Peripheral Vascular Disease Is Commonly Seen In Diabetics: Get To Know More

Do not ignore severe leg pain! Patients with severe peripheral vascular disease are at high risk of gangrene and leg amputation.

Peripheral Vascular Disease (PVD) is a blood circulation disorder commonly seen in people with diabetes and renal insufficiency. This condition results in narrowing of any blood vessels outside of the heart, like those supplying blood to legs, arms, brain, and kidneys. As a result, the organ may not get sufficient blood to function adequately. Most commonly PVD affects legs and feet.

In patients with leg PVD, early symptoms include pain in legs, cramping on walking, and numbness. When it progresses, they may feel pain even on resting, are at risk of developing wounds in the foot that may not heal, and eventually gangrene which may need an amputation of the toes, foot, or even the leg depending on the extent of involvement.

A 66-year-old patient with severe peripheral vascular disease, who was at high risk of gangrene and leg amputation, was successfully treated at Wockhardt Hospital, Mumbai. Thanks to a team headed by Dr. Amit Sahu, Senior Consultant, Neuro & Peripheral Interventional Radiologist, the patient can now walk pain-free and has resumed his daily routine with ease.

"Not treating him promptly could have led to gangrene, and leg amputation," the hospital said in a statement.

Do not ignore severe leg pain!

The patient, Mr. Hari (name changed), encountered severe leg pain, and he couldn't walk properly for the last one year. His health deteriorated further, and he became nearly bedridden, dependent on his family members and unable his daily chores without assistance. His underlying renal failure and poor cardiac function further complicated the condition.

According to doctors at Wockhardt Hospital, there were blockages in the blood vessels supplying blood to his left feet that caused him to feel severe pain after walking a few steps (vascular claudication). One year back, an open surgical by-pass (femoro-popliteal) was performed which improved his condition transiently but again worsened significantly after few months. The patient was brought to the Wockhardt Hospital where the team headed by Dr. Sahu successfully performed a complex minimally invasive procedure on the patient.

"This patient had a failed previous vascular surgical bypass and progression of PVD changes causing clinical worsening. No other surgical options were feasible for him. A complex peripheral angioplasty procedure was performed on several blocked vessels to open these and improve blood flow to the foot," said Dr. Sahu.

How peripheral angioplasty is performed?

According to Dr Sahu, a specialized angiographic assessment was performed on the patient to prevent further renal injury using carbon dioxide gas for angiography. This showed complete blockage of the previous by-pass graft and no major blood flow into the leg below his knee joint.

He explained, "Subsequently, successful plain balloon angioplasty was performed of the occluded arteries from the level of his knee up to his foot - the popliteal artery, tibio-peroneal trunk, common peroneal artery, and posterior tibial artery. Additionally, drug-coated balloon angioplasty was also performed which delivers drug at the local site to prevent late restenosis (which occurs when the treated vessel becomes blocked again) and achieves good long-term results. Good blood perfusion to the foot was successfully restored by this procedure."

Being minimally invasive (done from a small pin-hole injection), the entire procedure could be performed under local anesthesia with the patient being awake and comfortable throughout the procedure, Dr Sahu asserted.

"The procedure lasted around two hours, he recovered fully and was discharged. The patient could walk pain-free after the procedure and had complete relief of rest pain. He resumed his routine work and is now able to take walks as long as he wants (often lasting over 40 minutes of pain-free walks)," he added.

The procedure is very safe even in patients with as high a risk as Mr. Hari and have no complications or side effects. Peripheral angioplasty can even be performed in patients where surgical by-pass is not possible. It is now being performed as a first option worldwide due to its lower risk and similar long-term results, noted Dr Sahu.

Risk factors of peripheral vascular disease

Age, obesity, having co-morbidities like diabetes, cholesterol, heart disease, kidney disease, high blood pressure, smoking, lack of physical activity and illicit drug use, are all identified as risk factors of peripheral vascular disease.

A timely intervention can free patients from pain or any other complications arising from the severe blockages due to peripheral vascular disease (PVD). Interventional treatments, like angioplasty and stenting, play an important role in avoiding and treating any complications by opening these blockages and restoring blood flow. In patients where amputation is unavoidable because of advanced changes of gangrene, it is equally important to improve blood circulation by peripheral angioplasty so that the amputated stump healing is promoted, else it may develop gangrene too.

Therefore, it is vital to have an Interventional Radiology consultation in all patients with PVD, diabetic foot, and gangrenous changes during treatment planning, underscored Dr Sahu.

Tips to keep PVD at bay

• Keep risk factors under control.
• Avoid wearing poorly fitted shoes, cut down on alcohol, smoking, junk food, including fruits & vegetables in your diet.
• Exercise daily
• Regularly check your legs and feet for sores, changes in skin colour and stick to good foot hygiene practices.

Patients at risk need to be screened for identifying blockages and their severity. Interventional treatments, whenever needed, like angioplasty and stenting, are helpful to restore the blood flow and avoid amputation, the hospital noted in its statement.