Smoking increases risk of Peripheral Arterial Disease which could lead to leg amputation
Tobacco use is a leading cause of preventable illnesses. It is one of the most important causes of preventable premature death. According to WHO figures there are about1.3 billion smokers in the world. Each year, the global tobacco epidemic kills nearly 6 million people, including more than 600,000 who die from exposure to second-hand smoke.
Smoking also is a major risk factor for peripheral artery disease (PAD). PAD also known as leg attack is a condition in which plaque builds up in the arteries that carry blood to the head, organs, andlimbs. Leg attack is a leading cause of toe / foot amputations in India. The prevalence of PAD in the lower limbs in a general population is more in 55 years of age is between 10% and 25% and it increases with age. People who have PAD are also at increased risk for heart diseases and strokes.
Dr.Vimal Someshwar, Director, Interventional Radiology, Wockhardt Hospitals says, “A lot of my smoking patients come to me with advanced PAD. They come with non-healing wounds, intense leg pain (claudication) which is sometimes not even relieved with rest, hampering their ability to sleep at night. Some of these patients also come with gangrene of the foot.”
One of my patients named Viren, a 55 year old smoker for the last thirty five years came to me with intense leg pain. The main artery of his leg, the femoral artery was completely blocked leading to loss of circulation to his lower limbs. With timely intervention, we were able to open up the artery and now he is back on his feet. Viren says, “This was a wakeup call for me regarding my smoking. After this incident, I quit smoking completely.
Early identification of PAD, results in significantly better quality of life. A few simple life style modification steps can reduce your risk of PAD to a large extent. Diet control, controlled blood sugars, simple exercises like walking; cycling etc can improve your chances of keeping PAD at bay. The most common symptoms are burning or aching in feet or toes, painful cramps in the leg, numbness, weakness or heaviness in the feet. The skin of the feet can be cool to touch, there can be loss of hair of the feet, chronic sores – non-healing wounds or gangrene.
Patients with these symptoms should visit their physician or a surgeon immediately for a physical examination. The physician may prescribe an ultrasound test to check the blood flow and health of the artery. He may also recommend an angiogram, where the health of the artery is checked with a special X-Ray machine.
Treatment of PAD ranges from medical management to surgical limb salvage techniques such as bypass or grafts. With newer advances in technologies like drug coated balloons and stents, Doctors are now able to treat even advance disease with a fair amount of success.
To treat PAD your surgeon / interventional radiologist will introduce a balloon to the blocked artery. He will gently inflate the balloon to reopen the blocked artery. If after ballooning, blood flow is not restored, he may leave a small metal mesh (stent) behind to support the artery and keep it open.
Most patients do extremely well with a combination of lifestyle changes, medical management and angioplasty / stenting without requiring advance surgical intervention like bypass or grafts etc.
Though in this era, we have treatment for smoking related lower limb arterial blockages for most of the patients. Still there are significant numbers of patients who do have to undergo above knee or below knee amputation where even the medical, surgical and interventional radiology treatment is not helpful. So the message to give is that it’s better not to smoke or quit smoking before it’s too late. As we always say prevention in better then cure.