Silent Threat to Legs and Life: Why PAD Awareness Matters

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 to not only our legs, but to over all health as well. PAD is age related and as the global population is aging, the world is facing the increase in disease burden over last few decades. It has association with arterial occlusion in brain and heart too. A significant number of people loose their legs due to critical limb ischemia caused by PAD.

Dr. Manisha Joshi, Senior Consultant – Interventional & Neuro Radiology at Rajagiri Hospital, Kochi

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 significant incidence and huge social impact, still there is lack of awareness among public regarding this illness. It’s important for public to understand options for it’s prevention, detection, and various treatment options available.

Most important causes of PAD includes – diabetes mellitus and tobacco abuse. Other causes includes hypertension, high blood cholesterol and connective tissue disorders etc. Occlusion of arteries of leg affects oxygen and nutrient supply to the leg. One of classical presentation in early phase is calf muscles pain when person walks, which subsides on taking rest. Later, person can develop pain even at rest which disturbs the 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 be followed always and disease may reveal only when the person suffers trauma or infection of foot, which may not heal for long time and 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 non-healing wound; should immediately seek the medical attention and get examination done for blood vessels. Diabetics should keep their sugars under control and take proper foot care. A healthy lifestyle i.e healthy diet, exercise, and abstinence from tobacco can prevent the disease from developing in many and can reduce the disease severity as well.

Timely treatment is the key to save the leg. Early symptoms can be managed by lifestyle modification, sugar control, monitored exercise regime 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 recent past, endovascular interventions like angioplasty has gained popularity as it can be done without anesthesia, requires no suture, has 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 advancement 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, lets pledge to save more legs and lives by prevention, prompt diagnosis and timely treatment of this condition.