For a nation with a rising number of diabetics, National Vascular Week assumes more significance than normally. Between August 6 and 13, the country has been focussing on generating awareness to prevent peripheral vascular disease in the population.
Peripheral Vascular Disease involves the circulatory system excluding the heart and brain. It is characterised by a narrowing of the vessels that carry blood to the legs, arms, stomach and kidney, caused by thickening of the vessel walls, thereby thinning and eventually, cutting off blood supply.
“The major risk factors are smoking, diabetes, obesity, high cholesterol levels and a family history of heart attacks and strokes,” explains V. Balaji, senior consultant vascular surgeon at Apollo Hospital. So primary prevention is key, he adds. Vascular surgeons invariably have to advise their patients to stop smoking, eat a healthy diet, and control their cholesterol and blood pressure levels.
“The incidence is about 6-8 per cent among diabetics who come to the outpatient unit. In those who are over 60 years, it is higher at 30 per cent,” Vijay Vishwanathan of MV Hospital for Diabetes says.
Convert the percentage to real numbers and the tip of the iceberg emerges. P. Sekar, senior vascular surgeon, says in private practice, 90 per cent of PVD patients are diabetic. Patients from rural areas and towns where awareness is poor come in with very bad disease, he adds.
Dr. Balaji says there is a high risk of losing limbs with PVD, especially in combination with diabetes. “The symptoms are non-healing ulcers and leg pain while walking and even at rest. If a patient comes in with these symptoms, it is prudent that the doctor suspects PVD.”
It is said that 80 per cent of diabetic gangrene starts as an ulcer, Dr. Sekar points out. “If you pick up patients then, you can salvage the limbs.” Even surgeons who remove the gangrenous toe do not check for blood flow, thereby allowing the gangrene to spread.
“All they have to do is feel the pulse in the ankle. A Doppler test and the ankle brachial index can also determine blood flow to the feet,” he says, adding that patients have to watch for cold feet, hair loss (in the limb) and changes in nail texture and colour.
Medical management will be helpful at the initial stages and minimally invasive procedures are also being offered now.
The tests are simple and will have to be performed during annual tests for diabetics. Some people complain about the costs, but look at it as the price for keeping your feet and arms and it is nothing.” Also PVD is now being considered a marker for other diseases, including Coronary Artery Disease and Cerebral Vascular Disease.
