‘Poorly managed vascular ailments, issue for amputation’

Orthopaedic surgeons and cardiovascular experts have advised those at risk of having vascular diseases to always visit the hospital to ascertain their status, warning that if the condition is not detected early, or is poorly managed, may lead to limb amputation.

The specialists also urged those predisposed to the medical condition to seek early medical intervention if they suspect any form of peripheral artery disease, which is a major cause of medical amputation, or other serious bacterial infections and blood clots.

Though septic wounds among other factors also predispose to amputation, the physicians maintained that peripheral vascular disease is the major cause of amputation worldwide, and advised early intervention before the situation becomes irreversible.

According to an online medical portal, Mayo Clinic, peripheral artery disease, also known as peripheral vascular disease, is a common condition in which narrowed arteries reduce blood flow to the arms or legs, thereby, causing serious damage to the body.

To diagnose this condition, the professionals said a Doppler ultrasound test would be needed to show the direction and speed of blood moving through the arteries and veins, adding that it can also identify blood clots, narrowed arteries and other problems that affect the heart and blood vessels in the legs, arms and stomach.

Recall that the late presentation of these vascular diseases (blood clots and dead vessels) was reportedly the reason for the amputation and eventual death of the late Nollywood actor, John Okafor, popularly known as Mr Ibu.

Speaking exclusively with According Healthwise in different interviews, the experts warned that people with diabetes mellitus, serious bacterial infections and injuries, obesity, immunosuppressants and exposure to cigarette smoke are predisposing factors to amputation.

Speaking also, a Consultant Orthopaedic Surgeon at the Abia State University Teaching Hospital, Dr Isaiah Abali, affirmed that poorly managed vascular diseases can lead to medical amputation, and advised people to avoid any condition that may predispose them to loss of limbs, or eventual death.

He explained that Peripheral Artery Disease is a major cause of medical amputation worldwide, describing it as a circulatory condition in which narrowed blood vessels reduce blood flow to the limbs.

According to him, PAD is a sign of fatty deposits and calcium building up in the walls of the arteries medically known as atherosclerosis, revealing that “diabetes, obesity and cigarette smoking among others, are predisposing factors for peripheral vascular disease.”

Abali, who is also the Chairman of the Nigerian Medical Association, Abia State chapter, explained, “This condition occurs when the blood supply to the legs or upper limbs, depending on where it occurs, is cut off. When the blood supply is cut off, it may lead to gangrene and at this stage, the damage is irreversible because that part of the body is already dead and smelly. The only option for the orthopaedists is amputation.”

Gangrene, according to him, means the death of body tissues due to a lack of blood flow or due to a serious bacterial infection, saying that peripheral vascular diseases commonly affect the arms and legs, including the toes and fingers.

He noted that high blood sugar in the body damages the blood vessels, which is the reason gangrene takes place more in diabetic patients.

He added, “When the blood vessel is damaged, it can slow or block blood flow to certain parts of the body and this predisposes the individual to amputation. More so, obesity can push on arteries, slowing blood flow and increasing the risk of infection and poor wound healing.

 “When people with these conditions sustain an injury, it may be difficult for the wound to heal and such wounds might become infected by bacteria. This will worsen the situation and wounds may become septic and lead to gangrene.

 “Also, patients who go for cancer treatment like chemotherapy may have suppressed immune systems and this allows infections to thrive as the body has compromised immunity against infections. Human immunodeficiency virus can affect the body’s ability to fight off infections too.”

According to him, another condition that predisposes one to amputation is “Peripheral neuropathy, which occurs when the nerves in the body’s extremities, such as the hands, feet and arms, are damaged.

“People with this condition tend to get gangrene more than the others because they don’t know that something has entered their legs until it becomes a problem that leads to gangrene and amputation.”

He listed treatments for gangrene to include antibiotics, oxygen therapy, and surgery to restore blood flow and remove dead tissue, and advised that the earlier the condition is identified and treated, the better the chances for recovery.

Corroborating his views, a Consultant Cardiologist at the Lagos University Teaching Hospital, Idi-Araba, Dr Akinsanya Olusegun-Joseph, said most cardiovascular illnesses do have co-morbidities, saying that somebody with hypertension can also manifest other conditions.

On what could be indications for amputation, he said, “The blood flow may be reduced due to cholesterol deposits in the rumen of the blood vessels and with this; there may be a blockage in the artery, which also reduces blood flow to that part of the body.

“This situation is more in hypertension, diabetes and blood clotting. To manage these conditions in order not to lead to amputation, patients with hypertension, diabetes and high cholesterol which are the major risk factors should control their blood pressure, blood sugar, and cholesterol.

“They should go for Doppler studies and scan to understudy the blood vessel to know the impact of blockage to the blood supply. I, therefore, advise people to know their numbers (blood pressure), check cholesterol, eat healthy food, embrace a healthy lifestyle, embark on fitness exercises and reduce their stress level.”

Meanwhile, a study published in the National Library of Medicine, by Apama Swaminathan and team, titled, ‘Lower extremity amputation in peripheral artery disease: Improving patient outcomes,’ affirmed that poorly managed vascular diseases may lead to amputation.

The authors noted that peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss.

“In its most severe form, critical limb ischemia, patients are often treated with Lower Extremity Amputation, although the overall incidence of this is declining. In the US, there is significant geographic variation in the performance of major LEA.

“The rate of death after major LEA in the US is approximately 48 percent at one year and 71 percent at three years. Despite this significant morbidity and mortality, the use of diagnostic testing in the year prior to LEA is low and varies based on patient, provider, and regional factors.”