Do you know leg attack is more dangerous than Brain attack??


Yes you have heard it right. Leg attack is even more dangerous than Brain attack. The incidence of Critical Limb Ischemia (CLI) or “Leg Attack” is very high in India but as everyone is aware about brain attack & heart attack but there are very few people who have even heard about leg attack, which can be disastrous even fatal.

This problem occurs largely among the diabetic population in India. According to Dr. Rajiv Parakh , C.O.D, Division of  peripheral vascular & Endovascular sciences, Medanta - The Medicity 20% all diabetic people suffer from critical limb ischemia or leg attack, every year. Many Patients invariably lose their limbs (amputation) & sometimes if the infection spreads, also their lives. A study published in the New England Journal of Medicine quotes that 43% of diabetic patients undergoing foot amputation will die within 5 years — underlining the seriousness of the untreated diabetic foot.

For diabetics, it is said that they must take more care of their legs than their face. The reason being their feet are prone to arterial clogs & blocks and infections.

Diabetes, High BP, High Cholesterol and smoking are the risk factors of Peripheral artery disease.” Often people with a mild form of the disease do not have any symptom. But diabetics are advised to get their foot checkup, like Ultrasound Doppler studies , done once in a year so that detection can be done as early as possible” says Dr. Parakh

CLI is a very severe condition of peripheral artery disease (PAD) and needs comprehensive treatment by a vascular surgeon or vascular specialist. This condition will not improve on its own! It is a serious condition that requires immediate treatment to re-establish blood flow to the affected area or areas. (Most patients with CLI have multiple arterial blockages.) Treatment for CLI can be quite complex and individualized, but the overall goal should always be to reduce the pain and improve blood flow to save the leg. The number one priority is to preserve the limb — prevent an amputation.

Medications: Several medications may be prescribed to prevent further progression of the disease and to reduce the effect of contributing factors such as high blood pressure, high cholesterol and diabetes, and most certainly to reduce the pain. Medications that prevent clotting or fight infections may also be prescribed, but blockages once developed cannot be opened with medicines.

Endovascular Treatments: Just like ballooning, stenting of the heart arteries.  These treatments are the least invasive and involve inserting a catheter into the artery from the leg to allow access to the diseased portion of the artery. Angioplasty may be done to open blockages by using small balloons introduced on a catheter into an artery. The balloon is inflated and, as it inflates, it stretches and opens the artery for improved blood flow. A metallic device called a “stent” can then be inserted to maintain the expanded the artery, thereby improving blood flow to the limb. Other treatments atherectomy, in which a catheter with a rotating cutting blade is used to physically remove plaque from the artery, just like shaving with a blade.

Arterial Surgery: If the arterial blockages are not favorable for endovascular therapy, surgery is often recommended. This involves removing or bypassing the arterial disease using either a vein from the patient or a synthetic graft. In a few cases, the surgeon may open the artery and scrape out the blockage keeping the original artery functional.

Amputation: The last recourse would be amputation of a toe, part of the foot, or leg. Amputation occurs in about 25 percent of all CLI patients — a devastating complication of misdiagnosed, delayed diagnosis or incompletely treated diabetic foot.


The risk factors for critical limb ischemia include:

  1. Age (Men over 60 and women after menopause)
  2. Smoking
  3. Diabetes
  4. High cholesterol
  5. High blood pressure
  6. Family history of vascular disease
  7. Overweight or obesity
  8. Sedentary lifestyle

Warning Signs:

  • Severe pain in the muscles or numbness in the legs and feet while a person is walking.
  • A noticeable decrease in the temperature of your lower leg or foot compared to the rest of your body
  • Toe or foot sores, infections or ulcers that will not heal or heal very slowly (Longer than 10 days)
  • Gangrene (Dead Area)
  • Shiny, smooth, dry skin in the legs or feet
  • Thickening of the toenails
  • Absent or diminished pulse in the legs or feet


Since treatment depends on the severity of the disease and many individual parameters, it is essential that someone with ulcers, or pain in the legs or feet when walking or at rest, see a vascular specialist as soon as possible. The earlier a diagnosis can be made, the earlier the treatment can be started with less serious consequences.

Do not undergo amputation / surgical procedures on the foot — without confirming the blood supply to the area.









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