Towards an Amputation-Free Tamil Nadu

Let’s start with 2 important facts:

• Globally, every 2 minutes, someone is getting an amputation done.
• Most amputations are done for people with a diabetic condition, and for trauma cases.

This dismal scenario is due to two reasons:

• There are not enough vascular surgeons in our country.
• Awareness of vascular surgery is very poor.

So, the next time you come across an amputee, do pause and think – “Could this amputation have been prevented?”

The Need for Awareness of Vascular Conditions

Vascular conditions refer to any condition that affects blood vessels and leads to decreased blood flow to tissues.

• India has 101 million people with a diabetic condition – this number is only expected to increase further.
• 6-7% of this 101 million will develop vascular blocks. This translates to six million and sixty thousand – a huge number.
• India has a considerable aging population which will develop vascular conditions.
• Smoking among our youth population is unfortunately on the rise and smoking is the most important cause of vascular occlusions. The occlusion could be in the heart, brain or leg.

There are only around 300 full-time vascular surgeons in our country. Apart from this, there are 200 general and cardiac surgeons who also perform some vascular surgeries. Due to a lack of awareness and an insufficiency of surgeons, many patients neglect their condition and finally end up requiring amputations.

While on the subject of vascular surgeons, it should be noted that Tamil Nadu has the maximum number of vascular surgeons in the country.

But as a country, are we ready to face what seems like an unpreventable increase in vascular conditions?

Vascular Education

Only around 20 medical colleges in our country have dedicated vascular departments and a majority of these colleges are located in Tamil Nadu. Medical students complete their training without any knowledge of vascular diseases. As a result, diagnosing a vascular condition is delayed and as the condition progresses, amputation is the only option left.

Vascular Training Centres

Most of the vascular training and dedicated vascular centres are located in the South. Many states in the North and East are without any trained full-time vascular surgeons.

Kauvery Hospital is the only hospital approved by the National Board to conduct a super-specialty training course in vascular surgery.

Diabetes and Foot

Foot problems are common among people with a diabetic condition and hence are something to guard against.

As we all know, a patient diagnosed with diabetes has high blood sugar. Over time, this increased blood sugar can damage the nerves and blood vessels. When nerve damage happens, the ability to perceive pain is lost. As a result, these people are not aware when they sustain a small injury or an open sore on their feet. As blood circulation is also reduced, the wounds do not heal and might possibly get infected. The infection and reduced blood flow could lead to the death of tissue also known as gangrene.

Gangrene is 53 times more common in men who have diabetes and 71 times more common in women with diabetes. 35-50% of all amputations are done on people with diabetes. 25% of patient care for people with a diabetic condition is for foot problems. Up to 85% of all amputations done for people with a diabetic condition are preceded by a foot ulcer. Therefore, early detection is crucial to prevent amputation.

Diabetes and Vascular Disease

People with diabetes are at an increased risk of getting vascular disease because the increased blood sugar levels lead to plaque deposition and narrowing of the blood vessels (a condition called atherosclerosis). These narrowed blood vessels will lead to a condition called ischemia wherein the blood flow to the tissues is not enough.

The risk of developing an arterial block increases with the number of years for which the person has had diabetes. 40% of people who have had diabetes for 20 years have PVD (peripheral vascular disease). Many limbs are lost because of minor surgeries done on ischemic limbs. Before undergoing any foot surgery, people with a diabetic condition should have a complete vascular assessment done. 35-50% of people with diabetes who undergo amputation of one leg develop significant arterial disease in the other leg within 1-2 years.

Non-Operative Management

There are a number of things that can be done as preventive measures to avoid an amputation.

• Stop smoking and stop all tobacco products.
• Exercise helps in blood circulation. So, make sure to do some form of exercise.

Take care of your feet and wear good footwear.

• You can ask your doctor about using blood thinner drugs.
• You can also talk to your doctor about cholesterol-lowering tablets.
• Keep diabetes and hypertension under control.
• Change your lifestyle and diet for the better.

Treating Vascular Conditions at Kauvery Hospital

The advanced hybrid lab at Kauvery has made it possible to perform minimally invasive endovascular procedures as the treatment of choice instead of open bypass surgeries. Kauvery Hospital has been at the forefront of preventing amputations. Every year, 75 open surgeries and 150 endovascular procedures are performed for limb salvage. 25-30 stroke prevention surgeries (carotid endarterectomy) are also performed every year.

During the COVID pandemic, vascular block leading to gangrene and amputation was a major COVID complication. The Vascular Department at Kauvery Hospital worked round the clock to operate on these patients and saved over 100 limbs from amputation. This work has been published in a prestigious vascular surgery journal.

The Vascular Society of India

The Vascular Society was formed in Chennai on August 6th 1994. The VSI formation day is being observed as Vascular Awareness Day every year since.

The Amputation Free India walkathon was conducted on 6th August this year at Chennai and Kauvery Hospital played an active role in the event. Similar events were conducted in 26 cities across India.

A Request to the State Government

• Our state government should declare August 6th as Vascular Awareness Day.
• Every medical college should have a vascular surgery department.
• As vascular surgeons are fully trained in endovascular procedures, they should have access to cath labs or should be provided with hybrid operation theatres.
• All vascular procedures should be covered under insurance.