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Peripheral Vascular Disease and the Risk of Limb Loss
Peripheral vascular disease ( PVD ) is a serious and often alarming condition , particularly in its advanced stages . One of the most distressing signs is the darkening of the lower leg , which can lead to gangrene and ulcer formation , often necessitating amputation .
While it may appear to be a superficial problem , PVD is actually caused by a loss of blood flow due to blocked blood vessels .
The frightening reality is that clogged blood vessels is common and this is particularly true in Malaysia , where dietary choices and poor lifestyle habits contribute significantly to the prevalence of this condition .
Lifestyle factors play a crucial role in the development of PVD . Smoking accelerates the formation of plaque in blood vessels , while diabetes , with its resultant high blood sugar levels , prompting the blood vessels to brittle and more prone to injury . These are key contributors to the disease .
According to Datuk Dr . Kumara Gurupparan , a Consultant Cardiologist at Institut Jantung Negara ( IJN ), chest pains occur when these blockages affect the heart ’ s vessels , if the blockage is in the vessels supplying the brain . In the case of PVD , the blockage occurs in the vessels leading to the lower limbs , reducing or , in severe cases , completely cutting off the blood supply to these areas .
Early stages of PVD are characterized by pain in the buttocks , thighs , and calf muscles after walking short distances . At this point , the blood vessel is blocked , but no major damage has occurred . In later stages , ulcers and wounds may develop on the leg , and patients might experience pain even at rest .
Dr . Kumara notes that PVD is particularly common in Malaysia , where diabetes affects about 20 to 25 % of the adult population and smoking rates are increasing . Alarmingly , the disease is now appearing in younger individuals , with cases being reported in people in their 40s and 50s due to the earlier onset of diabetes and increased smoking among the youth .
Dr . Kumara , who has worked at IJN for 12 years and sees an average of 35 patients daily , reports that about 30 % of his patients suffer from PVD .
Treatment for PVD varies depending on the stage of the disease and the extent of damage to the blood vessels . In its early stages , patients may benefit from medications that help improve blood flow to the affected limbs , alleviate pain , and increase walking distances . These medications often work by dilating the blood vessels or preventing blood clots , thereby enhancing circulation . Alongside medical therapy , lifestyle adjustments such as smoking cessation and managing underlying conditions like diabetes and hypertension are critical in slowing the progression of the disease .
As PVD advances and symptoms worsen , more aggressive treatment approaches are needed . Surgical options include procedures such as bypass surgery , where a graft is used to reroute blood flow around the
blocked artery , or endovascular interventions to directly address the blockages . These advanced treatments are designed to restore adequate blood flow and prevent complications like ulcers , tissue death , or gangrene , which may otherwise lead to amputation if left untreated .
By tailoring treatment plans to the disease ’ s progression , physicians can manage PVD effectively , aiming to improve patients ’ mobility , reduce discomfort , and preserve limb functionality .
Dr . Kumara offers a sophisticated treatment known as peripheral intervention , a technique he learned during a year in Italy . This minimally invasive procedure uses wires , stents , and balloons , similar to those used in heart procedures , to expand clogged blood vessels in the legs . The method involves a small puncture to deliver these instruments , resulting in a shorter recovery period of two to three days , compared to five to seven days for traditional surgery .
Despite the availability of advanced treatments , Dr . Kumara emphasizes that prevention is always better than cure . Regular checkups and early medical intervention at the first sign of symptoms are crucial . Managing contributing factors such as diabetes , high cholesterol , and hypertension is vital . He advises diabetic patients to see a doctor every four to six months to monitor and optimize blood sugar levels . Hypertension patients should regularly check their blood pressure . Additionally , he warns against smoking and advocates for a healthy lifestyle with regular physical activity .
By adopting these preventive measures , the risk of developing peripheral vascular disease and its severe consequences can be significantly reduced .
Datuk Dr Kumara Gurupparan Consultant Cardiologist
Early stages of PVD are characterized by pain in the buttocks , thighs , and calf muscles after walking short distances .
GlobalHealthAsiaPacific . com ISSUE 6 | 2024
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