Posts Tagged ‘PAD’

Understanding Peripheral Vascular Disease

PVDDo you experience painful muscle cramps in your hips, thighs or calves when moving around? You may be surprised to learn that this is the primary symptom of peripheral vascular disease (PVD). PVD is defined as diseases of the arteries outside of the heart and brain. PVD is a term used interchangeably with peripheral artery disease, or PAD, but PVD encompasses diseases of the arteries AND veins.

Arteries move blood away from the heart, and PAD typically involves the narrowing of the arteries that transport blood to the arms and legs. Veins take the blood back to the heart and generally don’t get narrowed with cholesterol, but rather develop another very common condition called chronic venous insufficiency (varicose veins).

PAD – Arteries

Many patients go undiagnosed because the symptoms can be attributed to something else, such as arthritis, a neuropathy or normal stiffness that occurs with aging. Patients with PAD may also experience numbness, weakness or coldness in one or both legs. Often the symptoms come on slowly and the patient starts altering their life style and become more sedentary.

On the other hand, at least half of people who suffer from PAD have no signs or indications at all. Risk factors for PAD include aging, personal or family history, cardiovascular disease or stroke. Controllable risk factors include:

  • Cigarette smoking
  • Obesity
  • Diabetes mellitus
  • Physical inactivity
  • High blood cholesterol
  • High blood pressure Renal failure

Chronic Venous Insufficiency

This is more common than PAD and may start at an early age. The symptoms of this may include any one or more of the following: legs feeling heavy or tired especially at the end of the day, mild swelling of ankles, severe cramps at night time, restless legs, itching of legs, or formation of visible veins on the leg. In severe cases the skin around the ankle area may get darker in color and sores may form, generally above the ankle, which are slow to heal.

Some of the risk factors include age, family history of varicose veins, obesity, standing for long periods on hard surfaces and history of blood clots or phlebitis in the leg.

If you have any of the above symptoms or would like to discuss your risk factors, talk to your healthcare provider. PVD diagnosis begins with a physical examination.

At Emory, treatment of PVD is a combined effort within the Emory Heart & Vascular Center, the Division of Vascular Surgery and Endovascular Therapy and Interventional Radiology. To make an appointment, call 404-778-7777.

About Khusrow Niazi, MD

Khusrow Niazi, MDDr. Niazi specializes in interventional cardiology, carotid artery disease, peripheral artery disease and venous disease of the legs. He has been practicing at Emory since 2003. He has been involved in many trials in treating blockages in the carotid arteries and leg arteries with less invasive options. Dr. Niazi is involved in trials focused on the removal of plaque from the leg arteries with less invasive methods. He also has treated many patients with chronic venous insufficiency and varicose veins.

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.

Join Me for a Peripheral Artery Disease Online Chat

Peripheral Artery Disease Online Doctor ChatPeripheral Artery Disease (PAD), defined as diseases of the blood vessels outside the heart or brain, affects eight to 12 million people in the United States. PAD happens when there is a narrowing of the blood vessels outside of your heart. The cause of PAD is atherosclerosis, and occurs when plaque, a substance made up of fat and cholesterol, builds up on the walls of the arteries that supply blood to the arms and legs. Unfortunately, individuals with PAD are at an increased risk for heart disease, aortic aneurysms and stroke.

Additionally, PAD can be a precursor to diabetes, hypertension and various other medical conditions. If you get treatment early and take preventative steps, PAD can be managed effectively and does not  have to take over your life. Should you receive a diagnosis of PAD, you can often stop or reverse the buildup of plaque in the arteries with dietary changes, exercise and efforts to lower high cholesterol levels and high blood pressure. You can take control by leading a heart-healthy lifestyle and most cases of PAD can be managed with lifestyle changes and medication.

Join me on Monday, April 25 from 12:30 – 1:15pm for an interactive online Q&A web chat on the topic of PAD. I will be available to answer questions and discuss various topics about PAD including prevention, detection, symptoms, testing, treatment options and innovative new research.

If you are interested in learning more about this topic, you may register online for the live chat now. Spread the word about our education session to your friends who may suffer from this potentially debilitating disease.

About Dr. Khusrow Niazi

Dr. Niazi specializes in interventional cardiology, carotid artery disease, peripheral artery disease and venous disease of the legs. He has been practicing at Emory since 2003. He has been involved in many trials in treating blockages in the carotid arteries and leg arteries with less invasive options. Dr. Niazi is involved in trials focused on the removal of plaque from the leg arteries with less invasive methods

 

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.

What Are the Symptoms of Peripheral Artery Disease?

As we pointed out in our previous Peripheral Artery Disease (PAD) post, nearly half of people with this condition are unaware of their diagnosis because they experience no symptoms or are unaware that their complaints are due to PAD.  PAD can develop slowly over one’s lifetime so that symptoms may not present until arteries are severely blocked.

One of the major symptoms associated with this disease is referred to as claudication, which involves pain or cramping in the arms or legs during exercise or merely walking.  Every patient is different and some may experience it as heaviness, burning, or numbness.  The pain typically diminishes with rest, and may be severe, depending on the blockage of the artery.  When involving the legs, this symptom occurs most commonly in the calf muscle, but can often involve the buttocks or thighs.  Claudication may occur in one or both legs.  Discomfort is often worse when walking up stairs or uphill.

In severe cases, PAD can also cause symptoms that involve intense pain at rest. This is due to insufficient amounts of blood or oxygen reaching the legs even in the resting state.  Patients may find that they have severe pain at night relieved by hanging the foot down from the bed.

Other symptoms of PAD include:

-       Numbness of the limbs/extremities

-       Sensation of coldness in the legs or feet

-       Ulcers in the toes

-       Redness or discoloration of the skin

-       Foot and toe sore that will not heal

-       Loss of hair on the legs and changes in nail growth

Our next post will discuss which patients and/or candidates should be treated for PAD. If you have questions on the symptoms of PAD, or about this condition in general, please be sure to let me know in the comments.

About Chandan Devireddy, MD:

Dr. Devireddy specializes in Interventional Cardiology and Cardiovascular Medicine, and has been practicing with Emory since 2005. He actively participates in the Interventional Cardiology research department, which has been a significant enroller in several multi-center clinical trials. His individual research interests include acute coronary syndromes, novel coronary and peripheral technology, and medical and interventional treatment of peripheral vascular diseases.

Minimally Invasive Treatment for Peripheral Artery Disease: Dave Kirschner’s Story

In 2008, Dave Kirschner chose to retire from a successful 50-year career in the radio business. For years, CNN Radio listeners listened to him as he brought them up to speed on current events. Now, Kirschner spends his time working around the house, staying in touch with industry friends, and working out on the treadmill several times a week. However, when he began to notice a recurring pain shooting down the back of his right leg during exercise, he was concerned.

At first, Kirschner thought that he might have a pulled muscle, so he attempted to ease the pain with stretching, massage, and over-the-counter remedies. When nothing worked, he realized that he may have a deeper problem, and he called his internal medicine doctor.

His doctor conducted a test called an Ankle Brachial Pressure Index, or ABI—which revealed that Kirschner was suffering from peripheral artery disease (PAD).  As we’ve described in previous blog posts, PAD develops when arteries become clogged with plaque and fatty deposits that limit the flow of blood to extremities, especially the legs.

The major symptom that Kirschner was experiencing is called intermittent claudication—a pain that occurs during periods of exercise, such as walking or climbing the stairs. When we exercise our muscles require more blood flow—if there is blockage in the blood vessels, the muscles don’t receive enough blood, which causes intermittent claudication.

The first Atlanta cardiology group that Kirschner visited recommended that he have a stent inserted into his leg to unblock the artery. However, this option wasn’t appealing to him—he’d had cardiac bypass surgery in the past and wanted to avoid invasive surgery if at all possible.

Kirschner proceeded to search for other alternatives for PAD treatment—he researched the Internet and asked several of his trusted friends for advice. He even considered traveling out-of-state to find a facility that would offer what he was looking for. Finally, he spoke with a podiatrist friend, who recommended that he contact me at Emory.

After examining Mr. Kirschner, we reviewed his options and decided that a minimally invasive outpatient procedure would be the best way to treat his condition. We used a recently developed device to shave away the plaque in his arteries—the device deploys a tiny rotating blade on the tip of a catheter to remove plaque from the arterial wall. This procedure has been extremely successful in helping patients to prevent blood flow problems that could potentially result in something as serious as amputation.

The device doesn’t stretch the blood vessel wall, unlike the use of stents. It is used to treat calcified and non-calcified lesions of any length. Further, it is minimally invasive and doesn’t require that we open up the leg.

Kirschner’s procedure took less than two hours. When he asked me how long I thought it would be before he could go back to working out, he was shocked when I replied, “How about tomorrow?” He left our office the same day that he went in, with only a tiny incision at the top of his leg, covered by a band-aid.

Today, Kirschner can hit the gym and exercise with no pain. His workout regimen consists of hour-long walks, which he enjoys without any problems. We’re thrilled that we were able to treat his condition with our innovative technology, and we look forward to achieving the same results with future patients suffering from PAD.

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.

Examining Peripheral Artery Disease

Khusrow Niazi, M.D.

Peripheral Artery Disease (PAD) is defined as diseases of the blood vessels outside of the heart and brain. PAD is a term used interchangeably with Peripheral Vascular Disease, or PVD, and typically involves the narrowing of vessels that transports blood to the arms and legs.

Perhaps the most challenging aspect of this disease is the fact that it often carries no symptoms. At least half of people who suffer from it have no signs or indications. Unfortunately, up to 60% of an artery can be blocked by the time the condition is discovered.

Eight to 12 million people in the US suffer from PAD, and are at increased risk for heart disease, aortic aneurysms, and stroke. Additionally, PAD can be a precursor to diabetes, hypertension, and various other conditions.

Karthik Kasirajan, M.D.

PAD is usually accompanied by atherosclerosis, a process in which plaques, hard cholesterol material, and fatty substances collect along the interior walls of the arteries. As the material hardens, it ultimately causes the arteries to narrow, which can cause diseases in other organs throughout the body.

Atherosclerosis is a systemic disease; in other words—it affects the entire body. Therefore, it’s common for people with PAD to have blocked arteries in other areas of the body. Those who suffer from PAD are at increased risk of heart disease, aortic aneurysms, and stroke.

At Emory, medical, surgical and catheter-based treatment of PAD is a combined effort from the Emory Heart & Vascular Center, the Division of Vascular Surgery and Endovascular Therapy, and Interventional Radiology.

In our next series of blog posts, we’ll examine other aspects of PAD, including symptoms, prime candidates for treatment, treatment options, and patient stories.

Do you have questions regarding Peripheral Artery Disease? If so, please let us know in the comments section—we’re happy to address them.

About Khusrow Niazi, MD:

Dr. Niazi specializes in interventional cardiology, carotid artery disease, peripheral artery disease and venous disease of the legs. He has been practicing at Emory since 2003. He has been involved in many trials in treating blockages in the carotid arteries and leg arteries with less invasive options. Dr. Niazi is involved in trials focused on the removal of plaque from the leg arteries with less invasive methods.

About Karthik Kasirajan, MD:

Dr. Kasirajan specializes in surgery and vascular surgery, and has been practicing at Emory since 2003. Several of his areas of interest include peripheral arterial disease, endovascular surgery, abdominal and aortic aneurysm, vascular surgery, thrombotic disease, and stroke. Dr. Kasirajan holds many organizational leadership memberships, including the European Society for Vascular Surgery, International College of Surgeons, and the Peripheral Vascular Surgical Society, and is widely published in publications such as the Journal of Endovascular Therapy and the Journal of Vascular Surgery.