by Suman Gupta
Mumbai: A team headed by Dr. Amit Sahu, Senior Consultant, Neuro & Peripheral Interventional Radiologist, Wockhardt Hospital, Mira Road successfully performed a complex minimally-invasive procedure on a 66-year-old patient Mr. Hari with severe leg pain due to severe peripheral vascular disease (PVD) and failed previous bypass graft surgery. Not treating him promptly could have led to gangrene, and leg amputation. Now, the patient can walk freely and has resumed his daily routine with ease.
Mr. Hari ( name changed) encountered severe leg pain, wasn’t able to walk properly for the last 1 year. His health deteriorated further, and he was nearly bedridden for a couple of months. The patient was dependent on his family members and needed assistance for his daily chores. His condition was further complicated by underlying renal failure and poor cardiac function that worsened the matter. There were blockages in the blood vessels supplying blood to his left feet with severe pain after walking a few steps (vascular claudication). An open surgical by-pass (femoro-popliteal) for him was performed one year back which improved his condition transiently but again worsened significantly after few months. The patient was referred to Wockhardt Hospital, Mira Road wherein upon further treatment he was able to walk freely again without any pain.
Dr. Amit Sahu, Senior Consultant, Neuro & Peripheral Interventional Radiologist, Wockhardt Hospital, Mira Road, said, “On initial evaluation, the patient had pain at rest (severe pain in the legs and feet that occurs while a person is resting). This patient suffered from Peripheral Vascular Disease (PVD), a blood circulation disorder seen especially in diabetics and renal insufficiency that results in narrowing of any blood vessels outside of the heart, like those supplying blood to legs, arms, brain, and kidneys. As a result of narrowing, the organ may not get sufficient blood to function adequately. Legs and feet are most commonly affected by PVD. Initially, patients with leg PVD may have pain in legs, cramping on walking, numbness which may progress to pain even on resting, development on non-healing wounds, and eventually gangrene which may need an amputation. This patient had a failed previous vascular surgical bypass and progression of PVD changes causing clinical worsening. No other surgical options were feasible for him. A complex peripheral angioplasty procedure was performed on several blocked vessels to open these and improve blood flow to the foot.”
Dr Sahu added, “A specialized angiographic assessment was performed to prevent further renal injury using Carbon Dioxide gas for angiography which revealed complete blockage of the previous by-pass graft and no major blood flow into the leg below his knee joint. Subsequently, successful plain balloon angioplasty was performed of the occluded arteries from the level of his knee up to his foot – the popliteal artery, tibio-peroneal trunk, common peroneal artery, and posterior tibial artery. Additionally, drug-coated balloon angioplasty was also performed which delivers drug at the local site to prevent late restenosis (which occurs when the treated vessel becomes blocked again) and achieves good long-term results. Good blood perfusion to the foot was successfully restored by this procedure.”
The entire procedure being minimally invasive (done from a small pin-hole injection) could be performed under local anesthesia with the patient being awake and comfortable throughout the procedure. “The procedure lasted around two hours, he recovered fully and was discharged. “The patient could walk pain-free after the procedure and had complete relief of rest pain. He resumed his routine work and is now able to take walks as long as he wants (often lasting over 40 minutes of pain-free walks). The procedure is very safe even in patients with as high a risk as Mr. Hari who could undergo the entire peripheral angioplasty procedure under local anesthesia being awake throughout and having no complications or side effects. Peripheral angioplasty can even be performed in patients where surgical by-pass is not possible & is now being performed as a first option worldwide due to its lower risk & similar long term results.” said Dr Sahu.
A timely intervention allowed Mr. Hari to lead a normal, healthy life free from pain or any other complications arising from the severe blockages he had. “Patients with these types of blockages are at risk of developing wounds in the foot that may not heal. They may even progress to changes of gangrene of the toes or foot arising from severely compromised blood flow resulting in decay of tissues which ends up requiring amputation of the toes, foot, or even the leg depending on the extent of involvement. Interventional treatments, like angioplasty and stenting, play an important role in avoiding and treating such complications by opening these blockages and restoring blood flow. In patients where amputation is unavoidable because of advanced changes of gangrene, it is equally important to improve blood circulation by peripheral angioplasty so that the amputated stump healing is promoted, else it may develop gangrene too. It is vital to have an Interventional Radiology consultation in all patients with PVD, diabetic foot, and gangrenous changes during treatment planning,” underscored Dr Sahu.
“I was alarmed to notice pain in my leg on walking. Initially, I took medications under the care of a Vascular Surgeon. After some days, when the pain persisted and continued to increase, I was referred to Dr. Amit Sahu. He explained that the reason was that my bypass graft had got occluded along with the progression of the changes of peripheral vascular disease. The pain made moving around the house unbearable and I would also get pain while resting. I was in a desperate situation. I am thankful to Dr. Sahu and his team at Wockhardt Hospital for successfully treating me. I am now able to walk pain-free, do all my work and take morning walks as long as I want,” concluded Mr. Hari.
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Risk factors of PVD: Age, obesity, having co-morbidities like diabetes, cholesterol, heart disease, kidney disease, high blood pressure, smoking, lack of physical activity & illicit drug use.
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Tips To Keep PVD At Bay:
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Control of risk factors.
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Do not wear poorly fitted shoes, cut down on alcohol, smoking, junk food, including fruits & vegetables in your diet.
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Exercise daily, regularly check your legs & feet for sores, changes in skin color & stick to good foot hygiene practices.
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Patients at risk need to be screened for identifying blockages & their severity.
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Interventional treatments, whenever needed, like angioplasty, stenting are helpful to restore the blood flow & avoid amputation.
