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Saturday , 18 August 2018
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Peripheral Arterial Disease – The next big killer

Dr. K.R.Suresh, JIVAS Hospital, BangaloreWhile most understand the severity of heart attacks, few are aware of the condition of Leg Attacks.Similar to heart attacks, leg attacks occur when there are blockages in the vessels of the leg. Arteries carry purified blood to all parts of the body. Any disease – mostly blockage and sometimes “blowing up” or “dilatation” of any artery in the body, except in the heart and in the brain, is called Peripheral Arterial Disease (PAD).

Dr. K.R. Suresh, Vascular Surgeon, JivasHospital, Bengaluru says, “Smoking and Diabetes are the major causes of PAD. Abnormal lipids (high cholesterol), high blood pressure, obesity and certain other factors are also risk factors for Peripheral Arterial Disease. ”

“Peripheral Arterial Disease in diabetics in India is about 15%. Since we have more than 60 million (6 crore) diabetics, the numbers can be huge – estimated numbers of “critical limb ischemia” is about 60,000 in this population and another 500,000 in rest of the population. In critical limb ischemia – these patients invariably lose the legs and sometimes life. PAD in our population can be projected at about 4 million (4 crores) which makes the total suffering from these diseases huge.” adds Dr. Suresh.

Patients with PAD do not have symptoms, and can be diagnosed by clinical exam. The most common symptom is “claudication” meaning leg pain, mostly in the calf muscles on walking and relieved by short rest and can walk the same distance again. The walking distance can gradually decrease over time and progress to pain in the foot even while resting.In India most of these occur from bare foot walking. This can progress to Gangrene which means the toe or the foot can turn black and cannot be saved. If not corrected, patients may need amputation of a leg, which can also be life threatening. Hence these patients need early diagnosis and aggressive medical treatment to prevent complications.Similar symptoms can occur in other parts of the body though to a lesser extent: e.g. “Mini strokes” from blocked artery in the neck, arm pain, abdominal pain etc. Dilatation of arteries, especially in the abdomen called Aortic Aneurysm usually has no symptoms and is diagnosed by examination or ultrasound. These diseases have to be corrected before they cause symptoms, since they can be life threatening

Like all diseases, whether heart, brain or legs, the most important is “lifestyle” modification. The best way to prevent PAD is to control diabetes, stop smoking, healthy diet, regular exercise, correct medications for high cholesterol and control blood pressure.One should avoid high fat foods; if diabetic follow the dietary advice of your doctor, control salt in your diet. The diet has to be tailored to individual needs. There are also specific drugs to improve walking distance in patient which has very good response. They need drugs to prevent future complications (like aspirin, anti-cholesterol drugs etc.).  But once the diseases are advance with non-healing sore, the patients need vascular bypass and nowadays minimally invasive endovascular procedures like angioplasty and stenting similar to the heart. But the blocks in PAD are longer and no more difficult to treat with excellent results if performed by trained vascular surgeons.

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