Diabetic Foot/Peripheral Vascular Disease/Peripheral Artery Disease

Peripheral vascular disease, also known as peripheral arterial disease, refers to a range of symptoms that occur due to the narrowing of the arteries other than those that supply the heart or the brain. When narrowing occurs in the heart it is called coronary artery disease while in the brain it is called cerebrovascular disease.

Peripheral artery disease most commonly affects the legs, but other arteries may also be involved. The affected blood vessels continue to narrow over months and years, and at some point the arteries become completely blocked.

A. SIGNS AND SYMPTOMS:

The classic symptom is leg pain while walking which gets resolved with rest, known as intermittent claudication.

Other symptoms such as skin ulcers, bluish skin, cold skin, or poor nail and hair growth may occur in the affected leg.

Complications may include an infection or tissue death which may require amputation; coronary artery disease, or stroke.

Up to 50% of cases are without symptoms.

B. RISK FACTORS:

Smoking Smokers have up to a tenfold increase in relative risk for PAD in a dose-response relationship.

Increased blood lipids (fats and cholesterol)

Lack of physical exercise
Diabetes Mellitus

Hypertension (high blood pressure)

Being overweight

C.Peripheral Angiography and Angioplasty TREATMENT:

There are three lines of treatment, based on the severity of the disease

i. Lifestyle changes:
Smoking cessation.

Management of hypertension.

Regular exercise for those with claudication helps open up alternative small vessels (collateral flow) and the limitation in walking often improves.
Management of diabetes.

Management of high cholesterol with a low-fat diet



ii. Medication:
Cholesterol lowering drugs like statins

Antiplatelet drugs to prevent blood clots
Drugs to counter hypertension

iii. Revascularization :
These minimally invasive procedures are performed by the interventional radiologist in order to physically clear the occluded or blocked blood vessels with the help of a balloon catheter, stent or both. It is a type of guided surgery, wherein a guide wire is passed through the affected blood vessels. An angioplasty balloon is then passed over this wire and inflated so as to compress the plaque build ups. In some cases, a stent which is a small metallic mesh tube may also be placed, in order to keep the artery open.
Case Study
CASE -1:
45yrs male, heavy smoker and known diabetic for 7yrs had complains of severe leg cramps(Claudication) on walking for 100m. Angiography showed severe calcific stenotic occlusion at the left common iliac artery origin with a pressure gradient of >40mmHg. Also noted a plaque at the right common iliac artery causing 50-60% narrowing.

Bilateral common Iliac artery balloon mounted stent deployment done.

Post deployment, the left Iliac artery pressure gradient normalised.
CASE -2:
62yrs female, with uncontrolled diabetes and also has hypertension on regular medication came with a non healing wound involving the left great toe. On examination, no peripheral pulses felt.

Angiography showed diffuse atherosclerotic changes involving the left leg arteries with a focal 3-4 cm severe calcific stenotic occlusion at the mid Superficial Femoral artery with sluggish flow in the leg.

Left superficial Femoral artery was stented and balloon angioplasty done.

Post angioplasty, all the peripheral pulses were felt. The wound healed in one month.
ILIAC ARTERY STENOSIS
SUPERICAL FEMORAL ARTERY STENTING
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