Dr. Sushant Srivastava
Director & Sr. Consultant
Cardiothoracic & Vascular
Surgery, BLK Heart Centre
BLK Super Speciality Hospital

“One should undergo a yearly test of Ankle Brachial Index (ABI), which is a Blood Pressure measurement of Arms and Legs. Smoking should be stopped completely and a healthy lifestyle must be adopted. The only way to prevent PAD is by controlling Diabetes, Hypertension and Cholesterol.”

Smoking not only makes one prone to Heart Attacks, but can also cause severe, unbearable pain in the legs. If not treated on time, it can even lead to Amputation. Doctors at BLK Super Speciality Hospital performed a life-saving surgery on a 58-year-old man, after he was advised elsewhere to have his limb amputated.

THE CASE

Patel Singh was a heavy smoker suffering from severe Peripheral Arterial Disease (PAD), a condition in which arteries supplying blood to legs or other vital organs become narrowed or blocked. The patient will experience pain in calves and thighs, which occurs initially only while walking but later ensues even at rest. This symptom is known as Claudication. In severe cases, the patient develops a bluish discolouration of the distal part of the limb or even gangrene. Once gangrene is established, a variable amputation has to be undertaken. Claudication is sometimes not recognised correctly and valuable time is lost during which the disease progresses.

A CT Angiogram usually reveals the full extent and severity of the blockages and helps in planning the surgery. In Patel's case, the abdominal aorta was totally cut off at the level of the renal arteries and other multiple blocks involving Bilateral Iliac and Superficial Femoral Arteries.

THE PROCEDURE

Due to the extensive nature of the disease in this particular patient, complex Peripheral Bypass Surgery was required. The aorta was approached retroperitoneally through a thoracoabdominal incision to access its suprarenal part. The top end of a bifurcated dacron graft was anastomosed to the aorta at the diaphragm. The two limbs of the graft were tunneled into both groins where anastamoses to the common femoral arteries was achieved. The distal Superficial Femoral Arteries (SFA) were exposed through separate thigh incisions extending up to the knees and jump grafts were taken to the distal SFAs. To access and bypass different parts of the arterial tree, extensive incisions and complex techniques had to be employed.

THE RESULT

Patel's recovery was quite uneventful. He was out of bed on the second post-operative day and was discharged in seven days. He was asymptomatic and after many weeks, he could sleep peacefully and walk without pain. Timely intervention and the technique of surgery leading to complete revascularization produced gratifying result.