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#CrediTalk: Dr. Rajiv Parakh On Peripheral Vascular and Endovascular Diseases

In India, around 10 million people are affected by Peripheral Vascular disease. Also, as it is one of the important causes of morbidity in India, this disorder is going to be a major health problem in our country, especially among the age group 45 years and above. We had a conversation with Dr. Rajiv Parakh about the same.

Dr. Rajiv Parakh is the Chairman and Head of the Department of Vascular and Endovascular Sciences at Medanta – The Mediclinic Cybercity in DLF Phase – 2, Gurugram. This department came into being almost 10 years back. The hospital offers the best possible treatment for their patients. They have cutting edge technology to improve the outcomes.

Questions on Peripheral Vascular and Endovascular Diseases

Here are some questions answered by Dr. Rajiv Parakh:

Ques 1: What is vascular disease?

Ans: Vascular disease is essentially a disease of the blood vessels. You know that the human body is made of bones, muscles and blood vessels which supplies blood to the body. There are a huge number of blood vessels in our body.

Sometimes these blood vessels get damaged because of an accident or they may get blocked. Blockages can be because of various reasons. Due to the increase in cholesterol level, which means the lipid gets collected in the arteries. Because of that, the blood vessels start shrinking, that leads to a reduction in blood flow.

Everyone knows what a heart attack is. It means that the blood supply to the heart is getting narrowed, causing a heart attack.

The blood supply also goes to the brain, and if that supply gets narrowed, it is known as the heart attack of the brain. It is the same disease but it is affecting your brain. When the blood supply affects the brain, half of the body gets paralyzed. This is called Paralysis or Stroke.

Similarly, if the blood supply reduces in legs, it is known as a heart attack of legs. The disease is the same, just that the location has changed. If the blood supply of the leg gets blocked, that person will not be able to walk. He/she will feel muscle pain in legs. This is a symptom of vascular disease.

Mainly, this disease is found in people with uncontrolled diabetes, high blood pressure, chronic smokers and who have high cholesterol.

Ques 2: Concerning technology, Medanta The Medicity makes use of the most modern innovations. One such innovation consists in facilitating endovascular surgery using a robotic arm. Can you reflect on your experience of the merits of such technology? What difference do such innovations make?

Ans: Innovation is something that the doctor looks forward to, to increase their edge and add that X factor to their profession. If they can translate technology and be able to provide a better, safer procedure for the patients, this will improve the quality of outcomes. This will improve the ability of patients to get back to their normal lifestyle.

The robotic endovascular system that Medanta has is called Robotic Zeego cath lab. This is amazing technology at Medanta – The Medicity. This is available in the operation theatres. After receiving a command, this machine brings the X-ray camera right on the top of the patient’s affected body part.

This adds to the advantage of looking at the blood vessels while injecting and observing the contrast or dye ( to improve the visualisation). While operating, this technology can show the actual flow of blood. After detecting the issue, we can identify the problem and take the corrective measure to prevent any further damage.

Medanta – The Medicity is probably one of the only hospitals in the country that has this advanced technology available at all time.

Ques 3: Peripheral vascular disease is a rather slow-building one. Most patients realize the adversity of the condition much later because, in 75% of cases, it is asymptomatic. Are there measures to help detect these conditions earlier?

Ans: This statement is right. Our lifestyle, smoking, drinking and parties increase the deposition of cholesterol in our blood vessels. This starts at an earlier age.

If you remember, in the Vedas, the lifespan of an individual for 100 years was divided into four parts – the first 25 years were Brahmacharya Ashram in which the child went to school for education. From 25 to 50 years, was the Grihastha Ashram. From 50 to 75 years, it was the Vanaprastha Ashram in which one stepped back and allowed the children to grow and started to unwind themselves. Above 75 years, it was called Sannyasa Ashram.

A similar thing is happening inside our body. How does a person die at the age of 75 or 100? The arteries supplying blood get narrower after the age of 75 years. The arteries eventually get completely blocked and the blood supply to the heart stops.

The deposition of cholesterol doesn’t start at the age of 75 but the age of 25. The first deposition of cholesterol develops at the age of 25 in every individual all over the world. In the artery supplying blood to the legs, the first plaque happens in every individual above the age of 25.

Then the speed of deposition of cholesterol progressively increases. This is further governed by the way we live our life. If we are smoking, drinking or having a lot of fatty food, the deposition of cholesterol will speed up.

Also, there are other factors, including heredity. So the best thing to do to avoid this type of disease is to live a healthy lifestyle. Workout daily and keep a check on what you eat and drink.

Ques 4: Peripheral vascular diseases affect nearly 10 million Indians. It is also noted that the mean age of the presentation of these diseases is around 45 years (that inculcates the working population). What preventions can this population undertake to manage or avoid the onset of peripheral vascular diseases?

Ans: Peripheral vascular disease is the deposition of cholesterol in the arteries which supply blood to all the body parts. This disorder affects the age group for 45 years and above. They have high cholesterol or smoking habits.

Smoking is the single most incriminating factor for the development of Peripheral vascular diseases. Smoking is something that needs to be stopped to eliminate vascular disorders. If you have a choice, you can drink (in limits) but don’t smoke. Smoking is a complete no.

Smoking can damage your blood vessels. If a person has smoked even for a short period, its effects will be felt eventually.

Related read: Why Should I Quit Smoking?

Ques 5: 20-30% of diabetic patients suffer from peripheral vascular diseases. How are these two interlinked? Can a treatment method be done to cure both?

Ans: The WHO says that “close to 35-40 crore people in India will be suffering from diabetes, by 2025″. So we can estimate the disease burden that we will face in the future. In other words, one in three Indian will be diabetic.

If a person is a diabetic, 20-25% of which will have deposition of cholesterol in the blood vessels. If the diabetes is uncontrolled over a prolonged period, it will get worse. The arteries will keep getting blocked. If they get blocked completely, the blood supply to a particular part of the body, like a foot, will get blocked. When this happens, that part of the body will die.

So this is called as a foot attack or a blockage of supply to the foot. Now once the part of the body dies, that portion can not be revived and will have to be amputated.

This is the biggest challenge that people with diabetes face. If the blood supply is blocked because of uncontrolled diabetes, one may develop gangrene (death of a particular area).

So most of the amputations suffered by diabetic patients can be avoided provided diabetes is kept in control, smoking is completely stopped, cholesterol level is maintained, exercises regularly and has a healthy lifestyle.

Ques 6: How does cholesterol deposit causes blockages?

Ans: Suppose there is a crack in the wall. What we are going to do? We will take some cement and try to fix it, to avoid the crack from developing further.

Now that’s exactly what happens inside the blood vessels. Whenever a crack develops inside the blood vessels as a result of high blood pressure or high cholesterol, our body tries to repair that crack. Our body uses cholesterol to patch that crack.

In an individual who doesn’t smoke and has no diabetes, a thin layer of good cholesterol will layer over the crack and repair it. But if one has high cholesterol, diabetes, and is a smoker, then that bad cholesterol will start depositing around the artery. This deposit will increase as time passes and the blood vessel will shrink rapidly.

Once the blood vessel gets completely blocked, the blood supply will stop and because of that, it may cause problems like diabetic foot ulcer. These ulcers will continue until the blockage is removed.

It is not necessary to operate to open the blockage. This can be treated without any operation, with the help of angiography. With this process, doctors put a stent in the affected nerve. If this doesn’t work, then it will need bypass surgery.

If a patient is having a heart attack of legs, the doctor will recommend angiography of legs and the same procedure will be followed. If the blockage can not be removed by angiography, the doctor will do a bypass of that nerve.

Check out all the article in #CrediTalk series here.

About The Doctor

Dr Rajiv ParakhDr Rajiv Parakh is the Chairman in the Department of Vascular and Endovascular Sciences at Medanta -The Mediclinic Cybercity in DLF Phase – 2, Gurgaon. He has a rich experience of 34 years in this field.

He has completed his MBBS in general physician from Maulana Azad Medical College, New Delhi, MS in general surgery from Maulana Azad Medical College, New Delhi and FRCS from The Royal College of Surgeons (RCS), the United Kingdom in 1987.

For a priority appointment or more information, contact us at +91 8010994994 or book an appointment with Dr. Rajiv Parakh here

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