Times of India
30 August 2010
By Pushpa Narayan
Chennai, India

There Are Just 86 Experts Across The Country; Several States Have None
Casesheets of hundreds of patients whose legs have been amputated lie on the tables of vascular surgeon Dr N Sekar of Apollo Hospitals. Every time he sees them, he is pained. As a surgeon trained to perform surgery on blood vessels, he knows that at least 80% of these people could have walked, if specialists like him had attended to them. That does not happen as there aren’t adequate specialists like him in the country.

India has less than 100 vascular surgeons since the establishment of the first department of vascular surgery in 1978. Orissa, Madhya Pradesh, Bihar and Manipur don’t have any vascular surgeon. No government–run hospital in New Delhi, including the premiere All India Institute of Medical Sciences, has a department of vascular surgery. Chennai and Bangalore, with 20 surgeons each, are slightly better off. Only last year, the number of seats for postgraduate degree in vascular surgery in the country was raised from four to eight in medical colleges.

Including diploma holders, the country produces only 16 vascular surgeons yearly. This, experts feel, should be trebled in two years.

"A large number of people wheeled in for amputations are either trauma victims or long–term diabetics. At least 40% of people with decade–long diabetes develop vascular problems. In a country where more than four crore people are estimated to have diabetes, the number of people estimated to have vascular problems is large. Add to this road accident victims day and you know why there is a need to produce a greater number of vascular surgeons," says Dr Sekar, who is also the president of the Vascular Society of India. Though there are no clear statistics on amputations, it is estimated that at least one lakh people lose a limb every year. Of these, nearly, 80,000 amputations are avoidable.

Sakthiraj Ekambaram, 29, a chronic smoker, complained of pain every time he walked for more than 20 minutes. "I had to stop for a couple of minutes and walk again. The doctor sent me to the gym," he said. Luckily, Sakthiraj, decided to consult a vascular surgeon for the wound that did not heal for long.

"That is when I discovered that the blood supply to my legs was very low. My feet were cold unlike other parts where blood flowed and I did not have good sensation on my feet. I underwent a procedure that saved my legs," he said. But not all patients are as lucky has Sakthiraj, says Dr Sekar.

Pulling out the casesheets of a 40–year–old patient, he continues, "A chronic diabetic, this patient had one of his limbs amputated last year. This year, he had his other leg amputated too. Almost 50% of diabetics who go in for amputation of one limb, lose their second limb in another year. A vascular disease is an indicator of a heart disease because if there are blocks in the leg, there can be blocks in the heart too," says Dr Sekar.

"When people are disabled, the burden is high on the family and the government," says Dr Ravul Jindal, the only qualified vascular surgeon in Chandigarh. "Some patients who can afford the treatment are referred to doctors in other states. Others undergo amputation surgeries. These are done by general surgeons or orthopedic surgeons to prevent infection from spreading to other parts of the body," says Dr Jindal.

The society is now waging an aggressive war with the Union health ministry and at least 10 state governments urging them to start new departments in vascular surgery. Vascular surgeons say they consider several options before deciding to remove a limb. "The blood vessels in the legs and hands are just like arteries and veins in the heart. If there is a block in arteries of the heart, it can reduce supply of blood and cause heart attack, which is death of the heart muscle. When similar things happen on the leg, it leads to death of muscles in the leg. They begin to rot (gangrene). Just like the heart, we have options of using balloons to remove blocks by a procedure called angioplasty, place drug coated thin wires in the vessels to prevent clots or even do a by–pass graft," says Dr Paresh Pai, consultant vascular surgeon at Lilavathi Hospitals, Mumbai.

"But on most occasions, patients are referred to us very late. We want to create awareness among doctors and patients on foot care. For instance, if a wound remains unhealed for long, doctors should first check if there is adequate blood supply and restore it. For this, the patient should come in early," he says.

Representatives from the association want the Centre to plan a road map. First, they want the ministry to increase the number of seats for postgraduate degree in vascular surgery. "At present, there are only seven training centres for vascular surgery, training 12 students every year. We want them to double the number of seats in a year and increase it by at least three times by 2012," Dr Sekar said.

Put Your Best Foot Forward Why Foot Care?
A person is estimated to walk the distance equivalent to the circumference of the earth in his life span and the human feet need good care. Chronic smokers and people with diabetes, obesity, high cholesterol or high blood pressure are at high risk of developing foot problems. In such people, reduced blood flow to legs results in skin ulcers. To prevent infection spreading to other parts, amputation is done

Daily Care
Put your feet on a table in front of a mirror and check your feet every day Look carefully at the top, sides, soles, heels, and between the toes Wash your feet with lukewarm water and clean feet with mild soap Test the temperature with your hands and see if you feel the same on your feet. If you don’t, then it could be because of lack of adequate blood supply Wipe them clean and apply moisturisers. Do not put lotion between your toes. Trim your toe nails

How To Prevent
1 | Control your blood sugar and pressure
2 | Quit smoking
3 | Get your foot tested at least twice a year
4 | Check & care for your feet every day

Treatment | Just like cardiologists deal with the blood vessels of the heart, vascular surgeons deal with the blood vessels in other parts of the body. They may use drugs or procedures like balloon angioplasty to clear blocks, use thin drug–coated wires to prevent reclots or do bypass surgeries to restore blood supply