peripheral artery disease

New PAD Resources: 7 Peripheral Artery Disease Ask the Expert Videos & Live MD Chat

Peripheral Artery Disease ResourcesAs we have discussed in previous posts on PAD, millions of people in the United States suffer from this life, and potentially limb threatening, disease. What is unfortunate is that many people don’t know they have it.  In our Peripheral Artery Disease “Ask the Expert” video series we answer many questions about PAD including:

  • What is PAD?
  • What are common symptoms of PAD?
  • How do you test for PAD?
  • When should someone be tested for PAD?
  • What are the treatment options for PAD?
  • What physicians are involved in treating PAD?
  • What kind of research is being done at Emory for PAD?

If watching the PAD videos sparks questions, join my colleague Dr. Khushrow Niazi on Monday, April 25 from 12:30p.m. – 1 :15p.m. for an interactive, online Q&A web chat on the topic of PAD. He will answer questions and discuss various topics about PAD including prevention, detection, symptoms, testing, treatment options and innovative new research.

If you think you may have PAD after viewing the videos, please call Emory HealthConnection℠ 404-778-7777 to schedule an appointment.

Do you have questions about PAD in general? If so, please let me know in the comments section.

About Ravi Veeraswamy, MD:

Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Recently, Dr. Veeraswamy has published articles in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

Peripheral Artery Disease: Donna Seaman’s Story

My name is Donna Seaman, and I’d like to share my story of Peripheral Artery Disease with you.

First—a little background for you: I’m from Massachusetts, and I’ve lived in Atlanta for over 35 years now. I attended Emory University and majored in business before becoming a buyer for Rich’s (now Macy’s). I enjoyed the best of both worlds in that I spent several years as both a working Mom, and several as a stay-at-home Mom. I live in Dunwoody, and I have two children—a 26-year-old daughter, and a 23-year-old son.

I’ve been playing tennis now for over 20 years, and once I hit my late 40s I began to notice some leg pain and swelling. At the time, I attributed it to normal wear and tear, and assumed it was also due to all of the years I spent on my feet working in the retail industry. When the pain worsened after about a year or so, I knew it was time to seek medical help.

When Dr. Niazi asked me if I was experiencing any other symptoms, I shared the fact that my tennis game had been really “off”, and that I had noticed that I was stumbling around more and feeling clumsier in general. I would also pick up items and unintentionally drop them. I didn’t think much of these particular symptoms, but the folks at Emory really took notice when they heard me mention them, and decided to run some more tests.

After the tests, Emory called me with the results and informed me that not only did I have peripheral artery disease in my legs, the carotid artery in my neck was 97% blocked. (My neck artery blockage was what was causing the stumbling and clumsiness.) Dr. Niazi immediately warned me not to have any neck rubs or massages, and to exercise caution when I was getting my hair washed at the salon or bending my neck. With 97% of the artery blocked, I was dangerously close to experiencing a stroke.

Initially, I had less invasive procedure that involved the physician going through my groin area and then up into my neck in order to place a stent. However, after reviewing the results of the procedure, Dr. Niazi realized that my condition was worse than he anticipated. He recommended that I undergo total carotid artery surgery, which was necessary given my younger age and the severity of the blockage.

A week later (in October of 2009), I was back at Emory for the carotid artery surgery that would clean out the build-up of plaque.  I was in the hospital for three days for the procedure. I left Emory with a scar on my neck and the knowledge that I’d come dangerously close to having a potentially fatal stroke. In my mind, it’s a sort of miracle that my condition was discovered the way it was—if it weren’t for Dr. Niazi’s proactive treatment of my PAD, I’m not sure I’d be here to tell you my story today.

About a month later, I was treated for the PAD that was present in my legs. This was a much simpler procedure—and was practically right in and out of the hospital for it.

Since the surgery, I started taking medication for cholesterol and high blood pressure, and I have yearly checkups to the doctor. I no longer feel any pain in my legs when I exercise. My walking is better, and my balance has improved greatly.

I can’t say enough good things about Dr. Niazi and the team at Emory who treated me. They’re personable, professional, and top-notch, and they took a personal interest in me and carefully listened to me speak about my concerns and symptoms. I feel very fortunate that I was in such good hands and that I escaped the life-threatening repercussions of PAD.

Treatment Options for Peripheral Artery Disease

In this post, we’ll continue our blog series by examining the various treatments for treating peripheral artery disease (PAD).

Lifestyle

Before we delve into the various medical treatment options for PAD, we must point out the importance of taking control of your own health. If you’re suffering from diabetes, this means that you must carefully monitor your blood sugar levels. If you’re a smoker, we cannot stress the importance of doing everything in your power to quit the habit. PAD is very common among smokers, and smoking only exacerbates the effects of the condition.

Additionally, we strongly encourage regular exercise as a means of treatment—it increases blood flow to your legs and can actually alleviate symptoms. For some, exercise may be painful; however, you can often work your way up to a level of exercise that’s extremely beneficial as well as tolerable.

Medication

Medication may be necessary to offset the effects of PAD and lower the risk of heart attacks and stroke.

Antiplatelets affect blood platelets, causing them to be less likely to stick together to form blood clots. One of the most common antiplatelets is aspirin.

Anticoagulants prevent blood clotting, but must be monitored carefully for side effects. Two examples of anticoagulants are heparin and warfarin.

Cholesterol-lowering drugs have also proven to be effective in preventing heart attacks and stroke. Additionally, they can improve atherosclerosis and alleviate painful symptoms resulting from claudication. Statins and niacin are both examples of cholesterol-lowering drugs.

Angioplasty & Surgery

Many times, PAD patients require treatments such as angioplasty or surgery. As we described in our last blog post, angioplasty involves the insertion of a catheter into the groin area and then into the narrowing arteries. Partially blocked arteries can be opened through the insertion of a tiny stent or balloon.

For patients with more severe instances of PAD, more invasive means of surgery may be necessary, such as endarterectomy, which removes the buildup of plaque within the affected arteries. Bypass surgery may also be performed, which involves the replacement of blocked arteries with a graft. This encourages blood flow to move around the narrowed or blocked arteries.

If you have questions on any of these procedures or treatments, please be sure to let us know in the comments.

About Gregory Robertson, MD:

Dr. Robertson specializes in Cardiology and Internal Medicine, and is an Assistant Professor of Medicine at Emory. Some of his areas of clinical interest include atherosclerosis, cardiac catheterization, cardiovascular disease, valve disease, and peripheral artery disease. Dr. Robertson holds an organizational leadership membership at The American College of Cardiology, and has contributed to multiple publications in his field.

About Ravi Veeraswamy, MD:

Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Dr. Veeraswamy had major or recent publications in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

Diagnosing Peripheral Artery Disease

In previous blog posts, we’ve discussed patient stories and described symptoms of peripheral artery disease (PAD). Today, we’ll focus on what types of patients are candidates for screening and treatment, and the types of screening methods available.

Risk factors for PAD include people who are over the age of 70, over the age of 50 and suffering from diabetes, and smokers. In some cases, people under the age of 50 may be at risk, particularly if they’re obese, suffering from diabetes, or if they have high blood pressure.  High cholesterol or a family history of the disease also increases the risk of developing PAD.

If we suspect that you have PAD, we’ll perform one or more of the following tests:

General physical exam:

Here, we’ll examine your body in an attempt to pinpoint any potential signs of PAD. This typically includes checking the pulse (particularly below the suspected weakened artery), listening for sounds over your arteries, checking your blood pressure, and tapping areas of your body to assess the level of fluid in your organs.

Doppler Ultrasound:

The Doppler Ultrasound test gauges the blood flow within the arteries in your arms and legs. It can diagnose arteriosclerosis, blood clots and artery blockages, and venous insufficiency or occlusion.

Angiography:

With angiography, we insert a dye into your blood vessels, which enables us to view the flow of blood though your arteries. During the procedure, X-rays are taken, or MRA (magnetic resonance angiography) may be used to follow the flow of the dye. Additionally, a catheter may be used (this is referred to as catheter angiography), and inserted into the groin area and into the area of the body being examined. While this particular method is a bit more invasive, it’s also beneficial in that we can treat the area in question while we examine it by inserting medication or opening partially blocked arteries with a stent or balloon.

Ankle-brachial index:

The ankle-brachial test measures the blood pressure at your ankle and compares it to the blood pressure in your arm. Your blood pressure is measured before and after you walk on a treadmill to determine whether PAD is present. The ABI test is considered to be one of the most reliable for determining the presence of PAD.

These are the main tests that we typically perform in order to diagnose and evaluate PAD; however, additional tests may be necessary.

Do you have questions about how we diagnose PAD? If so, feel free to ask away in the comments section.

About Dr. Joseph Ricotta, MD:

Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010.  His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases. He holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery, and the Society for Vascular Surgery.