Vascular Diseases are broadly classified into Arterial, Venous and Diabetic Foot. Patients with arterial disease usually present with difficulty in walking, non-healing ulcers, gangrene or amputations. Venous patients have swelling in legs, hyper-pigmentation, ulcers with pain and skin changes in legs. Diabetic Foot patients have numbness in feet, non-healing ulcers, callous, pressure sores, and in severe cases gangrene and sepsis. Three of the most recognized vascular diseases include:
Peripheral Arterial Diseases
Peripheral arterial disease (PAD) is an arterial occlusive disease in either the aorto-iliac segment or below the level of the inguinal ligament, due to atherosclerosis. The reduction in blood flow to the foot due to blockages contributes towards formation of an ulcer or gangrene in the foot.
PAD in diabetes is a condition predominantly of the infra-inguinal vasculature and can be at a macroscopic or at a microscopic level. Presence of PAD among patients with diabetic foot ulcers is associated with worse outcomes, such as poor healing of foot ulcers, development of gangrene, toe / foot / leg amputations, increased cardiovascular events and higher death rates. Other common causes are smoking, obesity, high cholesterol levels, inactivity, hypertension and tobacco intake.
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Venous Diseases
Venous diseases are caused by abnormalities in veins causing varicosities or abnormal clotting. Venous diseases are fairly common and affects nearly 15 percent of the adult population. Mild venous disease is usually not a problem for patients, but as venous disease worsens, it can become debilitating chronic venous insufficiency.
Clotting of the deep veins of the leg and abdomen causes Deep Venous Thrombosis (DVT), which causes severe swelling in the legs, pain and pulmonary embolism (PE). In severe cases, it may also cause death due to massive pulmonary embolism.
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Diabetic Foot Care
Six percent of all diabetics can have an ulcer in their lifetime. Infective and the ischemic foot problems are major reasons behind hospitalisations in diabetic patients. Eighty five percent of all amputations are preceded by an ulcer, and an amputation is happening every 30 seconds somewhere in the world.
Diabetes also affects nerves in the foot and prevent any heat, touch, vibration or painful stimuli to the foot. Peripheral arterial disease (PAD) is more common in patients with diabetes, especially uncontrolled diabetes. PAD is a major contributing factor in more than half of patients with a diabetic foot ulcer. The reduced blood flow prevents ulcers from healing, which can become infected and can result in amputations. Prevention is the key to avoiding foot problems in diabetic patients.
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