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11th Annual AISCCON Conference.

Handicapness due to Limb Gangrene & Amputation, Limbs For Life Interventions in Peripheral Vascular Disease

Handicapness due to Limb Gangrene & Amputation

Limbs For Life Interventions in Peripheral Vascular Disease


1) What Is Peripheral Vascular Disease (PVD)?

This refers to disease of blood vessels outside the heart and brain. It’s often a narrowing of vessels that carry blood to the legs, arms, hand & foot. PVD can result from atherosclerosis, inflammatory processes leading to stenosis, an embolism or thrombus formation. The commonest cause of PVD is atherosclerosis, where a waxy substance forms inside of the arteries. This substance is called plaque. It is made of cholesterol, fats, calcium, and a blood-clotting material called fibrin. When enough plaque builds up on the inside of an artery, the artery becomes clogged, and blood flow is slowed or stopped. This slowed blood flow may cause “ischemia,” which means that your body’s cells are not getting enough oxygen.

2) What are the symptoms of PVD?

While clogged coronary arteries (the arteries that supply your heart with blood) may lead to a heart attack, and clogged carotid arteries (the arteries that supply your head with blood) may lead to a stroke (Brain Attack). Similarly clogged peripheral arteries of the limbs most often cause pain and cramping in the legs which may progress to gangrene.

Patients may feel pain in their calves, thighs, or buttocks, depending on where the blockage is. Usually, the amount of pain you feel is a sign of how severe the blockage is. In serious cases, your toes may turn a bluish color, your feet may be cold, and the pulse in your legs may be weak. In some cases, the tissue dies (this is called gangrene) and amputation may be needed.

Sometimes leg cramps develop when a person walks, and the leg pain usually gets worse with increased activity. This cramping is called intermittent claudication. Like the chest pain of angina, the leg pain of intermittent claudication usually goes away with rest.

3) What are the diagnostic tests for PVD?

Doctors can make a diagnosis by listening to you describe your symptoms and by checking for a weak pulse in the arteries in your feet. Further tests may include Ultrasound Doppler which is a test that uses sound waves to produce an image of blood flow through your arteries.

Angiography, which is a test that may be performed if your doctor thinks your condition, is serious enough for a transcatheter intervention or surgery. The test uses a harmless dye that is injected into the arteries. It lets doctors see where and how serious the blockage is.

4) How is a blockage (PVD) treated-Role of Interventional Radiologist?

Interventional Radiologist is a physician who can diagnose and treat various vascular & non vascular conditions through a very small hole in the body using Cath lab/DSA guidance. Interventional procedures are safer & less cumbersome for patients as they involve no surgical incision, less pain & shorter hospital stay.

When the blockages in the blood vessels are not severe, this form of PVD can be controlled by losing weight, quitting smoking, and following a regular exercise program & medications that has been approved by your doctor. A transcatheter intervention (balloon angioplasty or a peripheral stenting) may be needed for a severely blocked artery that is causing pain or other symptoms. Interventional Radiologist can open these blocked or narrowed blood vessels to regain the normal blood flow to the affected body part.

Angioplasty is a non-surgical procedure used to dilate (widen) narrowed or blocked peripheral arteries. A thin tube called a catheter with a deflated balloon on its tip is passed into the narrowed artery segment. The balloon is then inflated, compressing the plaque and dilating the narrowed artery so that blood can flow more easily. Then the balloon is deflated and the catheter is withdrawn.

In Stenting – a cylindrical, wire mesh tube (Stent) — is placed in the narrowed artery with a catheter. There the stent expands and locks open. It stays in that spot, keeping the diseased artery open.

Some time Thrombolytic therapy may be needed for clot dissolution. In this technique interventional Radiologist can insert multi side hole catheter inside the clot responsible for blockage. And via this catheter he can deliver clot dissolving lytic agents inside the thrombus in the pulse spray fashion. If the narrowing or blockage involves a long portion of an artery, surgery may be necessary to remove blockage from arteries or to bypass the blocked vessel. Vascular surgeon performs these procedures.


5) How do I Know I am at risk for PVD?

The risk factors for atherosclerosis in the peripheral arteries are the same as those for atherosclerosis in the coronary arteries. Smoking – tobacco, diabetes, high blood pressure, obesity and high cholesterol are believed to lead to the development of plaque.

A person with PVD has a six to seven times greater risk of CAD, heart attack, stroke, or transient ischemic attack (“mini stroke”) than the rest of the population. If a person has heart disease, he or she has a 1 in 3 chance of having blocked arteries in the legs. Early diagnosis and treatment of PVD, including screening high-risk individuals, are important to prevent disability and save lives. PVD treatment may stop the disease from progressing and reduce the risk of heart attack, heart disease, and stroke.

If you are having one of these precipitating cause factors and the symptoms, you should alert yourself for PVD & consult your personal physician / Interventional Radiologist for an evaluation at the earliest. So that to avoid the consequences of PVD like gangrene & amputation of limbs. Because limbs are for life!

6) Where can I get it done?

There are very few centers all over India with Interventional Radiology facilities. We at CARE HOSPITAL NAGPUR, having this Department of Interventional Radiology for due patient care at affordable cost.

“Limbs for Life” Save Limbs Save Life

If you have any queries in this context, you can contact

Dr. Sachin Dhomne
MD DNB FINR FISVIR ( KEM MUMBAI), CIST (USA)
Chief Interventional Radiologist, CARE HOSPITAL, Nagpur
e-mail:drsachinrad2000@yahoo.co.in
Mob: 09766539313




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