Dr K.K Pandey
Like heart, hand & foot too suffer from attacks and if timely intervention is not done, these attacks will lead to permanent disability or their untimely death. If the wall of heart get inadequate or no blood supply, it will lead to a heart attack, the same rule applies to limbs also, they too will get attacks if exposed to insufficient or no supply of pure blood and eventually will become almost dead, if no treatment is initiated in time.
Like heart, limbs do suffer from angina if blood supply to them remains inadequate. Angina, be it of chest or limb, if not treated in time will lead to a full-fledged attack. In heart attack, the sufferer may embrace an instantaneous death, but on contrary, a person who had limb attack may not die himself but surely his limbs will embrace death. This state of limb is called ‘gangrene’ in general terms. When the foot or hand becomes dead or gangrenous, it becomes all the more important to immediately detach (amputate) the dead limb from the rest of the body, otherwise the condition of the patient may become critical and may result into death.
What is Limb Angina?
As the cause of heart attack is due to blockade of the arteries that supply the pure blood to the wall of a heart, similarly the limb attack too is caused by blockade of blood-supplying limb arteries. Due to blockade of arteries, the supply of oxygen through blood to these target organs is considerably reduced. This leads to onset of pain in chest or limbs while walking. This typical pain caused by reduced supply of oxygen and blood is called ‘angina’. If this pain occurs in heart, it is called chest angina. If this occurs in hand or foot, it is called hand angina or leg angina respectively.
Why Does A Limb Angina occur?
The cause of the limb angina or in other words the cause of the blockade of arteries is due to accumulation of fat, blood clot or calcium inside the arteries. A patient who is a diabetic is more at risk of developing hand or leg angina, as the rate of deposition of fat and calcium inside the artery in such patients is comparatively faster than in a non-diabetic patient. Smokers and tobacco-chewers are precariously placed, as they easily fall prey to anginal attacks of hand and leg, because the common harmful substance “nicotine” found in cigarettes, Bidi and other tobacco products, constrict the wall of the arteries. This leads to narrowing of the arteries, which brings drastic reduction in blood supply to hand and legs and gives rise to hand or leg anginal pain. Therefore, especially a diabetic, a smoker and a tobacco – chewer must be very careful. As soon as anginal pain or numbness starts in the limb, immediately consult a Cardiovascular or a Vascular Surgeon for treatment.
How to identify hand and leg angina?
If working with hands or during eating & writing, pain appears in your hand or forearm. It indicates hand angina.
If you are a smoker or a tobacco chewer and your hands and forearm constantly ache, it indicates an angina attack.
If you are a diabetic & suffering from backache or pain in thigh, it means you have developed ‘waist angina’. It is more likely that the main arteries, which are situated in your lower abdomen & supply pure blood to your legs have blocked.
If you develop pain in legs as soon you start walking & pain does disappear as soon as you stop walking, this is sure indication of leg angina.
If the pain persists even in bed while taking rest or it disturbs your sleep, it indicates significant reduction of oxygen supply through pure blood to your legs.
If besides pain in the leg & foot, discoloration of skin of foot or leg too has appeared. This means complete stoppage of blood supply to your limbs has occurred.
Limb Arterial Bypass Surgery- an effective tool of treatment
On the basis of the condition of the diseased artery, the latest surgical techniques like artery reconstruction or arterial bypass operation are undertaken. For these types of operations, artificial tubes imported from America and European countries are utilized, to restore the oxygen – rich pure blood supply to limbs, in order to prevent gangrene in hands and legs. Sometimes, instead of using these artificial tubes, patient’s own natural leg veins are utilized for bypass surgery of limbs.
What precautions should be taken after a limb bypass surgery?
For the success of a limb Bypass surgery it is very important to keep the blood sugar level under control and the patient after surgery must undertake regular daily walk and leg exercises. Smoking and tobacco chewing are strictly prohibited after operation. “Doing less smoking” as claimed by a habitual smoker is very deceptive. Even one cigarette a day will keep the disease active. ‘All or none’ law strictly applies so far as smoking or tobacco chewing is concerned.
If a smoker does not abandon smoking even after hand or leg bypass surgery, the artificial tube grafts or patients’ own venous grafts used during surgery which act as a life – line of the limb, will get blocked completely at a faster rate. Blockade of grafts if occurs, will not only undo the whole surgical exercise undertaken, but will also lead to a dangerous and critical condition of the affected limbs and ultimately amputation of the affected limb will be an eventual outcome.
(The author is a Senior Consultant in the Department of Cardiothoracic & Vascular Surgery at Indraprastha Apollo Hospital, New Delhi India).
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