Diabetic Foot / Peripheral Vascular Disease / Peripheral Artery Disease
- Home
- Diabetic Foot/Peripheral Vascular Disease/Peripheral Artery Disease
A condition in which atherosclerotic plaque narrows or blocks arteries supplying blood to the limbs (usually legs), leading to reduced blood flow and ischemia.
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.
MOSTLY AFFECTED ARTERIES:
- Sup femoral artery
- Popliteal artery
- Tibial/peroneal arteries
CLINICAL FEATURES:
A. SYMPTOMS:
- Intermittent claudication- The classic symptom is leg pain while walking which gets resolved with rest.
- Rest Pain- occurs at night which is relieved by hanging leg down.
- Non healing ulcers/gangrene-on toes or feet
- Up to 50% of cases are without symptoms.
B. SIGNS:
- Cold limb
- Poor nail and hair growth
- Thin, shiny skin
- Muscle wasting
- Reduced/ absent pulses
C. COMPLICATIONS:
- Critical limb ischemia.
- Poor wound healing.
- Infection or gangrene (tissue death) which may require amputation
- High cardiovascular risk (MI, stroke, death)
B. RISK FACTORS:
Non-modifiable
- Age >50
- Family history
- Genetic predisposition
Modifiable
- Smoking (most important)
- Diabetes mellitus
- Hypertension
- Dyslipidaemia (abnormal level of lipids in bloodstream).
- Obesity
- Sedentary lifestyle (lack of physical exercise)
- Chronic kidney disease
DIAGNOSIS:
A.CLINICAL EXAMINATION
Pulse examination- femoral a, popliteal a, dorsalis pedis a, post tibial a.
B. IMAGING
- Duplex doppler ultrasound → first-line
- CT angiography
- MR angiography
- Digital subtraction angiography (gold standard)- used before intervention.
MANAGEMENT/ TREATMENT PLAN:
There are three lines of treatment, based on the severity of the disease
1) Lifestyle changes:
- Smoking cessation.
- Management of hypertension.
- Management of diabetes.
- Management of high cholesterol with a low-fat diet
- Regular exercise for those with claudication helps open up alternative small vessels (collateral flow) and the limitation in walking often improves.
2) Medication:
- Cholesterol lowering drugs like statins.
- Drugs to counter hypertension.
- Antiplatelet drugs to prevent blood clots.
3) Revascularization :
- These minimally invasive procedures are performed by the Vascular 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
