PERIPHERAL VASCULAR DISEASES

NONINVASIVE APPROACH FOR EVALUATION AND TREATMENT

Abstract

Objectives: To observe the prevalence & presentation and to review the noninvasive approaches for the evaluation and treatment of patients presenting with peripheral vascular diseases at Bahawal Victoria Hospital Bahawalpur. Design: Prospective randomized study. Place and Duration: This study was conducted from July 2003 to June 2005 at the department of Surgery Bahawal Victoria Hospital Bahawalpur. Patients & Methods: Twenty patients, 2 females and 18 males admitted with peripheral vascular diseases (PVD) fulfilling the inclusion criteria were evaluated and treated medically and surgically. A standard noninvasive approach for the evaluation of these patients was adopted by history & thorough clinical examination, Doppler USG of the vessels, Ankle Brachial Indices (ABI), Duplex Scanning and MRI in a few cases. Results: The relative frequency of PVD at BVH Bahawalpur was 1.2%. The majority of patients (60%) were in the 4th decade of life and male (90%). The smoking was exclusively the major predisposing risk factor (90%). The common (90%) presentation of patients was intermittent claudication with 60% gangrenous disease with an average duration of 4years, The lower limbs were involved in 90% cases with 70% bilateral disease. Majority (90%) of the patients was diagnosed clinically and the objective severity of the disease was assessed with Doppler sonography in all the patients. The ABI was <0.5 in 85% cases. The duplex scanning was needed only in 10% patients. The treatment procedures carried out were primary amputation in 45% followed by conservative on medicines 20%, atherectomy in 15%, lumbar sympathectomy in 10% and resection or repair of pseudoaneurysms in 10% of cases. The ultimate rate of amputation at various levels was seen to be 75%. Conclusion: The prevalence of PVD is rapidly increasing in our society which is causing a horrible threat in the form of physical disabilities at a younger age group of poor class mostly. Smoking remains exclusively the only major risk factor. Much time and money can be saved by evaluating and treating these patients by noninvasive approaches but prevention is the best
therapeutic strategy achieving by abstinence from the smoking.