EDITORIAL

Peripheral Arterial Disease-More Than Just Numbers: Lack of 
Disease Awareness and Hurdles in Management

Jahangir Sarwar Khan 

Global population is going through a serious 
epidemiological shift inside which the load of 
Peripheral Arterial disease (PAD) is converting 
towards third world countries. Therefore, we ought 
to shift our recognition toward prevention and 
control of this disease. Over the last decade, 
treatment plan has been advanced, such as early 
diagnosis, greater common utilization of diagnostic 
investigations and advanced revascularization 
techniques. In this writing I emphasize the need to 
expand the vision and know-how of peripheral 
a r t e r i a l  d i s e a s e ,  e n h a n c e  i t s  d i a g n o s t i c  
considerations and to  analyze and control this 
disease.
Lower limbs PAD is atherosclerotic disorder involving  
the arterial system of lower limbs. It is a prevailing 
condition considered to take hold of around 250 
million people internationally and is  related to 
expanded danger of numerous detrimental scientific 
effects such as amputations and MI. Amputation is 
the accidental loss or removal of part of the body . It 
is a transformative incident which influence one's 
capacity to be mobile, to do his routine chores , 
engage with people around and keep their self-
determination.
The word burden of disease is a -ive term as it focuses 
more on the adversities and losses related with 
disease, disability, and death.

4
Critical limb ischemia  is a drastic variety of arterial 
disease which is frequently described as peripheral 
arterial disease with associated limb pain at rest, 

2,5
non-healing ulcers, or gangrene. A study showed 
the 1-12 months incidence proportion for mortality 
as well as amputation is around twenty percent in 

6
patients with Critical Limb Ischemia.  In three 
different studies done at three different setups, 
there is an established relationship between lower 
socioeconomic group and high amputation rate in 

patients with CLI.
Despite being widespread and having unfortunate 
clinical outcomes in phrases of impaired workout 
and decreased physical function, PAD is still 
underrepresented and not thoroughly studied as in 
comparison with other related diseases. This little to 
no know-how is the reason behind disastrous 
approach to patients with PAD round the globe. In a 
latest systematic review by Bridgwood et al about 
PAD expertise and understanding, 61% of GPs were 
doing patients screening for arterial diseases and 
only 6% were treating patients according to the set 

1
guidelines.  During the same setup, the data of 
knowledge testing of undergraduate students and 
post graduate trainees validated negative to little 
overall knowledge regarding disease presentation 
and management. Disease awareness rate is 21%- 
61% among general population, according to this 
study. This lack of know-how and understanding is 
one of the motives towards delayed or underused 
treatment.
There seems to be many possible grounds for this 
underestimation of peripheral arterial disease. 
Firstly, it's a diagnostic dilemma thanks to broad 

13
spectrum of disease presentation.  Only 10%-30% 
presented with classical symptoms of intermittent 
claudication which is pain in calves that improved on 
rest of at least ten minutes, 20-50% are 
asymptomatic, whereas 40-50% having atypical 

3
presentation.  Secondly, the first-line investigation  is 
the ankle-brachial index (ABI) and  ABI ≤0.90 is 

2,7,8
diagnostic.  Research proved that ladies tend to 
own lower ABIs than males, mainly attributed 

9,10
towards their shorter height.  The ABI are often 
falsely high because of stiffened ankle arteries in DM 

11,12
or chronic kidney disease.  So here it is best to 
record the toe-brachial index i.e., measurements of 

2,7,12
toe and brachial systolic blood pressures.  As luck 
would have it, in our setups due to increased patient 
load, non-availability of resources and lack of 
expertise this is often not routinely done.
Also, many of us assume that morbidity and 
mortality related to leg diseases is lowered as 

Correspondence:
Prof. Jahangir Sarwar Khan
Dean Postgraduate Education
Rawalpindi Medical University, Rawalpindi
E-mail: jskdr@hotmail.com

Received: June 03,2022; Accepted: June 18, 2022

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compared to other atherosclerotic diseases.
In conclusion, PAD is prevalent in our society and 
needs to be addressed properly considering in mind 
the cost and maintenance of prosthesis after 
amputation is not a piece of cake for our people. In 
my opinion we can take steps towards attention of 
our healthcare workers within the shape of seminars 
and workshops. Also, we can distribute pamphlets in 
out- patient department for patient awareness. 
There should be screening of all high-risk patients 
with or without symptoms of PAD. An early and 
prompt referral of those patients to specialized 
clinics are going to be of great help. We should 
always stress more on prevention of disease instead 
of prevention of amputation.

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JIIMC 2022 Vol. 17, No.2