Recognizing Decreased Blood Supply to the Legs

Common Symptoms
In many middle-aged individuals, especially in our country, symptoms such as pain, tingling, and swelling in the legs are frequently reported. These individuals often experience:

• Pain: Moderate to severe pain in the calf region during walking, which typically subsides when walking stops. Pain reappears when walking resumes.
• Discoloration: Black discoloration of the toes in some cases.
• Swelling: Persistent swelling in the leg.
• Ulcers: Foot ulcers that are difficult to heal despite the application of various creams and ointments. These ulcers can persist for months or even years.

Despite numerous attempts to treat these symptoms with local remedies, many individuals remain unaware of the underlying cause of their condition.

How to Recognize Decreased Blood Supply to the Legs

1. Tingling Sensation and Pain:
   • If you experience a tingling sensation in your feet and are a smoker or habitual tobacco user (cigarettes, bidis, or hookah), it may indicate that the blood supply to your feet is decreasing.
   • Pain while walking is a sign of significant reduction in blood flow. If you experience pain in your feet while lying down or during sleep, it signals a severe reduction of blood supply, potentially as high as 90%. This is a critical condition that may lead to gangrene if not promptly addressed.
2. Diabetic Patients:
   • For diabetics experiencing pain and tingling in the feet, an increase in leg pain while walking suggests a substantial decrease in blood flow. Diabetes causes continuous deposition of calcium and cholesterol in blood vessel walls, leading to reduced blood supply. In severe cases, this can lead to complete closure of blood vessels, causing severe pain.
3. Leg Swelling:
   • Swelling in the leg may result from constriction or blockage of veins, preventing deoxygenated blood from returning to the lungs for purification. This condition leads to progressive swelling, black spots, and, if untreated, the development of leg ulcers. Prompt intervention is crucial to restore normal blood flow and prevent complications.
4. Vasculitis:
   • Inflammatory swelling of blood vessel walls, known as vasculitis, can narrow the blood vessels and disrupt blood flow. This condition may cause skin discoloration and, if not addressed, can lead to gangrene of the toes. Vasculitis is more common in females and is often associated with autoimmune diseases like scleroderma.
5. Impact of Old Injuries:
   • Injuries from road traffic accidents, particularly those involving bone fractures, can lead to narrowed or blocked blood vessels. Even after bones heal, blood vessels may become constricted or blocked, reducing blood supply and increasing the risk of gangrene. The blackening of skin color in the feet indicates the development of gangrene.
6. Backache and Leg Pain:
   • Individuals who are smokers, tobacco users, or diabetics may experience back or thigh pain while walking. This often indicates a blockage in the aorta, the main blood vessel in the abdomen, which reduces blood supply to the back and legs. This can lead to simultaneous pain in both the back and legs, affecting daily activities and work.

Diagnosing Decreased Blood Supply
To diagnose decreased blood supply to the legs, several investigations are essential:

• Doppler Study of Lower Limbs:
  • Arterial Doppler Study: Assesses arteries carrying oxygen-rich blood to the legs.
  • Venous Doppler Study: Examines veins carrying deoxygenated blood upwards towards the heart.
  • These studies help determine the presence of reduced blood flow or obstructions.
• CT Peripheral Angiography:
  • If a complete obstruction is detected in the Doppler study, CT peripheral angiography is used to assess the extent and length of the blockage and the amount of blood flow in the affected vessels.
• Echocardiogram:
  • Evaluates heart function and detects potential blood clots in the heart chambers that could travel to the blood vessels in the legs.

Where to Seek Help
Modern health centers and hospitals provide advanced facilities for managing decreased blood supply:

• 24-Hour Vascular Surgeon: Availability of a specialist trained in vascular surgery.
• Diagnostic Facilities: Access to Doppler studies, echocardiograms, CT peripheral angiography, and MR angiography.
• DSA Lab (Digital Subtraction Angiography): For angioplasty and stenting procedures.
• Modern Operation Theatre: Equipped for vascular surgery with necessary machines and instruments.

Increasing Blood Supply to the Feet
If there is narrowing or complete blockage of blood vessels in the legs:

• Consult a Vascular Surgeon: Immediate consultation with a specialist is crucial.
• Treatment Options:
  • Stenting: For short blockages, a non-invasive procedure to restore blood flow.
  • Bypass Surgery: Required for long blockages to bypass the obstructed vessels and restore blood flow.
• Decision-Making: Treatment decisions are based on factors such as the patient's age, angiographic findings, and other medical conditions. Prompt and appropriate treatment is essential to restore normal blood supply and prevent severe complications.

Key Takeaways:

Consult a specialist if you experience symptoms of decreased blood flow.

Early diagnosis and treatment are crucial to prevent complications.

Modern medical facilities can provide the necessary care for improving blood supply and preventing severe outcomes.

Dr K. K. Pandey, Dept. of Vascular& Cardiothoracic Surgery, Indraprastha Apollo Hospital, New Delhi