The prevalence of diabetes is rising globally and is projected to increase by 69% by 2030 in developing countries. As PAD is often associated with Diabetes, Diabetic patients are at an increased risk of limb amputations.
Incidence of Peripheral Vascular Disease (Diabetic Foot)
With the dubious distinction as the “Diabetic capital of the world”, more than 35 million Indians were affected with Diabetes in 2011, which is expected to rise to about 80 million by 2030. Limb amputations are also very common in India with almost 3 million people suffering from CLI caused by PAD. Lower limb amputations have been roughly estimated to be 45000 every year.
Peripheral Vascular Disease (PVD)
Blood flows from our heart to various parts of our body via blood vessels called arteries. Similarly, the vessels which transport blood back to heart are called veins. Peripheral Vascular Disease is a blood circulation disorder in which blood flow outside of heart via blood vessels is reduced or blocked. Such blockage can happen both with arteries or veins however since mostly the same is observed in arteries, PVD is also referred to as Peripheral Arterial Disease (PAD).
The blockage of arteries happens due to Arteriosclerosis i.e. hardening of arteries due to plaque formation in the arteries or blockage can also happen due to blood vessel spasms. In Arteriosclerosis, the plaque growth slowly inside the arteries increases and may ultimately completely block the artery resulting in organ damage, if left untreated.
While PVD is mostly observed in legs, it may also develop in blood vessels supplying blood to your other body parts like arms, kidneys etc.
Symptoms and causes of PVD
It should be noted that approximate 50% of people suffering from PVD do not show any symptoms till the point of the condition reaches at life threatening levels.
PVD begin slowly and irregularly. You may feel discomfort like fatigue and cramping in your legs and feet that gets worse with physical activity due to the lack of blood flow. If you feel pain, numbness, heaviness, cramps in your legs, ankles, calf muscles especially after some physical activity like walking on stairs, slope or if any soars on your feet are very slow to heal, you should immediately get yourself checked for PVD.
People having any coronary heart problem, diabetes are also susceptible to PVD and hence should get regular check-ups done for PVD.
PVD is characterised by narrowing of blood vessels thus obstructing free flow of blood in the body. This mainly happens due to Atherosclerosis i.e. build-up of plaque in the blood vessels. Plaque builds up on artery walls reducing the space for blood to flow effectively. It is the most common cause of PVD. Development of plaque in human body happens due to various factors.
Risk factors include any accidental injury or irregular muscle anatomy, any infection. Risk factors of PVD include items that can be changed and factors that cannot be controlled by the patient.
Following people are at high risk of developing PVD and should get themselves evaluated by expert doctors like –
- Heart patients
- Diabetic patients
- High blood pressure
- High cholesterol
- Family history of heart diseases
- Kidney patients
- Obese/ overweight individuals
Smoking and physical inactivity also increases risk of getting Peripheral Artery Disease.
Peripheral Vascular Disease (PVD/PAD) a serious health problem
Peripheral Vascular Disease or Peripheral Arterial Disease is a serious health condition which should not be left unattended. PVD is a leading cause of disability among people over age 60, as well as those with diabetes. However it should not be assumed that it is only age related problem as PVD develops and grows slowly in the body and hence an early treatment will avoid any complication in old age.
If PVD is not treated in time it may lead to following:
Amputation of Limb: As PVD advances, there comes a stage where blood flow to the limbs is fully blocked thus supply of fresh blood and tissue is stopped. The tissues start decaying due to lack of oxygen and results into development of Gangrene leading to amputation of limb.
Extremely Painful and Non Healing Ulcers: Fresh blood flow is required by body to heal any injury and maintaining health. Once blood flow is blocked, any injury in that part of the body is difficult to heal. Also due to non supply of blood, chances of development of infection is high. In advance cases such ulcers and injuries may lead to amputation or death.
Diabetic Foot Ulcers are commonly seen developed due to PVD and if untreated the same definitely leads to amputation of limb. Extreme Pain in the effected body part, restricted mobility due to loss of muscle strength in the effected body part, stroke: people suffering PVDs are three times more likely to get Stroke. While PVD is an extremely dangerous health condition, with aggressive treatment under expert doctor it may be treated and above complications be avoided.
A major problem with PVD/PAD is that almost 50% of patient do not show symptoms. In cases where the patients do show symptoms, many a times it is brushed aside as the symptoms appear generic and an expert doctor is not consulted in time.
A delayed diagnosis and delay in treatment can result into extreme complications. If you are experiencing any problem as mentioned in symptoms section above immediately consult an interventional radiologist as they are best trained to treat PVDs.
If you do not have any symptoms as but have any heart disease, cholesterol, blood pressure, diabetes, or any kidney disease you should regularly get yourself checked for PVD. All people above age 50 years are also highly recommended for evaluation on regular basis
Diagnosis of PVD
Early Diagnosis is key to treatment. While the early symptoms of PVD are generic, the good part is that there are various tests which can be performed to identify the complication.
Ankle-brachial index (ABI): An inexpensive test which can be a very good indicator of existence of PVD. It is highly recommended that you get this very inexpensive test included in your annual health check. If you do face any symptoms it is recommended that you consult your doctor or visit an Interventional Radiologist for this test. An ABI is a comparison of the blood pressure in the ankle with pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device.
Doppler Ultrasound: High-frequency sound waves and a computer is used to create images of blood vessels, organs & tissues. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.
Magnetic resonance angiography (MRA): This non-invasive diagnostic procedure uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. An MRA is often used to examine the brain and other soft tissues and to assess blood flow.
Angiogram: This is an X-ray of the arteries and veins to detect blockage or narrowing of the vessels. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.
The above are primarily used to diagnose PVDs. Ankle-Brachial Index is very inexpensive test and should be adopted earlier before getting other tests done.
It is often believed that PVD is normal with ageing. It is also believed that surgery is the only treatment option for PVD which is not true. With the advancement in technology there are options other than surgery available for treatment of PVDs.
The main objective of treatment of PVD is to control the symptoms and to halt the progression of disease to lower risk of stroke, heart attack, etc.
Medical Management: An expert like Interventional Radiologist may not suggest any procedure but plain medical management along with lifestyle changes to control the progression of PVDs.
Angioplasty: Angioplasty may be done with many arteries of the body and is frequently adopted for treatment of PVDs in limbs. It is preferred over surgery as it is less invasive and gives patient faster recovery. There are various kinds of Angioplasty performed depending on the condition of the patient like Balloon Angioplasty, Atherectomy oLaser Angioplasty and Stenting.
Vascular Surgery: A complex treatment line only adopted when patient condition does not allow other treatment options. It is traditional way of treatment and leads to long recovery time for the patient. Consultation with Doctor and evaluation to do angioplasty by interventional radiologist should be considered before opting for surgery.
Dr. Bhavesh Arun Popat is an Endovascular Specialist practicing in the city of Mumbai since last 10 years. After completing his fellowship in Vascular and Interventional Radiology from Seth G. S. Medical College, he continued to work as faculty at KEM Hospital. During his tenure at KEM Hospital he has been actively involved in treating complex endovascular cases along with training budding Interventional Radiologists.