Peripheral Arterial Disease. We Can Fight the Disease, Slow its Progression, But Not Defeat it

In one of my recent papers, "Peripheral Artery Disease: Double Focal Compression Bandaging Technique", I discuss several clinical cases involving severe peripheral arterial disease successfully treated with this technique.Despite a common belief among primary care physicians and nurses that, compression bandaging should be avoided in patients with peripheral arterial disease (PAD) and an ankle brachial index (ABI) of 0.80 or lower, this stance is misguided and may deny patients, the opportunity for early arteriopathy intervention by compression therapy.An ABI of 0.80 indicates the presence of peripheral arterial disease and should prompt evaluation by an angiologist.However, it is not a strict contraindication for compression therapy.Instead, close monitoring of the disease's clinical course, during the initial weeks, is advisable to detect any signs of deterioration and removing the compressive bandage.Compression therapy can be safely employed in patients with peripheral arterial disease and an ankle brachial index between 0.60 and 0.80, contributing to improved tissue blood flow and the healing of the vascular ulcer.I document the clinical progression of a patient diagnosed with severe peripheral arterial disease, starting from the amputation of half of the left foot, twelve years ago (2011) to the supracondylar amputation of the right foot (2023).The clinical evolution is categorized into three distinct phases: The first phase involves the patient undergoing a trans-metatarsal amputation of the left foot, twelve years ago (2011), until the second phase, the patient experienced an episode of decompensated heart failure and unstable angina (2016).The third and final phase outlines the patient's initial trans-metatarsal amputation of the right foot, followed by several leg surgeries.Despite these interventions, a deteriorating clinical condition ultimately necessitated a supracondylar amputation of the right lower extremity (2023).In my view, greater efforts could have been undertaken to prevent the need for the supracondylar amputation.It is not a solution, to stay in bed while waiting for the wound to heal.I will strive to articulate and justify my perspective.My intention is not to spark controversy regarding the actions of vascular surgeons, but rather to shed light on this matter to postpone, for as long as possible, the inevitable amputation.While we cannot completely overcome the challenges posed by atherosclerosis, we can slow its progression.