
By fostering healthier lifestyles and ensuring swift, effective treatment for early-stage PAD, we can significantly reduce the devastating impact of this silent killer. For those already at risk, rapid diagnosis and cutting-edge care are their best hope.
This article is adapted from research and insights originally provided by The Conversation.
