Tom, 51, suffered from pain in his left leg one year ago. Attributing it to musculoskeletal issues, he took calcium and glucosamine supplements. A few months later, the pain worsened, prompting him to seek medical attention at a hospital. There, he was diagnosed with peripheral artery disease and underwent stent placement to widen the blood vessel in his left leg, combined with prescribed medication. Six months later, the ulcer on his left foot failed to heal, and his right leg began exhibiting similar symptoms. He then sought treatment at Tam Anh General Hospital in TP HCM.

According to Doctor Nguyen Anh Dung, Head of Thoracic and Vascular Surgery at Tam Anh General Hospital, TP HCM, many patients with peripheral vascular obstruction have a history of smoking, similar to Tom. Some cases, detected late, require amputations of toes or limbs, leading to loss of working ability. Doctor Pham Hung, from the Center for Thoracic and Vascular Surgery, explained that peripheral artery disease (PAD) is a vascular condition where arteries in the legs and feet become narrowed or blocked. This is primarily caused by plaque buildup on arterial walls, reducing blood flow to leg muscles and tissues. This reduction in blood flow causes pain and slows wound healing, which contributed to Tom's slow-healing toe ulcer, infection, and signs of necrosis.

Doctor Dung further explained that nicotine in tobacco causes an inflammatory response in the arterial lining. This inflammation thickens the arterial walls, particularly in small, distal arteries such as those in the feet, calves, fingers, and toes. Consequently, the vessel lumen narrows, impeding blood circulation to the areas requiring nourishment and leading to localized ischemia.

Doctors surgically removed the infected toe. Concurrently, a CT angiography was performed to examine his right leg. The results confirmed severe narrowing (over 90%) in the right external iliac artery, moderate narrowing (over 70%) in the right femoral artery, and moderate narrowing (60-70%) in the tibiofibular trunk artery, fibular artery, and posterior tibial artery.

Doctor Dung assessed the patient's entire lower limb arterial system as having moderate to severe narrowing. Fortunately, a collateral blood vessel branch was supplying blood to his foot, preventing complications like toe ulcers or necrosis. However, without intervention to increase blood supply to the lower limbs, there would be a risk of necrosis.

Doctors performing stent graft intervention for the patient. Photo: Ha Vu

The medical team placed a stent graft (covered stent) for Tom. Utilizing an intravascular ultrasound (IVUS) system, doctors could observe the blood vessel structure more clearly, ensuring precise manipulation. Tom's leg pain symptoms reduced, and he was discharged after three days. Doctors advised the patient to quit smoking to prevent the disease from recurring.

PAD often affects individuals with diabetes, hypertension, high cholesterol, or a family history of peripheral artery disease, heart disease, or stroke. According to Doctor Hung, the risk of developing PAD is 2-6 times higher in smokers compared to non-smokers. In its mild stage, the disease often presents no symptoms or only mild fatigue after prolonged walking. As the disease progresses, it causes intermittent claudication (pain and discomfort in the legs during walking that resolves with rest), acute lower limb ischemia, numbness or weakness in the legs, cramping pain, and pain after walking. Besides limb necrosis, untreated PAD can lead to dangerous complications such as popliteal artery aneurysm, thrombosis, myocardial infarction, and cerebral stroke.

Doctor Dung recommends early screening for individuals with risk factors for peripheral vascular disease, including: being overweight or obese, hypertension, diabetes, smoking, and a family history of peripheral artery disease.

Thu Ha

* Patient's name has been changed