A middle-aged man who smokes daily noted leg pain on walking half-mile during vacation that progressed over time to a point limiting his routine activities. Further investigation revealed a severe blockage in the arteries of the leg. Another diabetic patient who had ulcerated wound on the foot which was not healing despite aggressive medical therapy. After evaluation found to have severe blockage in the arteries of the leg so Balloon Angioplasty (a procedure to open the blockages by dilating the vessel) was performed to treat the limb.
Then, this patient came with cold limb and impending gangrenous changes. CT angiography revealed a completely occluded vessel with clot. Immediate clot removal and instillation of clot-dissolving drugs help the limb to recover fast and saved.
All these patients are suffering from “Peripheral Artery Disease” that affects the vascular channels which are outside the heart and the brain by a process called Atherosclerosis. Atherosclerosis is a slow progressive disease of the human vasculature in which fatty material is deposited in the vessel wall causing a narrowing and eventual impairment of blood flow. Another unfortunate problem with PAD is that it can affect any part of the vasculature and remember, there are 50 thousand miles of blood vessels throughout the body.
Risk factors that can increase the chance of having this disease are diabetes, high blood pressure, high cholesterol levels, smoking, obesity, advanced age, family history, etc. Smoking – tobacco use in any form is the single greatest risk factor of Peripheral Artery Disease. The risk of PAD increases with the number of cigarettes smoked per day and the number of years smoked. Uncontrolled high blood pressure can lead to crack in the arterial wall which is catastrophic if not treated timely. Similarly, diabetes is one of the important risk factors which can affect various arterial beds.
Diagnosis is made based on clinical history and examination assisted by ultrasound, CT angiography, MRI, and Conventional angiography.
Symptoms depend upon the part of the body that is affected. Mostly, this subset of the disease involves lower limb vascular channels leading to clusters of symptoms. Among them, Claudication is the most common which simply means pain or cramps on exercise and relieved by rest. Claudication can occur in buttocks, thighs, calves, and feet. The more severe form of the disease can present as rest pain, skin discoloration, feeling of cold, and numbness in affected foot termed as Critical Limb Ischemia which is a medical emergency that requires immediate treatment to save the limbs. Sores or ulcers on your toes, feet, or legs that won’t heal is a possible sign of arterial blockage that requires medical attention.
Treatment includes medical management as well as non-surgical or surgical intervention. Aggressive lifestyle modification includes controlling high blood pressure and diabetes, smoking cessation, regular exercise, and a healthy diet. Finally, when the symptoms are intolerable or medical management fails, then the surgical or non-surgical interventions are needed.
Approximately 6 million Indians suffer from the most severe form of PAD (2018 report) but this might be the tip of the iceberg as only less than 25% general population are aware of this disease and 40% are still asymptomatic. PAD is associated with decreased functional status, diminished quality of life, amputation, heart attack, stroke, and death. Persons especially those who are at high risk should be aware of the symptoms and should make aggressive lifestyle changes and see a doctor without delay.
Common symptoms of PAD:
- Leg pain on exertion
- Poor wound healing
- Blue or black discolouration of toes
- Cold limbs
- Severe abdominal pain after meals
- Uncontrolled high blood pressure