Microvascular Disease Linked to Increased Risk of Leg Amputation

Highlights:

• Narrowing or constriction of the microvasculature (small vessels) that carry blood to soft tissues and muscles occurring in any part of the body has been found to independently increase the risk of amputation of the lower limb
• Peripheral arterial disease (PAD) involves constriction of arteries in the extremities away from the heart and usually affects the legs. If not treated, PAD can result in lower limb gangrene needing an amputation
• Patients diagnosed with both microvascular disease as well as peripheral arterial disease (narrowing of lower limb vessels) have the highest risk of amputation and need urgent interventions to prevent the same

Narrowing of the microvasculature (small vessels) that carry blood to muscles and connective tissue may independently increase the risk of amputation of the lower limb, according to a recent study led by Joshua A. Beckman, M.D., professor of medicine and director of Vascular Medicine at Vanderbilt University Medical Center in Nashville, Tennessee. Typically microvessel disease is seen in diabetes causing diabetic retinopathy and nephropathy. Funding for the study was provided by the American Heart Association Strategically Focused Research Network in Vascular Disease and the U.S. Department of Veterans Affairs, and the findings appear in the American Heart Association's journal Circulation.

Dr Beckman says, "This study advances the idea that microvascular disease is a system-wide disorder rather than only affecting one part of the body.”

Estimating Amputation Risk in Microvascular Disease and PAD

The study included more than 125,000 veterans having either microvascular disease or peripheral artery disease (PAD) and those who had both PAD as well as microvascular disease. The study team obtained data from the Veterans Aging Cohort Study. The participants had not had any amputations at the start of the study and were followed up over an average duration of 9 years.

The key findings included:

• Those with the microvascular disease had 3.7 times higher risk of lower limb amputation, and included 18% of all amputations that occurred during the follow-up period
• Participants with PAD had a 13.9 times more risk of lower limb amputation and included 22% of all amputations
• Participants having both microvascular disease and PAD showed 23 times higher in the risk of lower limb amputation including 45% of all amputations during this period

The findings of the study suggest therefore that persons having both microvascular disease and peripheral arterial disease (PAD) have the highest risk of lower limb amputation and require closer surveillance and appropriate interventions to save the limb.

"PAD (in the legs) has long been considered a sign that a patient likely also has narrowed arteries leading to the heart or brain. If a patient has PAD, they have a higher risk of other cardiovascular diseases, such as heart attacks and strokes," said Beckman.

What is Peripheral Arterial Disease?

• Peripheral arterial disease (PAD) involves constriction of arteries in the extremities away from the heart and usually affects the legs and smoking is a major risk factor
• Patients with PAD complain of pain and muscle cramps while walking or climbing stairs (claudication) which is relieved by resting
• PAD patients show an increased risk of heart disease and stroke
• PAD is diagnosed by vascular ultrasound of the lower limb
• Treatment includes stopping smoking, healthy diet and exercise, medical treatment and lastly surgery if these fail to relieve symptoms
• Patients with PAD should be advised to seek immediate medical attention for ulcers or any trauma to lower limb since if these are not treated promptly, it can result in gangrene of the affected part necessitating amputation

In summary, patients having the microvascular disease and peripheral arterial disease have a much higher risk of lower limb amputation and need close monitoring and appropriate interventions to prevent amputation.

References:

1. Microvascular disease anywhere in the body may be linked to higher risk of leg amputations - (https://newsroom.heart.org/news/microvascular-disease-anywhere-in-the-body-may-be-linked-to-higher-risk-of-leg-amputations?preview=2e66)

Source-Medindia