September is observed as Peripheral Arterial Disease (PAD) awareness month. Dr. Manisha Joshi, senior consultant – Interventional & Neuro Radiology at Rajagiri Hospital, Kochi, explains that PAD, in simple words, means occlusion of peripheral arteries (blood vessels) supplying to our limbs (more commonly, legs).
PAD is a threat not only to our legs, but to our overall health as well. PAD is age-related and as the global population is aging, the world is facing an increase in disease burden over the last few decades. It is associated with arterial occlusion in the brain and heart as well. A significant number of people lose their legs due to critical limb ischemia caused by PAD.
This disease not only impacts the life of the person affected by this, but also brings immense physical, psychological, and financial burden on the whole family. Timely diagnosis and treatment of this disease can save many legs, lives, and families. Although this disease has a significant incidence and huge social impact, there is still a lack of awareness among the public regarding this illness. The public needs to understand options for its prevention, detection, and various treatment options available.
The most important causes of PAD include diabetes mellitus and tobacco abuse. Other causes include hypertension, high blood cholesterol, and connective tissue disorders, etc. Occlusion of the arteries of the leg affects oxygen and nutrient supply to the leg. One of the classical presentations in the early phase is calf muscle pain when a person walks, which subsides on taking rest. Later, a person can develop pain even at rest, which disturbs sleep and compromises the quality of life. Many develop ulcers or gangrene of toes, which may progress to involve the entire foot or leg. This sequence may not always be followed and the disease may reveal only when the person suffers trauma or infection of the foot, which may not heal for a long time, and the person suffers non-healing wounds or major infections, ultimately requiring amputation of the leg.
When someone develops symptoms such as pain on walking or on rest, gangrene or a non-healing wound, they should immediately seek medical attention and get an examination done for blood vessels. Diabetics should keep their sugar under control and take proper foot care. A healthy lifestyle, such as a healthy diet, exercise, and abstinence from tobacco, can prevent the disease from developing in many people and can reduce the disease severity as well.
Timely treatment is crucial for saving the leg. Early symptoms can be managed by lifestyle modification, sugar control, a monitored exercise regimen, and medications. But more advanced disease will require endovascular intervention or surgery to open the arteries with angioplasty and related procedures, or to bypass the occlusion using a surgical graft. In the recent past, endovascular interventions like angioplasty have gained popularity because they can be done without anesthesia, require no suture, have no pain, and the patient can walk home early after the procedure. In this, through a needle inserted into the blood vessel, occlusion is opened using specialized balloons and stents and related techniques, under X-ray guidance. With advancements in treatment techniques, it has been possible to save more limbs from amputation.
Working as an Interventional Radiologist and vascular specialist, we experience day to day, how timely treatment can save legs, lives, and families, and on the other hand, how delays can lead to loss of the same. In this PAD awareness month, let’s pledge to save more legs and lives by prevention, prompt diagnosis, and timely treatment of this condition.
