Shortage of vascular surgeons along with a growing incidence of Peripheral Arterial Disease (PAD) in India’s diabetic population is expected to increase the number of fatalities, according to Dr KR Suresh, vascular surgeon, Jivas Hospital, Bengaluru.

Currently, India has only 70 vascular surgeons whereas the country requires 10 times more of these professionals. Only 16 vascular surgeons are trained annually in India as against 250 in the US. There is a serious impending shortage of experts to handle the growing patient pool to treat this morbid condition, Dr Suresh told Pharmabiz.

Indian PAD incidence amongst diabetics is around 15 per cent of its 6 crore diabetic patient pool. Estimated numbers of critical limb ischemia is about 60,000 in this category and another 5 lakh in rest of the population. In critical limb ischemia, patients invariably lose legs and sometimes life. PAD affecting only the legs in our population can be projected at about 4 crore which makes the total suffering from these diseases huge. Cases of PAD in abdomen, arm and neck are not included in this list,” he said.

“Unlike awareness about the severity of heart attacks, leg attacks are seen to be an un-familiar condition. Leg attacks occur with blockages in vessels of the leg. Any blockage or dilation of an artery in the body, excluding heart and brain is identified as PAD. Diabetes and smoking are the major causes of PAD. Abnormal high cholesterol, hypertension, obesity are key risk factors for PAD, he added.

Patients with PAD do not have symptoms, but are diagnosed by clinical exam. The most common symptom is claudication or leg pain, mostly in the calf muscles on walking and relieved by short rest and can walk the same distance again. The walking distance can gradually decrease over time and progress to pain in the foot even while resting. Much of this condition is because of bare foot walking in India.

Eventually it progresses to Gangrene and would require leg amputation. Hence patients need early diagnosis and aggressive medical treatment to prevent complications. Similar symptoms can occur in other parts of the body though to a lesser extent: like mini strokes from blocked artery in the neck, arm pain, abdominal pain etc. Dilatation of arteries, especially in the abdomen is Aortic Aneurysm which manifests with no symptoms but diagnosed by examination or ultrasound. These diseases have to be corrected before they cause symptoms, since they can be life threatening, he noted.

The best way to prevent PAD is to control diabetes, quit smoking, opt for healthy diet, regular exercise, intake of regular medications to manage lifestyle diseases. It is vital to limit intake of salt and fats besides tailor diets for individual needs. Currently patients have access to specific drugs to stall complications. But if PAD is seen to advance, then vascular bypass and minimally invasive endovascular procedures like angioplasty and stenting are the only options. India is home to a pool of trained vascular surgeons who can treat PAD with surgical interventions but their numbers are found wanting, said Dr Suresh.