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Times of India
31 July 2012

While everyone speaks of blocked arteries leading to heart attacks, equally risky clots lodged in the limbs are going unnoticed

In a clear case of a star disease stealing the limelight from other equally dangerous ailments, Mumbai’s vascular surgeons are speaking of the heart overshadowing the limbs. With the media writing reams about fat deposits blocking blood flow through the heart (blame our ghee–maar–ke diet and lack of exercise), and celebrities like actor Saif Ali Khan and Shiv Sena chief Uddhav Thackeray checking into hospitals after a heart scare, Indians know what they must do to avoid a cardiovascular attack.

Few however, know anything about leg or hand attacks, let alone how to detect or treat them.

Pushpa Patel, a 72–year–old from Daman, whose family owns a chain of hotels in the seaside town, ignored what she thought was a nagging leg pain for seven years, before she landed at Mumbai’s Lilavati Hospital two weeks ago, and was advised amputation. "I never took it seriously, although the pain was acute enough for me to have taken note," says Patel, with a hint of regret.

It was as recent as three months ago that Patel hit the panic button when she noticed a discolouration in her left heel. "It had developed gangrene, and a doctor in Daman administered medication and shaved off the wound. When it worsened, I was taken to Surat, where they amputated my heel. Even then, my woes didn’t end," she says. At Lilavati, vascular surgeon Dr Pankaj Patel, made sure that blood circulation in her legs improved with the help of angioplasty, a procedure that mechanically widens obstructed arteries – before her left leg was cut off mid–calf.

What Patel suffered is called a leg attack or limb ischemia. It’s characterised by a shooting pain in the leg that develops due to restricted blood flow in arteries running through the lower limbs. "It’s no different from a heart attack," says Dr Patel, an expert in Peripheral Vascular Diseases (PVD), including limb ischemia. "Fat deposits along the walls of the arteries lead to atherosclerosis or thickening, narrowing the passage where blood can flow. This leads to the formation of blood clots," explains Dr Patel.

While Acute Limb Ischemia refers to a sudden halt in blood flow to the limb, Chronic Critical Limb Ischemia develops after years of neglect leading to a condition that has worsened over time. "An acute leg attack needs urgent medical intervention. If not revascularised within eight hours, the patient could lose his limb," he says. Just like with a heart attack, a leg or hand attack is the result of artery blockages that are worsened by smoking, eating an unhealthy diet, lack of exercise, and diabetes or hypertension, says Dr Hemant Deshmukh, Head of Radiology at KEM Hospital. "In fact, a majority of leg attack patients are also heart patients," he adds. Blocked arteries in the heart indicate a 30 per cent chance of the patient suffering from a vascular condition in other parts of the body, research has proven. "But a blocked artery in the leg pushes the chance up to 70 per cent. A patch of cholesterol deposit or a blood clot abruptly dislodges from an artery close to the heart and blocks an artery supplying blood to the limbs. If the clot travels to arteries that supply blood to the brain, the patient could suffer a stroke," says Dr Patel.

A leg attack is diagnosed using a Colour Doppler test, or an angiography, which is an imaging technique that helps visualise the inside of blood vessels. Commonly, blockages occur around spots where blood has to face resistance, like at an arterial bifurcation near the thigh, says Dr Patel. "In the initial stages, the blockage can be tackled with medication and physiotherapy. In more serious cases, we suggest angioplasty or a bypass. Amputation, is of course, our last resort."

While a sedentary and stressful urban lifestyle is increasing the incidence of leg and hand attacks, awareness remains low. A 2010 research on peripheral vascular diseases across India revealed that 98 per cent cases were undiagnosed until it would reach the last stage, when amputation would be the only option.

Signs of a leg or hand attack

» Deep, nagging pain in the limb » Pain or cramps only when walking (Intermittent Claudication) » Numbness and coldness in the limb
» Redness of limbs and delay in healing of wounds

Peripheral Vascular Disease
Fat or plaque deposits along artery walls lead to the formation of clots that prevent blood flow to the limbs, leading to leg and hand attacks

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