Yes, the above heading carries a pertinent question. Many of us are unaware of the term Leg Attack for sure. Those among us, who don’t know about the disease, let them know that Leg attack is even more dangerous than Brain attack. The cases of Critical Limb Ischemia (CLI) – as per the medical terminology – or Leg Attack is on a rise in India; unfortunately, very few people are aware of Leg attack, an attack which is disastrous and even fatal at times.
This problem occurs largely among the diabetic population in India though they are not the only vulnerable chunk. Every year, 20% of diabetic patients suffer from Critical Limb Ischemia or Leg attack. Many patients invariably lose their limbs (amputation), and sometimes if the infection spreads badly, they even lose their lives. A study published in the New England Journal of Medicine quotes that 43% of diabetic patients undergoing foot amputation will die within 5 years – underlining the seriousness of the untreated diabetic foot.
For diabetics, taking care of the legs is more important than that of the faces. The reason being their feet are prone to arterial clogs & blocks and infections.
Diabetes, High BP, High Cholesterol, and smoking are the risk factors for Peripheral Artery Disease. Often people with a mild form of the disease do not have any symptoms. However, diabetics are always recommended to get their foot checkup – like Ultrasound Doppler studies – done once in a year so that the detection should be done as early as possible.
CLI is a very severe condition of Peripheral Artery Disease (PAD) and requires ample treatment by a vascular surgeon or vascular specialist. The patient’s condition doesn’t improve on its own and requires immediate treatment to re-establish blood flow to the affected area or areas. It is often found that patients with CLI have multiple arterial blockages. Treatment for CLI is quite complex; the foremost objective should always be to reduce the pain and improve blood circulation. Of course, the first priority always remains to save the limb – prevent an amputation.
Several medications may be prescribed to reduce the effect of contributing factors like high blood pressure, high cholesterol, diabetes, and to reduce the pain most likely. Medications that prevent blood clotting or cure infections may also be prescribed, but blockages once developed cannot be opened with medicines.
Just like ballooning, Stenting of the heart arteries. These treatments involve putting in a catheter into the artery from the leg to allow access to the diseased portion of the artery. ‘Angioplasty’ is a process by which blockages are cleared by using small balloons introduced on a catheter into an artery. In this process, the artery is widened with the help of a metallic device called stent. Atherectomy is another treatment, in which a catheter (sort of rotating blade) is used to remove plaque from the artery – just like shaving with a blade. Both the procedures enable a proper flow of blood to several parts of the body including the limbs.
If the arterial blockages are not suitable for endovascular therapy, surgery is often recommended. This involves removing or bypassing the arterial disease using either a vein from the patient or a synthetic graft. In a few cases, the surgeon may open the artery and scrape out the blockage keeping the original artery functional.
The last recourse remains is amputation of the affected part of the leg. Amputation occurs in about 25 percent of all CLI patients – a shocking complication of delayed diagnosis, misdiagnosed, or incompletely treated diabetic foot.
Who are prone to Critical Limb Ischemia?
- Age (Men over 60 and women after menopause)
- High blood pressure
- High cholesterol
- Family history of vascular disease
- Overweight or obesity
- Sedentary lifestyle
- Severe pain in the muscles or numbness in the legs and feet while a person is walking.
- A noticeable decrease in the temperature of your foot or lower leg as compared to that of the rest part of the body
- Toe or foot sores, infections or ulcers that will not heal or heal very slowly (longer than 10 days)
- Gangrene (Dead area)
- Shiny, smooth, dry skin in the legs or feet
- Toenails Thickening
- Absent or diminished pulse in the legs or feet
Since the treatment depends on the condition of the patient and health history of an individual, it is advisable that someone with ulcers, or pain in the legs or feet when walking or at rest, should consult a vascular specialist as soon as possible. Early diagnosis always helps.
Inputs have been taken from Dr. Rajiv Parakh, Chairman, Vascular Department, Medanta – The Medicity, located in Gurgaon, India.
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