Peripheral Vascular Disease and Endovascular Therapy in Singapore

Abstract

Peripheral arterial disease (PAD) is a significant complication of diabetes mellitus and accounts for the majority of amputations among these patients [1]. A major lower limb amputation due to complications from diabetes occurs once every 30 seconds worldwide. In Singapore, it is estimated that about 1500 major lower limb amputations take place a year (approximately four per day). In addition, PAD is a manifestation of systemic atherosclerosis and is associated with increased risk of mortality and ischaemic events [2]. Despite its associations with increased morbidity and mortality, PAD is under-diagnosed and under-treated in the general Singaporean population. Patients with diabetes have unique problems with PAD, as the disease appears to affect predominantly the tibial blood vessels where open bypass surgery is often difficult with generally poor results and angioplasty generally the better option. Furthermore, pain is often not prominent due to superimposed neuropathy, and this puts them at risk of seeking medical attention only in advanced stages when there is a significant wound to heal [3]. This in turn leads to increased costly consequences such as hospitalisation for ulcers, revascularisation, amputation, need for rehabilitation and loss of employability and income.