Many people who find walking painful may believe that it is related to arthritis or is a natural effect of aging. Quite often, it is the result of the blockage of the arteries of the leg due to atherosclerosis called peripheral vascular disease (PVD). It commonly affects men and women over 50 who often also suffer from heart disease, diabetes, high cholesterol and high blood pressure, and are smokers.
PVD affects about one in 20 people over the age of 50. People with early PVD will be asymptomatic at rest, but on walking they will get a crampy pain in their calf muscles, thighs or buttocks. With very severe blockage, the patients may get rest pain in their toes and feet. Other symptoms may include numbness, tingling, weakness, burning or aching in the leg.
Rarely, there may be no obvious early symptoms. This was seen in an otherwise very active diabetic hypertensive lady golfer patient of mine from the TriCity, who ended up with an amputation as her first symptom was gangrene. With the progression of the disease, there may be ulceration, bluish discoloration and even blackening of the toes or foot (gangrene).
The severity of the blockage can be assessed by a diligent history taking a good clinical examination followed by non-invasive tests like an ABI (ankle brachial index), Duplex ultrasound, CT and MRI.
ABI is a good screening tool in susceptible groups. Screening for PAD using ABI is very simple —measurement is quick and painless with no injection, taking just five minutes, the equipment costs only a few thousand rupees with no recurring cost, and nurses can be trained in its use. It is also highly specific for leg artery stenosis (>50%) and highly sensitive (>95%).
PVD patients should no longer be treated as second-class atherothrombotic patients – whether asymptomatic or symptomatic – they die 10 years early and run the risk of gangrene and amputation. A huge number of lives could be saved if patients with PVD would be identified with ABI and treated in a timely manner. PVD can be as life threatening as heart disease.
If the block is discrete it may be opened with a balloon and a stent by a vascular surgeon. If the cause is an acute blood clot it may respond to medicines which dissolve the clot or a surgical procedure – embolectomy – to remove the clot. Sometimes a sophisticated device may be used to suck out the clot without a surgery. However, the block is usually of a fibro-atheromatous plaque and may be long and totally choking the vessel. In such patients a peripheral vascular bypass surgery is required.
An innovative new procedure for treating PVD using the patient’s own hand artery (radial artery) was developed by the author and has found a place in the Limca Book of World records. The procedure has been demonstrated at various conferences and workshops in India and abroad and is being used successfully by some surgeons all over the world.
In the early stages, the use of dietary modifications – basically, a low fat vegetarian diet, weight reduction (if overweight), graded exercise, along with the use of blood thinners, vessel dilators and cholesterol reducing drugs (statins) – help prevent progression of the blockage and encourages the development of collaterals. Regular exercise is the most consistently effective treatment for PVD. Avoidance of smoking and all other former of tobacco use is mandatory for a permanent solution. People should take more care of their legs after the age of 50 as the incidence increases with age.
Thus, simple measures should be taken from an early stage in life to prevent a crippling and even life-threatening condition from developing.
What’s Your Risk?
What puts you most at risk for peripheral vascular disease (PVD) and heart attack?
Here’re 12 factors to examine your lifestyle and current state of health:
1. Increasing age: About 4 out of 5 people who die of coronary heart disease are 65 or older.
2. Gender: Heart disease is more common in middle-aged men than women. As women age, the rates become similar. Elderly women are more likely to have angina than men.
3. Heredity: Children of parents with heart disease are more likely to develop it.
4. Smoking: A smoker’s risk of heart attack is twice that of a nonsmoker. Use of birth-control pills further increases a lady smoker’s risk.
5. Abnormal lipid profile: High LDL (low-density lipoprotein) cholesterol and low HDL (high-density lipoprotein) cholesterol both increase the risk of heart disease.
6. High blood pressure: High blood pressure makes the heart work harder, causing it to enlarge and weaken.
7. Physical inactivity: Regular, moderate to vigorous exercise helps prevent heart disease.
8. Obesity: Body fat, especially if it’s on the waistline, puts you at risk. A good measure of body fat is the body mass index, or BMI. To calculate your BMI, multiply your weight in pounds by 703. Divide that answer by your height, in inches. Divide that answer once again by your height, in inches. You are overweight if your BMI is above 25, obese if it is 30 or more.
9. Type 2 diabetes needing Insulin: About two thirds of people with diabetes die of some form of heart or blood vessel disease.
10. Stress, repressed anger: These increase blood pressure and heart rate, which can lead to arterial damage and thickening.
11. Alcohol: Light to moderate drinking is fine, but too much alcohol can raise blood pressure and cause obesity .
12. Saturated fats: Among the proteins you consume, choose lean meat, poultry or fish, soy products and legumes which are relatively low in saturated fats.