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Peripheral Artery Disease (PAD)


When the arteries in your legs become narrowed or blocked, the legs do not receive enough blood. This is called peripheral artery disease (PAD). It can cause pain when you walk, known as intermittent claudication (IC.) In very advanced cases, the tissues of the legs might not receive enough blood and nutrients to maintain their health even in the resting state. This can cause pain at rest and can lead to the development of ulcers or wounds on the lower extremities.

Risk factors for PAD are smoking, diabetes, high cholesterol, family history of vascular or heart disease, increased age, and obesity. Both men and women can have PAD, but it is more common in men.

The symptoms of PAD can vary. Some people with very early PAD may not have any symptoms at all. However, certain clues about the presence of underlying PAD may be seen on a physical examination. When symptoms are present, many individuals with PAD will feel pain or tightness in the muscles of the calf or buttock area when walking. This may be worse when walking up a hill or a flight of steps as compared to walking on a flat surface. Typically, the pain will subside with rest and then reoccur with additional walking. The problem may be progressive over time, causing the onset of pain to occur with shorter walking distance.

In more advanced cases of PAD, an individual might experience pain in the feet when not walking. This is known as ischemic rest pain and is a symptom of more serious PAD. This most commonly occurs when the legs are elevated, such as when in bed. In the most advanced cases of PAD, the skin of the lower extremities can begin to die, known as gangrene.

The treatment of PAD depends upon many factors, including the severity of ones particular situation and other medical conditions.

Treatment option may include:

  • Lifestyle modification (quitting smoking, exercise, diet, etc.)
  • Medications
  • Minimally invasive procedures (angioplasty, stenting, atherectomy.)
  • Surgery

 Each case is individual and your doctor will explain what treatment options are recommended for your particular situation.


PAD


Carotid Artery Stenosis


The carotid arteries are the blood vessels in the neck that provide the majority of the blood to the brain. When they become narrowed with plaque, an affected individual may be at risk of having a stroke. That is because small pieces of plaque or blood clot that develops on the plaque can break off and become lodged in the small arteries in the brain. In some cases, the carotid artery plaque can progress to the point of completely blocking the main artery, interrupting blood flow to a large area of the brain.

 In the early stages of carotid artery stenosis an individual may not have any symptoms. The process may be completely silent. However, as the disease progresses, one might develop warning signs, such as a transient ischemic attack (TIA.)

Symptoms of a TIA can be:

  • sudden onset of weakness, tingling or loss of function of an arm or leg
  • loss of coordination of an arm or leg
  • the inability to speak
  • loss of vision in one eye

The symptoms of a TIA are temporary. However, they can be an important warning for an impending stroke. If you experience any of these symptoms, you should seek immediate medical care.

Some of the treatments for carotid artery stenosis are:

  • Lifestyle modification (quitting smoking, diet, etc.)
  • Medications
  • Ultrasound surveillance to rule out progression of blockage
  • Surgery (carotid endarterectomy)
  • Carotid stenting

Unfortunately, the first symptom of carotid artery stenosis can be a major stroke causing permanent paralysis, other disability, or even death. Therefore, diagnosis of carotid artery stenosis is extremely important. The diagnosis can be made with noninvasive vascular ultrasound testing, called a carotid duplex scan. This is a painless test that is able to determine whether the carotid artery is block, and if so, the degree of blockage. Carotid duplex scan is one of the vascular tests performed in our IAC Accredited noninvasive vascular laboratory. The treatment of carotid artery stenosis depends upon a person’s symptoms, the degree of blockage and a person’s other medical conditions. Each case is individual and you doctor will explain what is most appropriate in your particular situation.

Carotid 5_edited-1


Abdominal Aortic Aneurysm (AAA)


The aorta is the largest artery in the body. The walls of the aorta can weaken, causing the artery to expand similar to a balloon. When it expands beyond its ability to hold the pressure of the blood being pumped by the heart, an aneurysm can burst, known as a ruptured aneurysm. This causes severe internal bleeding and often results in death. The risk of rupture is related to the size of an AAA. The risk increases when an AAA reaches 5cm – 5.5cm in diameter. Diagnosis of AAA is essential to allow for treatment of appropriate sized AAA prior to it rupturing.

The risk factors for AAA are:
  • Smoking
  • Increasing age (more common over 60)
  • Family history of AAA in an immediate relative
  • High blood pressure
  • Chronic lung disease
  • More common in men (although women can also have AAA)


 

 Sometimes, in very thin individuals, an AAA can be felt on a physical examination. However, the aorta is located in the back of the abdomen against the spine. Therefore, it can be difficult to feel in most people. Diagnostic tests such as ultrasound, CT scan and Magnetic Resonance Imaging (MRI) can be used to make the diagnosis of AAA. Abdominal aortic aneurysm is often silent, with affected individuals not knowing they have it until it is either discovered on a diagnostic test, or the AAA ruptures causing a life-threatening emergency. Individuals with certain risk factors for AAA should undergo routine screening with ultrasound to determine whether they have an AAA. Sometimes, people with AAA will feel a pulsating sensation in the abdomen. In certain cases, one might notice painful discolored patches on the skin of the feet related to material from the AAA breaking off and traveling to the small arteries of the feet. Severe back pain or pain in the flank area in someone with an AAA can be an indication that the AAA is beginning to leak or is about to burst. This is a life-threatening emergency and immediate medical attention is necessary.

The type of treatment for AAA depends on its size, whether the individual is experiencing symptoms, and a person’s other medical conditions. Each case is individual and your doctor will explain what approach is most appropriate for you. When an AAA is small, often “watchful waiting” with repeat diagnostic tests at certain regular intervals is recommended. With this approach, an AAA can be followed over time to be sure that it is not increasing to a dangerous size. When repair off AAA is recommended, either due to its size or symptoms, either standard open surgery, or a less invasive technique called an endovascular stent graft may be recommended.

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