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Surgeons hope to stop misdiagnosis of obscure disease

Surgeons are urging fellow medical professionals to check for a pulse in the lower limbs of patients before taking drastic measures such as amputating a troubled limb, as they aim to spread information about a rather obscure condition, peripheral arterial disease (PAD).

Wang Shoei-shen (王水深), the president of the Taiwan Society for Vascular Surgery, said that many cases of PAD are missed because of a lack of knowledge about the disease on the part of doctors and patients alike.

"When a person experiences pain and fatigue after walking, they think they're getting old," Wang said. "They don't even consider that it could be Peripheral Arterial Disease."

PAD is a condition in which narrowed or blocked arteries impede blood flow to the extremities. It is often associated with diabetes or other cardiovascular conditions. In serious cases, it can cause extensive tissue necrosis, making amputation of the limb necessary. In other cases, it makes walking for extended distances extremely painful, because the inadequate supply of blood to the limb prevents enough oxygen from reaching leg muscles, a symptom called "claudication."

"I recall a patient who went to an orthopedist because he couldn't walk far without experiencing pain," Wang said. "The orthopedist found bone spurs, removed them and showed the fragments of bone to the patient, who recovered splendidly. Everybody was happy until he started to walk again and was no better."

Wang eventually performed an femoropopliteal bypass on the patient, in which an artificial blood vessel is used to bypass the blocked section of the artery.

"He is now walking around like a man in his salad days," Wang said.

In another case recounted by Wang, a patient with a lesion on his calf that refused to heal underwent a number of skin grafts, all of which refused to take.

"A cosmetic surgeon at National Taiwan University was about to apply yet another when he checked for a pulse in the leg and found none," Wang said.

"We hope that in the future we can encourage more doctors to check for abnormally low blood pressure in the lower limbs before taking more drastic action," Wang said. "Many unnecessary procedures, even amputations, can be avoided."

To Liau Chiau-suong (廖朝崧), chief of integrated diagnostics at the university hospital, misdiagnosis of PAD reflects a wider problem. People experiencing health problems usually go straight to a specialist for diagnosis without being referred there by a family doctor, Liau said.

"General practitioners have an overall view of all fields and can refer the patient to the correct specialist," Liau said. "Unfortunately, it is not a branch of medicine that is taken very seriously in this country."

Liao also said milder cases of PAD can be treated with "blood thinning" medication like aspirin, exercise and by quitting smoking.
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