Red Sock Day for PAD Awareness

Wear Red Socks for PAD Awareness

The third Saturday in February (February 19, 2022) is designated as annual “Red Sock Day” recognizing Peripheral Artery Disease (PAD).

For everyone who has PAD, knows someone with PAD, or treats patients with PAD, this is big news.  TheWaytoMyHeart.org, a national non-profit Peripheral Artery Disease (PAD) patient advocacy group out of California, announced that February 19, 2022, will be the first annual national “Red Sock Day” building awareness for Peripheral Artery Disease (PAD), its patients, and treatment.

Kym McNicholas, who heads TheWaytoMyHeart.org explains the importance of the day’s designation.  “We are using this day as a way to build awareness of PAD and encourage patients to take their socks off when they visit the doctor.  Just taking two fingers and two seconds to check the foot pulses of a patient over 50 can make a huge difference in the early diagnosis and treatment of PAD and related life-threatening diseases.”

Modern Vascular will be recognizing the day in a big way with over 300 employees wearing red socks in the clinic the Thursday before and creating a social media presence celebrating the day on the 19thYury Gampel, CEO of Modern Vascular explains his passion for the project, “The secret is in the collaboration.  On Red Sock Day every PAD treatment facility puts aside its own practice and focuses on awareness, diagnosis, and access to care for patients.  Modern Vascular’s mission is to eliminate unnecessary amputations due to PAD, so definitely wanted to take a leading role in this initiative.”

On February 19, we are encouraging everyone to pull out their red socks in solidarity.  Any red sock can be a show of support.  Thewaytomyheart.org is asking folks to post photos online with the hashtag #nationalredsockday.  For more details, visit the official National Red Sock Day webpage.

Deciding between amputation and revascularization

Revascularization or Amputation?

Technology has opened the door for innovation in medicine that has led to great advances in the treatment of many chronic diseases. Over the last 20 years, patients with Peripheral Artery Disease have benefited from life-saving revascularization treatments that are minimally invasive and focused on limb salvage. These changes although remarkable for those with success stories, don’t come without scrutiny and can result in tension within the vascular community.

The History of PAD Treatment

Historically, treatment for peripheral artery disease is based on risk-factor management or surgical interventions that were only done in a hospital setting.

Risk Factor Management

Roughly 30% of Modern Vascular patients receive a recommendation to move forward with a procedure at their initial consultation. Many more are recommended to control their risk factors through:

Interventions & Amputations

If risk factor management approaches are not successful, other treatment options include revascularization therapies to treat blockages. Revascularization techniques can be minimally-invasive using stents and balloons or can include open surgery such as bypass surgery.

Treatments for Severe PAD Include:

  • Balloon Angioplasty/Stenting
  • Bypass Grafting
  • Cryoplasty
  • Percutaneous or Laser Atherectomy

Patients with critical limb ischemia have an advanced form of peripheral arterial disease where patients are getting no blood flow in their foot and are in danger of losing a leg to amputation.

Amputation is a procedure used when tissue destruction, infection, or disease affects a body part so severely that it is impossible to repair or puts the person’s life in danger. For instance, in PAD patients, a foot or leg may be removed by surgical amputation if blood flow cannot be returned to the foot or leg.

Unfortunately, amputation can impact a patient’s life expectancy. According to a study in Vascular Health and Risk Management, the rate of death after major lower extremity amputation in the US is approximately 48% at year 1, and 71% at year 3.4  

This is why it is so important to catch PAD early so that a doctor can intervene before the disease cuts off blood flow to a body part for an extended period of time, leaving the patient with limited options.

About 54% of all surgical amputations result from complications of vascular diseases and other conditions that affect blood flow, such as diabetes and PAD.2

Chronic vascular problems can lead to tissue death in the toes, feet, and legs. Of patients undergoing amputation for complications of these diseases, nearly half will die within five years of the amputation procedure.

Innovation & Tension in the Vascular Community

Over the last decade, there have been great advancements in the treatment or therapy used for Peripheral Artery Disease. PAD affects 8 to 10 million Americans, primarily those with diabetes, over the age of 65, and ethnic groups including Black, Latinx, and Indigenous communities. With technology, we have been able to detect PAD much earlier and treat it without the need for amputation or other invasive procedures.

The innovations have not come without a cost, as there is a bit of tension within the vascular community on the legitimacy and necessity of certain approaches.

With regard to the evolution of medical innovation, not everyone has been this forward-thinking. While some in the vascular community hesitate to deviate from the traditional methods, tension is increased further as many vascular surgeons who are not embracing endovascular treatment are losing patients to those who are. These revascularization procedures can be done more safely and earlier in the disease progression, in outpatient facilities like Modern Vascular with multiple clinics throughout the country.

Patient advocacy has played a huge part in emphasizing the importance of treatment options for patients because the patient’s best interest should ultimately be the focus of care. Patient advocate and Founder of The Way to My Heart, Kym McNicholas shares, “When it comes to treating patients with peripheral artery disease, every single vascular physician needs to respect the fact that different doctors have different tools, techniques, and approaches… Patients should be made aware of, whether one physician or another offers them so that they can make a well-informed decision on what it will take to give them a better quality of life.”

Sources:

  1. Logar, C. M., Pappas, L. M., Ramkumar, N., & Beddhu, S. (2005, March 21). Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: A cohort study. BMC nephrology. Retrieved December 2, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079864/.
  2. Amputation | Society for Vascular Surgery. Retrieved December 8, 2021, from https://vascular.org/patients/vascular-treatments/amputation.
  3. Torbjörnsson E;Ottosson C;Blomgren L;Boström L;Fagerdahl AM; (n.d.). The patient’s experience of amputation due to peripheral arterial disease. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing. Retrieved December 21, 2021, from https://pubmed.ncbi.nlm.nih.gov/28527728/
  4. Swaminathan, A., Vemulapalli, S., Patel, M. R., & Jones, W. S. (2014, July 16). Lower extremity amputation in peripheral artery disease: Improving patient outcomes. Vascular health and risk management. Retrieved December 21, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107174/
  5. Innovations in pad therapy: Make sure you’re up-to-date on … (n.d.). Retrieved December 21, 2021, from https://journals.lww.com/nursing/Fulltext/2008/03001/Innovations_in_PAD_therapy__Make_sure_you_re.3.aspx
National Kidney Month

National Kidney Month

March is National Kidney Month, so we’re taking the time to spread awareness about Chronic Kidney Disease (CKD). This is especially important to note as people with CKD are at a higher risk of developing peripheral artery disease (PAD) and its adverse health outcomes than individuals with normal renal function.

Caused by narrowing and blockages in the arteries in your legs, PAD is a progressive condition most commonly due to atherosclerosis, which is an accumulation of plaque on the inner walls of the artery.1 CKD also contributes to atherosclerosis.2

CKD is characterized by reduced kidney function, while PAD is characterized by reduced blood flow to the extremities, particularly the legs. This can potentially cause wounds to heal slowly or not at all.

Reportedly, there’s evidence suggesting CKD patients are at an increased risk of developing atherosclerosis and other cardiovascular diseases. With atherosclerosis as the common denominator, it has become more apparent that there could be a link between PAD & CKD in the form of an increased risk.4 However, until recently, there was little research on their possible correlation.

According to researchers, it appears that patients with CKD have an increased risk of developing PAD.4

Additionally, CKD and PAD share some notable risk factors like diabetes, high blood pressure, and 60+ age. The prevalence of PAD in patients with chronic kidney disease is higher than the prevalence of heart attack and stroke in CKD patients.4

Renal Failure & Contrast

Although contrast dyes are generally safe for most patients, those with renal failure may be at additional risks of developing contrast-induced nephropathy (CIN) a rare disorder that occurs when kidney problems are caused by the use of certain contrast dyes.

In most cases contrast dyes used in tests, such as CT and angiograms, have no reported problems, with only 2% of people receiving dyes can develop CIN. That being said, the risk for CIN can increase for people with diabetes, a history of heart and blood diseases, and CKD.4

Modern Vascular uses minimal contrast and we have a CO2 option for renal patients in order to carefully evaluate patients while being cognizant of the risks associated with reduced kidney function.

Screening for PAD

Since roughly half of PAD patients have no apparent symptoms, it’s difficult at times to know if someone has the disease,1 making early detection and treatment of PAD that much more important to stay on top of. It’s imperative to avoid infections and prioritize treatment to avoid the necessity of amputation.

Patients who have chronic kidney disease should undergo evaluation, even if they show no symptoms of peripheral artery disease.

In order to screen for PAD several imaging tests are used to diagnose and evaluate PAD:

  • Vascular ultrasound
  • Doppler ultrasound
  • Catheter angiography
  • CT angiography (CTA)
  • MR angiography (MRA)

Your Healthcare Team

Patients with both CKD and PAD should have healthcare providers from several specialties working in cooperation on their care. According to doctors in a 2015 paper, it is recommended that patients with PAD-CKD be managed by a multidisciplinary team including the following specialists: vascular specialists, nephrologists (kidney experts) and wound care specialists.3

Even with a great team, the role the patient plays in their own healthcare is crucial. If you have CKD it’s always a good idea to get checked for PAD even if you aren’t experiencing any PAD symptoms and asking your team for more information about your risks. Keep your entire healthcare team up to date on your health history, including your current medications and any new or changing symptoms.

It is also important to adhere to a healthy diet, exercise regularly (we recommend walking), avoid smoking and drinking excessive alcohol. Finally, always follow the advice of your healthcare providers and take any medications as prescribed.

Sources:

  1. Johns Hopkins. Peripheral Vascular Disease. (accessed 3/18/2021)
  2. Kon, V., Linton, M. & Fazio, S. Atherosclerosis in chronic kidney disease: the role of macrophages. Nat Rev Nephrol 7, 45–54 (2011). https://doi.org/10.1038/nrneph.2010.157
  3. Garimella, P.S., Hirsch, A.T. “Peripheral Artery Disease and Chronic Kidney Disease: Clinical Synergy to Improve Outcomes.” Adv. Chronic Kidney Dis., 2014. 21(6): p. 460-471
  4. National Kidney Foundation “Contrast Dye and the Kidneys” Accessed (3/18/2021)
Woman holding her foot PAD Treatment Modern Vascular

Saving Native American Limbs and Lives

Peripheral Artery Disease (PAD) disproportionately affects a number of underserved populations, which is why at Modern Vascular we endeavor to bring our services to these communities. One of the groups of people we are most passionate about is the Native American Community, which suffers more from PAD than most others and represents a large population not far from our clinics in Arizona.

There are nearly 300,000 Native Americans – including members of the Navajo, Apache, Hopi, Gila River, Salt River, and Prima tribes – in Arizona out of more than 5 million in the entire U.S. Many live in 20 reservations across the state.1

Many in the Native American community lack easy access to quality medical care, yet they are at a higher risk of many persistent and life-threatening health issues, including diabetes and PAD. Native American adults have a higher rate of diabetes, the leading cause of PAD – 16 percent — than any other race or ethnicity.2 Native Americans are also found to have moderate-to severe PAD at a rate of 1.5-2 times that of white people.3

PAD and diabetes not only inhibit the ability to feel the pain of a foot wound; they can also impair the body’s ability to heal an ulcer, and elevations in blood glucose can reduce the ability to fight infection, both factors leading to further damage and, again, increasing the danger of amputation. Due to a lack of feeling, you must learn to recognize other symptoms aside from the obvious ulceration, including discharge on your socks and redness and swelling of the foot.

Native Americans and Peripheral Artery Disease

Adding to the urgency of the PAD risk for Native Americans is the deep spiritual aspect. Some considering themselves connected to the earth, losing a foot – and that connection – is sacred. Dr. Brannan, Chief of Endovascular Surgery explains- “We like to say in our practice that saving limbs is saving lives, but with Native Americans, that phrase has a deeper and more literal meaning. In working with Native American patients of the Southwest United States I have had patients tell me they would rather pass away than lose a limb.”

This great need and cultural importance synergizes with Modern Vascular’s own passion for saving limbs and lives. Modern Vascular supports the First Nations Limb Preservation Foundation, which Dr. Brannan helped found, and its mission to take on any patient and alleviate the hardship of PAD in the Southwestern Native American community. Through its partnership with the Foundation, the Modern Vascular doctors in Phoenix have successfully treated hundreds of Native American patients in the last 3 years.

Sources

  1. Gallup Independent
  2. National Health Interview Survey and Indian Health Service, 2010-2012
  3. NIH: Increased Prevalence of Moderate and Severe Peripheral Arterial Disease in the American Indian (AI)/Alaskan Native (AN) Population; a Study of 96,000 AI/AN, 2016
Asymptomatic PAD

PAD is a Silent Disease

Did you know that you could have a potentially deadly disease and not even know it? When peripheral artery disease (PAD) initially presents it is a silent disease. Early on, there aren’t any symptoms that your arteries are becoming stiff and narrow. In fact, as many as 2 out of every 5 people with PAD do not experience any leg pain at all.

It’s typically not until you’ve engaged in an activity that your body will start to tell you that the tissues are not getting enough oxygen. Claudication is cramping in the calves, ankles, or feet during activities like walking, or climbing stairs, that subsides at rest.

Pay Attention to The Signs & Symptoms

Peripheral artery disease is the narrowing of peripheral arteries due to atherosclerosis, which is the word used to describe plaque buildup on arterial walls. This causes a decrease in blood flow to the legs, feet, and toes. Lack of blood to the lower limb extremities can cause symptoms in the legs and feet like numbness, cramps, weakness, wounds that won’t heal, and discoloration. If it is left treated, peripheral artery disease can progress into infections and gangrene that may require amputation.

Foot wounds that do not heal or heal slowly are an important sign of PAD and an indication that you need to see a specialist immediately. The development of a diabetic foot ulcer can lead very rapidly to infection of the bone, which can very rapidly lead to amputation. At Modern Vascular, there are interventional radiologists that specialize in the revascularization techniques that can treat PAD.

Avoiding Amputation

In the US, only one year after a major amputation the mortality rate is about 48%. Critical limb ischemia is an advanced form of PAD when the blood is unable to flow to the foot. If blood flow cannot be returned to the foot or leg, then surgical amputation may be considered. Early detection of PAD is crucial so that a doctor can intervene before the disease progresses to that point. Of all surgical amputations that occur, about 54% are the results of conditions that affect the flow of blood, like diabetes and PAD.

Get Evaluated For Peripheral Artery Disease

Evaluations typically start with a review of your medical history and the current medications that you’re taking. Then, a physical examination is performed the pulse is measured in the legs and arms. Next, an ultrasound evaluation is performed for a real-time look at the velocity and the quality of the blood flow.

When there is a reduction in the caliber of a vessel that is 50% or greater, the force and velocity of the blood flow are reduced sufficiently to cause symptoms to present. In these cases, minimally invasive treatment is recommended to help open up that artery. Not every evaluation leads to a procedure. Many patients are recommended lifestyle modifications and a follow-up with their doctor to see if their symptoms have improved.

PAD Awareness

Why Don’t Many People Know About PAD?

September is Peripheral Artery Disease Awareness Month. This is important because awareness of the disease is still very low. Peripheral arterial disease (PAD) affects the arteries carrying blood away from the heart. It occurs when these arteries narrow due to plaque buildup on arterial walls, reducing blood flow to legs, feet, and toes. PAD complications include critical limb ischemia, gangrene, and amputation if it is allowed to progress too far before any intervention.

Awareness of PAD is Low

While you don’t often hear about PAD, the prevalence of the disease is significant. It is estimated to be between 15% and 20% in people with an age greater than 60. If a person is over 80, it can jump as high as 40%. Despite how common it is, especially in people that are higher in age, many people have never heard of it.

PAD Screening is Not Difficult

PAD is easy to screen for, easy to evaluate, and treatable when an early diagnosis can be made. Our goal is to promote awareness of peripheral artery disease and its risk factors, encourage early screening, and educate people about treatment options. With more awareness, patients and doctors will be able to identify early signs of PAD and ensure early intervention in order to decrease these numbers.

Top Risk Factors for PAD

Age is the most notable risk factor for peripheral artery disease. Diabetes is another major risk factor. The prevalence increases significantly for those who have had diabetes for ten years or longer. Another extremely important factor is any history of smoking.

If you have smoked cigarettes for a total of ten years or more, you have a significantly higher risk of developing PAD even if you no longer smoke. In order to prevent your risk from increasing further, it is important to quit smoking so your vascular health can recover. Finally, other risk factors such as high cholesterol and high blood pressure are also very important in determining who will develop this disease

Are You at Risk?

If you have any two of the major risk factors mentioned above, you are at a considerably increased risk of developing peripheral arterial disease. It would be a wise choice to be evaluated for PAD. If you aren’t sure, take our PAD Risk Assessment Quiz for a recommendation based on your symptoms and risk factors.

Diabetes, neuropathy and PAD

A Growing Epidemic

Diabetes has been a growing epidemic over the past 30 years. Notably, it has been on the rise with the increase of corn syrup and high sugar substrates in our diets. However, hereditary and cultural influences also contribute factors to diabetes. It is increasingly common to see signs of neuropathy and PAD in pre-diabetic patients.

Diabetes Disease Progression

 

  1. Fatty deposits in the blood

    Diabetes

    Puts fatty deposits and other substances in the blood.

  2. Deposition of plaques of fatty material on inner artery walls

    Peripheral Artery Disease (PAD)

    Atherosclerosis clogged artery.

  3. Inadequate supply of blood to lower extremities

    Neuropathy and Ischemia

    Oxygen starved nerves and tissue.

  4. Amputation due to infection, ulcers, or gangrene

    Dead Tissue and Amputation

    If left untreated, the lack of blood to your feet and toes can lead to infection, foot ulcers and gangrene.

Diabetic blood cells

Neuropathy may occur in over 60% of patients with diabetes. The symptoms of diabetic neuropathy may also include leg cramping or a sensation of aching pain, similar to the PAD. Therefore, from a practical standpoint, neuropathy and PAD frequently coexist as related conditions. That makes it hard to tell vascular pain and neuropathic pain apart.

Diabetes can lead to neuropathy… and the path it takes is through PAD

Neuropathy may occur in over 60% of patients with diabetes. The symptoms of diabetic neuropathy may also include leg cramping or a sensation of aching pain, similar to PAD. So from a practical standpoint, neuropathy and peripheral artery disease frequently coexist as related conditions, which makes it difficult to differentiate vascular pain from neuropathic pain.

The leading risk factors of PAD are age and diabetes. Some of the common warning signs are pain and cramping in your legs and feet. PAD restricts blood flow to your lower legs and feet,  preventing oxygen-rich blood cells from reaching your lower extremities.

Ultimately, this can lead to a breakdown of the skin and diabetic skin ulcers. Sores that will not heal can lead to infections. What you need to know about the relationship between diabetes, neuropathy, and PAD is that diabetes can lead to neuropathy, and the path it takes is through PAD.

The leg pains and warning signs are similar enough that if you are experiencing one or more of these symptoms you should seek a comprehensive evaluation. This is your time to take preventative action. Contact one of the Modern Vascular clinics for a PAD evaluation if you are experiencing warning signs of neuropathy and peripheral artery disease.

Signs and Symptoms of PAD on man walking up stairs

Peripheral Artery Disease Sign & Symptoms

Peripheral artery disease is a circulatory condition that is chronic and potentially life-threatening. It is caused by the arteries becoming narrow or blocked due because of a buildup of plaque. Plaque in the arteries is made of fatty materials and cholesterol. It causes a reduction of blood flow that is carried away from the heart towards the rest of the body, except for the brain. It is especially prevalent in the legs and feet.

The signs of Peripheral Artery Disease vary based on age, weight, and lifestyle choices. There is about a 50% chance that patients with PAD will experience noticeable symptoms. These symptoms are almost always caused by a reduction in blood flow to your leg muscles. This can vary based on which artery is affected and to what extent your blood flow is restricted.

Women on beach without PAD symptoms

What Are The Signs of Peripheral Artery Disease?

The most common symptom of Peripheral Artery Disease is pain in one or both calves, thighs, or hips. Intermittent pain usually occurs while walking or climbing stairs. This is because the need for oxygen-rich blood increases during these activities and other exercises. The name of this pain is claudication.

Leg cramps are fairly common, but cramps that start with exercise and subside when you rest are most likely due to claudication. When there is a blockage in the blood vessels in your legs you may even experience pain at night or in your sleep. It usually is a dull, cramping pain. It may also feel like a heaviness, tightness, or tiredness in the muscles of the legs.

Other PAD Symptoms

  • Numbness, tingling, or weakness in your legs
  • Burning or aching pain in your feet or toes
  • Dull pain in your buttocks
  • One or both legs or feet feel cold
  • One or both legs or feet have different color
  • Impotence or the inability to maintain an erection
  • Lingering sores on the feet or legs or loss of hair

Because the signs of PAD can be easily excused as tiredness or fatigue, or masked by conditions such as peripheral neuropathy, it is important that you’re mindful of common risk factors. Some of the risk factors include a history of smoking, diabetes, obesity, and age.

There is a link between smoking and peripheral artery disease that has been confirmed by a number of studies. Quitting smoking reduces the risk of developing cardiovascular disease, including the risk of peripheral artery disease.

If you are experiencing one or more of these PAD symptoms, and you have some of the risk factors, you should check with a doctor to figure out what is causing your symptoms.

If you are interested in learning more about Peripheral Artery Disease, you should read our frequently asked questions page.

You Have PAD Symptoms – Now What?

If you have any of the symptoms of PAD you should first speak to your doctor. If you are diabetic you should speak to your endocrinologist. If you have chronic wounds on your feet or legs you should speak to your podiatrist or wound care specialist, respectively. It would be beneficial to receive a comprehensive evaluation to determine the severity of your condition and to determine a treatment plan. At Modern Vascular, there are highly skilled physicians and staff that are trained to detect and treat Peripheral Artery Disease.

The condition may improve with adjustments to one’s lifestyle. Some of the risk factors can be addressed through these changes, allowing for the possibility of improvement. For instance, smoking is a risk factor. If a PAD patient quits smoking, they may see an improvement in their condition. Other lifestyle changes include sticking to a healthy diet and developing an exercise routine. Doctors may also prescribe medications that should be taken as prescribed.

For some patients, changes to their lifestyle aren’t enough to manage the disease. If that’s the case, there are minimally invasive endovascular procedures that can help restore blood flow to the affected extremities. People that have PAD that think that would benefit from one of these procedures can reach out to Modern Vascular to schedule an evaluation to determine if that is a viable option.

Watch the following video to learn more about the risk factors:

Common Risk Factors of Peripheral Artery Disease

Doctor PAD Advice

Ask your Doctor About PAD

Do you have leg pain or cramps during normal activities like walking or climbing stairs? This could be a sign of peripheral artery disease. Luckily, PAD can be treated if diagnosed early and properly. Therefore, it is a great idea to know the warning signs and risk factors so that you know when you should talk with your doctor.

Are You at Risk For PAD?

Risk factors are anything that may increase a person’s chance of developing a disease. Some common factors are stress, activity, diet, family history, or lifestyle choices. Take note of the following risk factors so that you have a better understanding if you are at risk for Peripheral Artery Disease.

Inherent PAD Risk Factors

The inherent risk factors for PAD include some pre-existing conditions and demographic factors, including:

  • Type 2 diabetes
  • Peripheral neuropathy
  • Age over 65
  • Wounds or ulcers on the legs or feet
  • Feet cold to the touch
  • History of stent or heart attack
  • Family history of heart disease

Learn more about PAD risk factors.

Treatable Conditions and Contributors

If none of those risk factors apply then you should also consider these treatable conditions:

Those who smoke or have diabetes have the highest risk of complications from PAD because these risk factors also cause impaired blood flow.

If you have been experiencing any of the symptoms of PAD and have any of the risk factors then you should ask your doctor if they think that it might be PAD. However, it would also be a good idea to have your doctor check if you are experiencing some of the risk factors without any symptoms. Around 50% of people with PAD do not experience any noticeable symptoms. Unfortunately, it can lead to problems if left untreated.