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Sinusitis

Understanding Sinusitis Complications What Patients Should Watch For

Introduction

Sinusitis is common, treatable and preventable, provided its causes and symptoms are not taken lightly but addressed promptly and on time. As per the National Institute of Allergy and Infectious Diseases (NIAID), sinusitis affects Indians significantly. Nearly 134 million suffer from this condition, and one out of eight Indians is infected by chronic sinusitis. The condition has more prevalence than asthma, diabetes, and coronary artery disease among Indians. The condition demands proper treatment or could aggravate severe complications that could be dangerous to the patient’s health. 

This blog discusses sinusitis, a common condition that must not be overlooked, as the various potential complications it carries if left untreated could be severe and life-threatening.

Sinuses and Sinusitis

Sinuses are cavities in the nasal passage with mucus lining that helps keep the passage moist and lubricated. Healthy sinuses are air-filled without any bacterial or pathogen presence. Sinuses are behind the cheeks, forehead, eyes, and nasal bones. They act as air filters and humidifiers, help enhance voice resonance, and reduce the head’s weight.

Sinusitis is a condition of inflamed sinuses. When the air in the sinuses gets infected with bacteria, viruses, or pathogens, they get inflamed and blocked with mucus, causing difficulty in breathing. It has symptoms similar to the common cold and is often confused with the latter. Though the condition is non-communicable, the infection-causing bacteria or viruses may pass from person to person.

Sinusitis symptoms – The condition causes headaches, facial pain and pressure, stuffy nose, sneezing, eye and nose itchiness, and breathing difficulties. Some other sinusitis symptoms are bad breath, loss of smell and taste, running nose, fever, cough, sore throat, and fatigue.

Causes of sinusitis- Sinusitis could affect anyone at any time. However, people with allergies, bronchitis, asthma, weakened immune systems, nasal polyps or nasal deformity, smokers, and second-hand smokers are more prone to developing sinusitis.

Types of sinuses- The four major types of sinuses are-

  • Maxillary sinuses – on each side of the nose, next to the cheekbones (the maxillae), and below the eyes.
  • Frontal sinuses – close to the forehead and above the eyes.
  • Ethmoid sinuses – close to the eyes on each side of the nasal bridge. 
  • Sphenoid sinuses – deeper within your skull, behind the eyes.

Need for Sinusitis Treatment

Sinusitis is a common condition affecting your sinuses with inflammation. Still, it requires adequate and appropriate treatment to prevent its aggravation. It is not just an allergic condition. 

It is more than an occasionally irritating condition requiring just a few doses of medication and rest.

The treatment for the condition starts with self-care, medications, and alternative treatment modalities. If these do not help treat the condition, medical procedures drain the fluid from the nasal passage.

If treated appropriately, one can be relieved of sinusitis symptoms for good, but if not, the condition can worsen and may cause severe health issues. 

Potential Sinusitis Complications from Untreated or Poorly Treated Sinusitis

One must watch for the potential sinusitis complications that may arise in the long term if the condition is left untreated or improperly treated. These complications can adversely affect the overall health of an individual. 

The various complications associated with chronic sinusitis are-

  • Loss of smell and taste- The loss of smell renders an individual unable to enjoy food and other finer things in fine, be it food, natural fragrance of flora, or scents. The loss of smell could be partial, called hyposmia, or complete, known as anosmia. The loss of taste makes food taste bland, causing patients to add more salt and other spices that might lead to problems like high blood pressure and gastrointestinal or kidney issues in the long run. Patients often lose interest in eating food, leading to weight loss, nutritional deficiency, depression, and other health problems.
  • Infection to other body parts- Though sinusitis is not contagious, the bacteria and viruses that cause the condition can, if not treated, spread to other parts of the body like the eyes, ears, skin, or the brain. The spread of the infection may damage the functionality of the affected part.
  • Mucocele- Known as paranasal sinus mucocele, it is a cyst that gets formed when the sinuses cannot drain the mucus. The hardened mass of cysts may grow in size and exert pressure on the nose and sinuses, leading to difficulty in breathing. Infection in this mucocele may need an operation for its removal.
  • Meningitis- Meningitis is the inflammation or infection of the membrane or fluid surrounding the brain or spinal cord. The membrane is a protective layer of the brain and spinal cord. Untreated sinusitis could spread infection in the fluid or membrane surrounding the brain, bones, or spinal cord, leading to meningitis, a severe and life-threatening condition.
  • Sinus thrombosis- Cavernous sinus thrombosis is the formation of a blood clot in the cavernous sinuses. Cavernous sinuses are cavities under the brain and behind the eye sockets. The blood clot may develop due to infection in the face or skull. Blood clots prevent the spread of infection, but when the clot is in cavernous sinuses, it restricts the blood flow from the brain, creating pressure and damaging the brain, eyes, and other nerves. It could turn fatal without immediate treatment.
  • Orbital cellulitis- Infection of the soft tissue of the eye socket behind the orbital septum is known as orbital cellulitis. The orbital septum is a thin tissue that separates the eyelid and the eye socket. Sinusitis can spread infection in the eyes, causing eye irritation, swelling, puffiness, redness, and even vision loss in the long run without adequate treatment.

Conclusion

It is unwise to consider sinusitis a common and less harmful condition and ignore its treatment. Untreated conditions can be potentially dangerous, with severe complications that may adversely affect the individual’s health beyond repair. The potential risk to overall health could be chronic and life-threatening. Ensure your sinus health through hygiene, adequate hydration, and avoiding exposure to sinus irritants. Consult your doctor immediately if you have sinusitis symptoms and get the treatment without any delay. 

References

https://www.mdpi.com/2673351X/5/1/2#:~:text=An%20estimated%20134%20million%20Indians,congestion%20and%20obstruction%20%5B1%5D
https://www.merillife.com/blog/medtech/sinus-causes-symptoms

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Bariatric

Long-Term Impact of Bariatric Surgery on Physical and Emotional Well-being

Introduction

Bariatric surgery has emerged as a transformative solution for individuals grappling with severe obesity. As obesity rates continue to rise worldwide, the popularity of bariatric surgery as a treatment option has soared, driven by its potential to not only facilitate significant weight loss but also to improve overall health and quality of life. However, beyond the physical transformations lies a deeply intertwined emotional journey that accompanies bariatric surgery. In this blog, we delve into the lesser-explored realm of the long-term impact of bariatric surgery on the emotional Well-being of patients. Drawing insights from recent research studies and our own practice, we aim to unravel the complexities of this emotional journey and its implications for patient care.

The Emotional Landscape of Obesity

  • Mood disorders: Individuals with obesity commonly face mood disorders such as depression and anxiety, which can significantly impact their well-being. In last the 20 years. Majority of the patients (> 75%) have sub clinical or clinical depression due to obesity. Some children are bullied in school for obesity and their body appearance.
  • Low self-esteem: Excess weight often leads to feelings of low self-esteem and poor body image, contributing to emotional distress. Some youngsters do not attend any social gatherings because of obesity.
  • External pressures: Societal stigma and pressures related to weight can exacerbate psychological challenges, leading to feelings of shame and isolation.

Insights from the qualitative study conducted by Kubik et al[1].. shed light on the psychosocial experiences of individuals pre-bariatric surgery. Participants in the study reported a range of emotions and challenges related to their weight, including feelings of frustration, shame, and dissatisfaction with their bodies. Many expressed a desire for change and a hope for improved health and quality of life through bariatric surgery. Overall, the psychological landscape of obesity is complex and multifaceted, encompassing internal struggles, external pressures, and societal stigma.

Preoperative Emotional Distress

Exploring the psychological distress commonly experienced by individuals seeking bariatric surgery unveils the emotional complexities underlying their decision-making process. Research studies have shed light on the prevalence of emotional comorbidities among bariatric surgery candidates, highlighting the significant impact of preoperative psychological health on postoperative outcomes. Understanding the depth of preoperative psychological distress is crucial for healthcare providers involved in the care of bariatric surgery patients. By addressing these emotional challenges early in the treatment process, healthcare providers can significantly improve patient support through their surgical journey and enhance the likelihood of positive outcomes.

  • Significant Impact on Outcomes: Preoperative psychological health significantly influences postoperative outcomes.
  • Early Intervention: Addressing psychological challenges early enhances patient support and improves outcomes.
  • Comprehensive Assessment: Thorough preoperative assessment is vital for identifying and addressing psychological distress effectively.

Guidelines:

All patients should undergo psychological counseling and be encouraged to meet other post-operative patients who have undergone Bariatric Surgery a few months or a few years ago. The confidence that a patient builds up before surgery is very important for good outcomes after bariatric surgery.

Recognizing and addressing preoperative psychological distress is paramount in ensuring the success of bariatric surgery interventions. By prioritising comprehensive assessment and early intervention, healthcare providers can provide the necessary support to patients as they navigate the emotional complexities of their surgical journey, ultimately leading to improved outcomes and enhanced patient well-being.

The Bariatric Surgery Journey: Transformations and Challenges

  • Transformative Effects: Bariatric surgery initiates profound transformations in patients’ lives, encompassing significant weight loss, improved self-esteem, and enhanced quality of life.
  • Challenges and Adjustments: Despite the transformative effects, patients often encounter challenges and adjustments in the post-bariatric surgery phase. These may include shifts in identity as individuals navigate their new bodies and lifestyles, as well as changes in social dynamics and relationships.Providing ongoing support and guidance to patients throughout their bariatric surgery journey is important. From preoperative education and counselling to postoperative support groups, comprehensive care plays a pivotal role in helping patients navigate the challenges and embrace the opportunities for growth and well-being.

Key Takeaways and Implementable Suggestions for Bariatric Clinics and Practitioners

  • Implications for Clinical Practice: Incorporate routine psychological assessments into preoperative evaluations to identify patients at risk for psychological distress.
  • Comprehensive Approach to Bariatric Care: Develop integrated care pathways that address both the physical and psychological aspects of obesity and bariatric surgery.
  • Recommendations for Supporting Patients: Conduct thorough preoperative assessments to identify patients’ psychological risk factors and tailor interventions accordingly.

The confidence boost for post-operative bariatric patients after significant weight loss is remarkable. Many individuals often find themselves starting new jobs, launching businesses, or returning to college.
By implementing these strategies, bariatric clinics and practitioners can better address the psychological dimensions of obesity and bariatric surgery, ultimately improving patient outcomes and promoting overall well-being.

The blog has been authored by Dr. Neha Prashant Shah, Advanced Laparoscopic & Bariatric Surgeon. The content is for informational purposes only and should not be taken as professional medical advice.

Reference links:

https://pubmed.ncbi.nlm.nih.gov/23606952/

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C-section surgery – Add more to Life
C-Section/Caesarean

Behind the Decision: Factors Determining Cesarean Section Requirements for Women

Introduction

The most special moment of life for a woman and the loved ones, is when a new life is brought into the world. Giving birth to a child is sacred and bringing a healthy child in the world holds utmost importance, ensuring safety to the mother’s health as well. Maternal health needs to be taken care of during pregnancy and pre and post childbirth. Despite medical advancements and progress, death of women during and following pregnancy and/or childbirth is at a strikingly high rate with approx. 28700 deaths reported in 2020. Healthcare professionals have an active and responsible role in ensuring a safe and healthy delivery experience for the mother and child.

The decision to deliver a child through vaginal delivery or caesarean section depends on various factors that a healthcare professional has to consider in the best interest of the mother and the offspring. Though, generally vaginal delivery is considered safe, advisable, and preferred option for delivery, many a times conditions might not warranty a safe delivery. In such an event, a caesarean section becomes necessary.

Continue reading this blog to know more about the factors that determine and contribute in deciding caesarean section as the best option for child delivery.

What Is a Caesarean Section (C-Section)?

C-Section is a surgical procedure for a delivery of a child through an incision in the mother’s abdomen and uterus. Unlike vaginal delivery, one can plan and schedule a surgery. The incision made could be either vertical (the incision is from the belly bottom to the pubic hairline) or horizontal (the incision is across the pubic hairline).

Factors Determining the Need for Surgical procedure

C-Section could be either a medical need to avoid any risks and complications to the mother and child, or elective and scheduled as a preferred choice. The healthcare professional may decide to have a C-Section in the following conditions.

  • Stalled labour- Delay in labour, also called prolonged labour, is when the mother is unable to progress with the delivery once gone into labour, either during the first phase or the second. The condition could be either the cervix (a canal connecting the uterus and the vagina) that starts to open but does not open fully or when the baby does not move down the canal, even after the cervix is opened.
  • Fetal distress- When the baby does not get enough oxygen, that may result in the heart rate slowing down below the healthy fetal heart rate.
  • Abnormal fetal positioning- Head-down or head-first toward the canal is the ideal condition for a normal delivery. However, at times the babies may have a breech (feet towards the canal) or transverse (shoulder or side first towards the canal) position.
  • Cord prolapses- When the umbilical cord slips through the cervix and into the vagina before the baby enters the birth canal. This creates pressure on the cord depriving the baby of blood flow, that may result into an emergency situation requiring a C-section to save the life of the baby.
  • Health issues- Health issues of the baby at the time of birth, like congenital heart diseases, or excess fluid in the brain require a caesarean to avoid risk to the baby. Similarly, any issue with maternal health as gestational diabetes, high blood pressure, heart diseases require a C-section surgery.
  • Multiple babies- The need for C-section arises in cases of multiple babies, there are more chances of prolonged labour, abnormal positioning of the fetal or one or more large babies.
  • Placenta issues- Placenta (a structure that develops in the uterus that enables the exchange of oxygen and nutrients between the mother and the fetus). At times the placenta may cover the part or whole of the birth canal (placenta previa) or it may prematurely get detached from the uterus before childbirth. In either case, caesarean delivery becomes necessary.
  • Previous C-Section- Previous caesarean is one of the reasons, the mother may not be able to have a normal delivery the second time. However, this does not necessarily mean that one has to go through C-section surgery. A normal delivery may be possible if the health of the mother shows low-delivery risks.

Conclusion

Before planning a C-section, one must consult the doctor and stay informed about the why and what to expect during the procedure. Any queries and concerns regarding the procedure must be asked to ensure that they are addressed satisfactorily. All the myths surrounding the need for C-section surgery be removed through awareness about pregnancy and related matters.

A surgical procedure might be a need in certain circumstances for a safe childbirth. However, like any surgical procedure its carries risks, that need to be taken into consideration, especially while opting for it as a preferred choice. Future pregnancies and maternal health often get affected due to C-Sections; hence the decision should be a well thought out decision. Stay informed and be aware of all the issues concerning a safe and healthy pregnancy and childbirth experience.

References

Cesarean Section | Johns Hopkins Medicine
https://www.health.harvard.edu/womens-health/ask-the-doctors-what-determines-whether-a-woman-needs-a-cesarean-section
Maternal health (who.int)
https://www.bbc.com/news/health-38223502

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Contraception

Life with an Intrauterine Device: Dispelling Myths and Addressing Concerns

Introduction

The unverified and unwarranted information about pregnancy preventive measures often becomes overwhelming for couples who are planning birth control. Such things mislead people into believing that contraception is harmful and dangerous to maternal health. The spread of misconception triggers anxiety, stress among the patients, and distrust in the clinical solutions of birth control and family planning. For a long time, the lack of awareness and ignorance about family planning had been the cause of reluctance and resistance among the masses in availing of the benefits of these contraceptive measures. Contraceptive methods have witnessed a profound transformation in sophistication, safety, and effectiveness. However, there are many myths still prevailing about birth control methods, and in particular, the Intrauterine devices that need to be dispelled for good.

What is an intrauterine device?

As a contraceptive method, an Intrauterine device (IUD) is one of the safest and effective methods of preventing pregnancy in women. It is a long-acting reversible contraceptive method for avoiding pregnancy. The device is small and T-shaped and is inserted in the woman’s uterus to prevent her pregnancy. Removed any time when the woman wants to become pregnant, IUD has a string at the bottom that extends to the vagina, enabling the health provider to remove the device when required.

IUD insertion is a safe and simple procedure of a few minutes in which the healthcare professional uses a speculum to widen and examine the patient’s vagina and insert the IUD. 

These devices could be Copper IUDs or Hormonal IUDs. Copper IUDs release copper ions into the uterus and act as a spermicide by killing the sperm in the uterus. Hormonal IUDs release a synthetic hormone, the progestin-like hormone Levonorgestrel (LNG), similar to the progesterone hormone secreted by the woman’s reproductive system, preventing ovulation.  

Myths and Facts About Intrauterine Devices

Myth –  IUDs cause abortion and, hence, end pregnancy.

Fact–  IUDs do not cause abortion. They are contraceptives and not abortifacients.
Abortion is the termination of pregnancy when the embryo or fetus is removed. 
IUDs are devices that prevent pregnancy. They either act as spermicides, killing the sperms, or thickening the cervical mucus and preventing the sperms from entering the uterus. So, it prevents the fertilization of the eggs.

Myth – IUDs are unsafe and harmful to maternal health, with side effects and chances of infection, cancer, and sexually transmitted diseases.

Fact –  IUDs are a safe and effective method of contraception. 
Gone are those days when IUDs did carry the chances of pelvic infection. New devices do not carry such risks of infection. Moreover, hygiene awareness and access to hygienic medical facilities and methods have contributed to reducing this infection risk. It may be noted that IUDs may not prevent infection but do not cause it. Proper device insertion helps avoid infection, perforation, and expulsion. 

IUDs do not cause cancer in healthy women, nor does it increase the risk of STDs. The chances of STDs are higher in sexually active women who do not use IUDs than those using them.

Myth– IUDs cause infertility or miscarriage post-removal.

Fact- IUDs are safe, reversible, long-acting contraceptive methods that women can at any time stop using, if they want to become pregnant. IUDs do not cause infertility or miscarriage in women after their removal. In the absence of proper hygiene care, a woman may develop pelvic inflammatory disease. If the condition is not treated timely, there are chances of infertility. However, such cases are rare.

Due to improper IUD insertion, if, in the rarest of cases, a woman becomes pregnant and the IUD is left in the uterus during pregnancy, there may be a chance of preterm delivery or miscarriage.

Myth–  It affects the sex life by causing inconvenience during intercourse.

Fact– IUDs provide relief from the stress and worries of getting pregnant and hence have a sex life stress-free and enjoyable. IUDs do not cause inconvenience in the sex life, discomfort, or pain during intercourse, nor do they get displaced due to intercourse.

Conclusion

IUDs are safe and effective when appropriately inserted. They are long-acting and reversible and can be removed when needed. The proper insertion of an IUD is the condition precedent to the successful and safe prevention of pregnancy. All the myths surrounding its use need to be dispelled and discouraged to ensure that more women use this method for safe and effective contraception. Maternal health and safe childbirth are paramount. To enable an informed decision, consult your doctor before planning birth control, who can address all your concerns and questions relating to contraception. 

References

https://theincidentaleconomist.com/wordpress/there-are-too-many-myths-about-iuds-lets-dispel-some/
https://pubmed.ncbi.nlm.nih.gov/9834505

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Peripheral Vascular

Therapeutic Approaches for Peripheral Artery Disease: Understanding Their Necessity

Introduction

Experience of any sharp pain or numbness in your legs after an extended period of sitting, painful cramps or aching in your hips, thighs, or calf muscles common and frequent after any physical activity, or coldness in lower feet, are signs of blockages in the arteries of the lower extremities. The condition is known as peripheral artery disease. As per reports, it is common, with nearly 41 to 54 million[1] estimated cases in India and nearly 4.2.to 6.2 million[1] people are afflicted by critical limb ischemia. According to the American Heart Association statement, approx. two hundred million people suffer from arterial blockages of the extremities worldwide.

The alarming statistics and the rising cases of other complications associated with arterial blockages in diabetic patients and people with smoking and alcohol consumption and/or obesity raise more significant concern for its stringent preventive measures and prompt and effective address.

The blog discusses the condition of arterial blockages, its causes, symptoms, and the treatment options for its effective control and management.

Peripheral Artery Disease- Its Causes and Symptoms 

Peripheral Artery Disease (PAD) results from the narrowing of the arteries that carry blood from the heart to the peripheral arteries as well extremities, commonly the legs. The lack of oxygenated blood supply due to the narrowing of the arteries causes ischemic pain. The causes of arterial blockages are-

  • Atherosclerosis – Plaque (fatty deposits) buildup over time results in the narrowing of the arteries, interrupting the blood supply to the peripheral arteries.
  • Thrombosis– A clotting of the blood in the narrowed artery is one of the reasons for arterial blockages.
  • Embolism– A condition of blocked artery caused by a blood clot or an air bubble in which the smooth flow of blood to the artery is interrupted, leading to an insufficient supply of oxygen. This causes pain, cramps, and other related symptoms of PAD.

Symptoms of PAD

People with PAD may not experience any symptoms until they become severe, which could at times adversely affect the heart health of the patient, if left unaddressed. This is so because PAD shares many common risk factors like diabetes, high cholesterol, high blood pressure, obesity, and smoking with heart disease.

The main symptom of PAD is claudication, where the person experiences flared cramping and pain in the legs and thighs when walking and subsides when at rest. The other symptoms include coldness in feet, numbness, tingling, or slow healing or unhealing of wounds.

Treatment for PAD

Preventing diseases and related complications is the best way to live a healthy life and enrich your quality of life. People with PAD are at a high risk of cardiovascular diseases and chances of stroke, heart attack, and other heart-related issues. Treatment for PAD requires rigorous and stringent healthcare precautions and aggressive lifestyle modifications.

Self-care and medications

A healthy diet, regular exercise, quitting smoking, management and control of comorbidities through medications, effective stress management, regular checkups, and monitoring through routine tests go a long way in preventing PAD and other related complications.

Surgical and non-surgical approaches

After the color doppler test, ankle-brachial index and vascular ultrasound test, the healthcare provider decides whether the patient needs surgical intervention to treat PAD. The severity of the condition is the primary and deciding factor for surgical intervention with other anatomical and health conditions of the patient.

Vascular Surgery

Known as open surgery or bypass surgery, the surgeon creates a new path around the blocked artery, using the healthy blood vessels from the other part of the patient’s body. This is known as grafting. The blood flows through the new path, bypassing the blocked artery.

During this bypass surgery, the patient is put on general anesthesia to keep them comfortable. The surgeon makes incisions to access the arteries and veins. The surgeon may use healthy veins like the saphenous veins (superficial veins in the legs), cephalic veins (veins from the arm), femoral veins (from thighs in case of more extensive artery grafting) from the patient’s body or use a synthetic material for grafting when natural healthy veins cannot be used. The surgeon sews the bypass in place and closes the incisions.

Endovascular Interventions

Atherectomy- It is a minimally invasive procedure to remove plaque from blocked arteries. During the procedure, the healthcare provider uses a sharp blade or laser attached to the tip of the catheter to cut or scrape out the hard plaque. The atherectomy could be Excisional (the blade cuts the plaque in one direction), Orbital (the plaque gets removed with a spinning tool), Rotational (the blade cuts the plaque in a rotating movement), or Laser ablation (the plaque is removed using laser) atherectomy.

Angioplasty – To treat any blood vessel damage, the interventional healthcare professional accesses them through minimal invasiveness. In endovascular intervention, the healthcare professional usually makes a tiny incision in the groin to gain access to the damaged arteries. Using the X-ray real-time images, the catheter, with a balloon attached, is guided to the damaged artery. Once in place, the balloon is inflated, pushing the plaque to the sides of the arterial walls, and paving the way for the uninterrupted flow of the blood.

In the case of angioplasty, the healthcare professional implants a stent, clearing the passage for the blood to flow in the affected artery. A stent, a small mesh tube, keeps the artery open for blood flow. Once the stent is placed, the balloon is deflated, the catheter is removed, and the incision is closed.

Apart from treating peripheral arteries, these stents are widely used to treat various artery blockages, like the coronary, renal, and carotid arteries.

Angioplasty has been gaining acceptance as a standard of care for treating blocked arteries due to its minimal invasiveness, resulting in less pain and tissue scarring, faster healing and recovery, shorter hospital stays, and quicker return to normalcy.

Conclusion

There are many risk factors common between PAD and heart disease; hence, effective control and management of one help to prevent the incidence of the other. PAD with other conditions of diabetes, high blood pressure, high cholesterol, or obesity puts the patient at a higher risk of heart disease. Rigorous, consistent, and aggressive lifestyle changes are a must for its prevention. However, in severe cases, where self-care, medications, lifestyle changes, and other alternate treatment modalities do not offer the desired results, surgical and non-surgical treatment options should be resorted to for timely and effective treatment.

The choice of the medical treatment option depends on the healthcare professional’s decision, arrived at after considering the severity of the condition, the age, anatomy, and overall health of the patient. Surgical and non-surgical treatment help repair the damage to the artery by removing the blockages. However, one must own responsibility toward one’s health and adhere to the doctor-recommended diet plan, exercise regime, and recovery plans, and quit smoking and tobacco consumption post-treatment for healthy living.

References

https://journals.lww.com/cmii/fulltext/2020/18030/endovascular_therapy_in_vascular_surgery___how.2.aspx#:~:text=41%E2%80%9354%20million%2C%20with%20an%20estimated%204.2%E2%80%936.2%20million%20patients%20of%20critical%20limb%20ischemia
https://www.heart.org/en/news/2023/06/15/routine-tests-may-reduce-disparities-in-peripheral-artery-disease-and-amputation-risk
https://www.narayanahealth.org/blog/what-is-peripheral-arterial-disease-pad/#:~:text=According%20to%20an%20International%20organization,built%20up%20in%20the

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