New Patients: (888) 853-1278 | Existing Patients: Click Here

PAD Risk Assessment Quiz

Category: Peripheral Artery Disease

Limb amputations

The Truth Behind PAD Amputations

The following blog was taken from an Op-Ed piece entitled “The Truth Behind PAD Amputations”, which was published by the Executive Director for the Way to My Heart.  The Way to My Heart is a 501(c)(3) focused on improving the quality of life for patients suffering from vascular disease.

Excerpt:

Every patient presents differently and at different stages. That is true. But other modifiable factors are contributing to the nearly 150,000 PAD-related amputations each year1 2 3, most of which are preventable. Early diagnosis, early treatment, and lifestyle modifications help, but the greatest contributing factor for unnecessary amputations is in the hands of physicians.

The “right” way to treat is highly contested among key physicians treating PAD: Vascular Surgeons (VS), Interventional Cardiologists (IC), and Interventional Radiologists (IR), along with the “right” place to treat — hospitals, ambulatory surgical centers (ASC), or office-based labs (OBL). At the center of this debate is who or what is leading the majority of needless PAD-related amputations? Everyone thinks their way is the best and only way. It’s always their competition that’s leading to poor patient outcomes, not them.

What is the right treatment, and isn’t there a standard treatment protocol that works for everyone with PAD? Yes and no. Frontline treatment, if PAD is diagnosed, is lifestyle modifications, including smoking cessation, diet, and exercise. It also may include medication such as blood thinners and statins to increase flow and reduce cholesterol. Most insurance requires three months of this conservative approach to see if claudication improves. Many believe the next step is intervention, then surgical bypass, and amputation as a last resort. The question is when to switch to the next level and how to perform it. Some skip steps, even performing amputation as frontline treatment.

It’s difficult to standardize when physicians should switch treatment levels because many patients are poorly diagnosed or not diagnosed at all until advanced stages. At that point, lifestyle modification and medication are not going to be effective. If someone is in the advanced stages of PAD, called critical limb ischemia (CLI), has a non-healing ulcer or gangrene, then the first step for these patients is intervention or surgery. It is imperative that these patients are appropriately evaluated to save their limbs.

Some physicians stick with conservative treatment too long, withholding interventional or surgical treatment. Lifestyle modifications are important, especially walking. Withholding angioplasty to restore just enough flow to relieve some debilitating pain for a patient who complains of lifestyle limiting claudication, happens much too often. But also waiting to treat a chronic total occlusion (CTO) can lead to a situation where it is much more difficult to resolve.

And then there are those physicians who go straight to performing bypass or extremely invasive bypass. This shouldn’t be frontline treatment and blockages should first be addressed percutaneously (intervention). Different physicians have different approaches, tools, techniques, skills, and even philosophies to treat blocked arteries, particularly in the legs of patients with PAD.

I founded The Way To My Heart, a 501(c)(3) nonprofit, to help these PAD patients. It is a network of nearly eight thousand patients around the world, which provides high-touch advocacy for patients with PAD. We help patients explore and understand all options available to them so they can make an informed decision as to what treatment will help them to live a better quality of life.

Read the full article here.

Sources:

  1. Weitz JI, Byrne J, Clagett GP, et al. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation. 1996;94:3026-3049.
  2. Hirsch AT, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease) endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006;47:1239-1312.
  3. Dormandy JA, Thomas PR. What is the natural history of a critically ischemic patient with and without his leg? In: Greenhalgh RM, Jamieson C, Nicolaides AN, eds. Limb Salvage and Amputation for Vascular Disease. London: WB Saunders; 1988:11-26.
Arteries and Veins Blood Vessel Differences

The Difference Between Veins & Arteries

We often get questions regarding the similarities and differences between veins and arteries. We have noticed that there seems to be some confusion between the two, and oftentimes people think that they are the same thing. We want to help people understand the key similarities and differences between arteries and veins.

Blood vessels help circulate blood throughout your body. They form a complete loop, starting and ending at the heart. The human body contains around 60 thousand miles of blood vessels. There are three types of blood vessels: arteries, veins, and capillaries. These vessels work together to form the cardiovascular system.

The Cardiovascular System

Let’s get to the heart of the matter, the cardiovascular system. It starts and ends with the heart, keeping a continuous and controlled movement of blood that delivers nutrients and oxygen to every cell in the body through arteries, veins, and capillaries in between.1 The cells of the body rely on this system to get everything that they need to function properly.

There are two types of circulation processes: pulmonary circulation and systemic circulation.

Pulmonary Circulation

Pulmonary circulation is when unoxygenated blood is sent to the lungs to become oxygenated and to remove carbon dioxide. The unoxygenated blood comes into the right side of the heart before being taken to the lungs for oxygenation and then finally delivered to the left side of the heart.

Systemic Circulation

Systemic circulation is when oxygenated blood that has been delivered to the left side of the heart is delivered to the rest of the body to provide oxygen and nutrients to the cells of the body.

Read 5 Tips for Improved Circulation

Pulmonary circulation blood flow between heart and lungs
Veins Vectors by Vecteezy

What Do Arteries and Veins Have in Common?

Arteries and veins are two of the body’s main types of blood vessels. Arteries are blood vessels that carry oxygen-rich blood away from the heart to the body. Veins are blood vessels that carry blood that is low in oxygen from the body back to the heart for reoxygenation.

How Can You Tell the Difference?

In terms of function, arteries and veins are quite different from one another. A key difference between arteries and veins is that the arteries carry oxygenated blood to all body parts, whereas veins carry the deoxygenated blood to the heart, with the exception of pulmonary arteries and veins.

Arteries have thicker walls because they deal with the pressure of the blood forcibly moving away from the heart. Veins don’t have to deal with as much pressure, but they do have to deal with the forces of gravity. There are valves in the veins to prevent blood from flowing backward or pooling that can become damaged. This can cause a person to develop varicose veins.

What are Veins?

Visually speaking, veins are more commonly identifiable because of superficial veins, which are closer to the surface of the skin. Pulmonary veins are in charge of transporting oxygenated blood to the heart from the lungs. Systemic veins, located throughout the body from the legs up to the neck and arms, transport deoxygenated blood back to the heart. There are also deep veins that are located deep within the muscle tissue.

Common Venous Disorders

  • Chronic venous insufficiency
  • Deep vein thrombosis
  • Excessive blood clotting
  • Superficial venous thrombosis (phlebitis)
  • Varicose and spider veins

What are Arteries?

Carrying blood away from the heart in two distinctive pathways there is the systemic circuit and the pulmonary circuit. Systemic arteries carry oxygen-rich blood towards tissue whereas pulmonary arteries carry oxygen-depleted blood from the heart to the lungs where it can acquire fresh oxygen.4 There are a few types of arteries including elastic arteries that have a thick middle layer so they can stretch in response to the pulse of the heart. Muscular arteries5, draw blood from elastic arteries and branch into resistance vessels. Arterioles are the smallest division of arteries that transport blood away from the heart. They direct blood into the capillary networks.

Common Arterial Diseases 4

  • Abdominal Aortic Aneurysm
  • Thoracic Aortic Aneurysm
  • Coronary Artery Disease
  • Carotid Artery Disease
  • Peripheral Arterial Disease
  • Vertebrobasilar Disease
  • Renal Vascular Disease
  • Thoracic Outlet Syndrome

Learn about interventional radiology and how endovascular procedures differ from open vascular surgeries.

Are Veins or Arteries Related to Peripheral Artery Disease?

The peripheral arteries supply oxygenated blood to the body, and the peripheral veins lead deoxygenated blood from the capillaries in the extremities back to the heart.2 Sometimes small blockages build up inside your blood vessels. These blockages are called plaque. They develop when cholesterol sticks to the wall of the artery. Your immune system, sensing a problem, will send white blood cells to attack the cholesterol. This sets off a chain of reactions that leads to inflammation. In a worst-case scenario, cells form a plaque over the cholesterol, and a small blockage is formed. Sometimes they can break loose and cause a heart attack. As the plaques grow, they may block blood flow in an artery entirely. This blocked blood flow to the lower extremities is effectively Peripheral Artery Disease (PAD).

What Can You Do to Unclog Arteries?

Peripheral artery disease doesn’t always require a procedure. There are lifestyle changes and medications that can help promote healthy arteries. Here are some ways you can promote healthy arteries:

Consult with your primary care physician before starting any new diet or workout routines. Defer to your doctor to evaluate potential concerns and to make the referral to a vascular partner. Our goal is to promote Peripheral Artery Disease awareness, its risk factors, and 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. Modern Vascular treats PAD through a non-invasive outpatient clinic setting. To learn more about our clinics,  PAD, and PAD-related problems, or you are searching for the right vascular partner for your procedure, call Modern Vascular (888) 853-1278 or use our online form to schedule your consultation today.

Sources

  1. Frothingham, Scott. Artery vs. Vein: What’s the Difference?, Healthline.com, 12 Apr. 2018, www.healthline.com/health/artery-vs-vein.
  2. Hochauf, Sandra; Sternitzky, Reinhardt; Schellong, Sebastian M. (2007). “Struktur und Funktion des venösen Systems”. Herz (in German). Springer Nature. 32 (1): 3–9.
  3. Gilvydis, Rimas. “THE DIFFERENCE BETWEEN VEINS AND ARTERIES.” https://Niveinclinic.com/the-Difference-between-Veins-and-Arteries/, Northern Illinois Vein Clinic, 23 July 2019, niveinclinic.com/the-difference-between-veins-and-arteries/.
  4. “Arterial (Artery) Disease.” Arterial (Artery) Disease | Frankel Cardiovascular Center | Michigan Medicine, www.umcvc.org/conditions-treatments/arterial-artery-disease.
  5. Seladi-Schulman, Jill. Arteries of the Body, 26 Feb. 2019, http://www.healthline.com/health/arteries-of-the-body.
  6. Holland, Kimberly. Is It Possible to Unclog Your Arteries?, 17 Sept. 2019, www.healthline.com/health/heart-disease/how-to-unclog-arteries.
Modern Vascular How to Choose Your Vascular Partner

How to Choose the Right Vascular Partner for You

Severe leg pain, slow-healing wounds, and cold lower limbs are many of the signs of the common circulatory condition periphery artery disease (PAD) in which narrowed arteries reduce blood flow to the limbs. Left untreated, PAD can eventually lead to amputation.

Once you have decided to seek treatment for peripheral artery disease, the next step is to choose a physician that serves as your vascular partner. Unfortunately, there are far too many lower extremity amputations without any prior testing, such as non-invasive vascular studies, which is why it is important to seek a second opinion if you have been told amputation is your only option.

What Kind of Doctor Treats PAD?

While doctors may say they can treat PAD, not all will have the same level of experience or training. Your vascular partner could be a vascular and interventional radiologist or a vascular surgeon.

Vascular and Interventional Radiologists

Interventional radiologists are medical doctors with 6 or 7 years of additional training following medical school and use minimally invasive, image-guided procedures to treat diseases. Procedures that are performed by interventional radiologists are less risky and have a shorter recovery period when compare to open surgery. Vascular and interventional radiologists are certified in both diagnostic radiology and endovascular procedures (treatments).

Vascular Surgeons

Vascular surgeons are also highly-trained physicians who manage and address PAD, aortic aneurysms, carotid artery blockages for stroke prevention, and venous insufficiency. At Modern Vascular, both interventional radiologists and vascular surgeons are trained to treat PAD through minimally invasive endovascular procedures, which reduce recovery time and lower costs versus open vascular surgery. When choosing a vascular specialist you want to make sure you feel comfortable about your treatment options.

At Modern Vascular, our team of providers understands the importance of choosing the right vascular specialist for your needs, that is why our providers are leading experts in the endovascular treatment of peripheral arterial disease.

Things to Consider

You want to make sure that your vascular provider is knowledgeable of the disease that they intend to treat and that their main concern is helping their patients. Ultimately, choosing a vascular provider is a personal one, but here are some more things to consider:

Reputation

With the advancement of review platforms, before you even meet a potential physician you can see how other patients feel about them. The best physicians will have a great reputation both with their patients as seen in the reviews and in the greater medical community with their peers. Do your research to identify their public reception and pay attention to how they handle unfavorable or negative situations. You can also ask your primary care physician if they have a recommendation.

Although time is of the essence in terms of getting your PAD treatment, another great way to support your decision as a vascular physician is if they are highly sought after. Are the vascular physicians busy? If they are experts in their field? Most likely they will be.

If you have any friends or family members who have had vascular surgery, you should ask them about their experiences. Their first-hand accounts of how it went, for better or worse, with their physician and procedures can add some great insight.

Mission-Driven Partner

You want to choose a vascular physician who is just as passionate about their expertise as they are about you. Here at Modern Vascular, it is our mission to save limbs and lives. We are committed to innovation and research incorporating cutting-edge techniques and state-of-the-art technology into our everyday patient care to improve the lives of our patients. If your physician is recommending even a toe amputation, you owe it to yourself to get a second opinion from a doctor passionate about limb preservation.

Vascular Physician Experience

How experienced is the physician in the procedure you need? This is incredibly important in weighing your options. There are physicians who specialize in very specific procedures, while others perform a wide range. For the treatment of specific conditions like PAD, it might be more important to go with someone who has spent time perfecting their skills for PAD.  At Modern Vascular, we treat and see hundreds of PAD patients each year and specialize in the care and treatment of those with this chronic disease.

Rapport

You are making a limb-saving decision, in seeking treatment for PAD, so why shouldn’t you feel comfortable with the physician managing your procedure?  Some people are willing to forgo comfort with a professional in favor of certifications and reputation. However, it is important that you are comfortable with anyone who will perform surgery on your body regardless of how notable the resume is. You should feel comfortable enough with your physician or advanced practice providers to speak candidly about your medical problems, and openly discuss all treatment options.  The right fit will take the time to make sure you understand the associated risks and benefits.

Are There Other Options?

Not every patient requires a procedure and is important to choose a provider who treats PAD at all stages and is willing to try non-surgical medical management in less serious cases. At Modern Vascular, if you do not meet the criteria for revascularization and you have mild to moderate symptoms of claudication, your practitioner can put you on an At- Home Medical Management Program. Your practitioner will provide specific directions and tools for managing your PAD through lifestyle modification, which may include diet, exercise, quitting smoking, and medical monitoring.

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)
Smoking and the blood vessels

How Smoking Affects the Blood Vessels

The health risks associated with smoking are often regarded as common knowledge, which is why roughly 70 percent of American smokers want to quit. Unfortunately, according to a recent government study, only 6 percent succeed 1. Although damage to the lungs is common knowledge, many have no idea that smoking is also bad for their blood vessels and is among the many causes of peripheral artery disease (PAD).

The chemicals in tobacco detrimentally affect how the heart and blood vessels function. This can increase your risk of developing atherosclerosis, a condition in which plaque builds up in the arteries. Over time, plaque can harden and cause your arteries to narrow, limiting the flow of oxygen-rich blood to your organs and other parts of your body.2

Smoking and Peripheral Artery Disease

There is a very strong connection between smoking and peripheral artery disease (PAD). Reportedly, smoking half a pack of cigarettes a day may increase your risk of having PAD by up to 50 percent.4 Additionally, about 90 percent of patients with PAD have a history of smoking.3

Most smokers learn about the impact that smoking has on the lower extremities when a physician diagnoses them with PAD. Any amount of smoking, even occasionally, damages the heart and blood vessels. Secondhand smoke also can hurt the heart and blood vessels, greatly increasing the risk of heart attack and death in adults.3

Why You Should Quit Smoking

Considering the risks and how so many smokers who actually want to quit face challenges, it is incredibly important to quit smoking. Smoking increases the risk of PAD by up to six times and makes the symptoms worse. 5 Initiatives like Take Down Tobacco National Day of Action help encourage smokers to kick the habit.

 

 
 
 
 
 
View this post on Instagram
 
 
 
 
 
 
 
 
 
 
 

 

A post shared by Modern Vascular (@modernvascular_pad)

By quitting smoking, PAD patients can increase their chances of long-term survival. In fact, one study found that 82 percent of former smokers were still alive after 10 years, compared with only 46 percent of patients who continued smoking.3

Regardless of how much or how long you’ve smoked, quitting has a variety of benefits, including reducing your risk of developing heart disease, having a stroke, lowering your risk of atherosclerosis, blood clots, and PAD. 2

Tips for Quitting Smoking

Quitting smoking is truly a journey, not just a single event that happens on one day. In order to quit, you will have to put the prospect of improving your health, and the quality and duration of your life as your focus.

With the right plan, your journey will be off on the right step with some of the following ways one can begin the quitting journey. Here are five ways to tackle smoking cessation:

  • Prepare for the Quit Day.
  • Know your triggers and avoid them early on.
  • Know that the first few days are the toughest.
  • Don’t give in to your cravings.
  • Try a new hobby with friends who don’t smoke.

Sources

  1. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Reports (MMWR)Quitting Smoking Among Adults (accessed 3/12, 2021)
  2. National Heart, Lung, and Blood Institute. Smoking and your heart. https://www.nhlbi.nih.gov/health-topics/smoking-and-your-heart (accessed March 12, 2021)
  3. Lu JT, Creager MA. The relationship of cigarette smoking to peripheral arterial disease. Rev Cardiovasc Med. 2004 Fall;5(4):189-93. Review. PubMed PMID: 15580157. http://medreviews.com/sites/default/files/2016-11/RICM_54_189_0.pdf (accessed March 12, 2021)
  4. Vascular Disease Foundation. Life Saving Tips About… Smoking and PAD http://vasculardisease.org/flyers/lifesaving-tips-on-smoking-and-pad-flyer.pdf (accessed March 12, 2021)
  5. Centers for Disease Control and Prevention. Peripheral Arterial Disease (PAD) Fact Sheet https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_pad.htm (accessed March 12, 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
Modern Vascular Case Study Foot wounds and Ulcers

Foot Ulcers & Wounds

The importance of preventing and recognizing foot wounds cannot be understated: Up to 24 percent of diabetic patients who develop a non-healing foot ulcer will require amputation; put another way, foot ulcers precede 85 percent of diabetes-related amputations.

Foot Wounds and How they Occur

How do foot wounds occur? Any number of factors can contribute to a foot ulcer: poor circulation and lack of feeling, irritation of the area exacerbated by friction or pressure, trauma to the foot, and existing deformities, to name a few. In addition, long-time diabetics often develop neuropathy – nerve damage that inhibits the ability to feel the wound, often adding days before it is even detected.

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.

Foot Wounds and Peripheral Artery Disease

Among the most obvious signs of advanced Peripheral Artery Disease are foot wounds and ulcers. Perhaps it is more accurate to say that foot wounds should be among the most obvious signs of advanced PAD. However, the nature of circulatory issues and numbness that is prevalent in Type 2 diabetes sufferers and others with PAD means that many people do not know they have a foot wound until days later – days that can be long enough to let infection set in and amplify the risk of amputation.

What Can You Do About Foot Ulcers and Wounds?

Before foot wounds get bad enough where amputation is an imminent risk, there are a number of things you can do:

  • See your podiatrist regularly to check for neuropathy and signs of foot ulcers.
  • Follow your doctor’s recommendations for diet and exercise to treat your diabetes and minimize the risk of foot wounds and diabetic ulcers.
  • Incorporate regular self-checks into your daily routine so that unfelt wounds do not go undetected; look for cuts, bruises, cracks, blisters, and any other abnormal signs that indicate a wound.
  • If you do have a foot wound, see your podiatrist immediately; keep it clean and change dressings regularly to prevent infection, and follow other instructions from your doctor.
  • Always remember to cool down by slowly walking for 5 minutes followed by light stretching of your calf and thigh muscles.
  • Take our PAD Risk Assessment Quiz to evaluate your own vulnerability and educate yourself on symptoms and prevention.
  • Even when taking precautions, you may still develop foot wounds and ulcers. Don’t delay treatment.

Modern Vascular Wound Care

If you live in Southaven, Mississippi then you have to ability to visit Modern Vascular’s Wound Care clinic. Chronic wounds are concerning and should be taken care of. Wounds that go untreated can become infected. If an infection becomes severe it may require amputation. There is a mortality rate of 50% 5 years after an amputation. It is absolutely crucial to take care of wounds, especially if they are taking longer than usual to heal.

Tips for managing peripheral artery diseaseWatch “Tips for Managing your PAD” Video
Just a little walking may help prevent a PAD procedure

Walking Program: Benefits & Tips

Before starting any exercise program make sure to speak with your doctor. They can assist you with a structured walking program either through a physical therapy program or simply walking on a treadmill, around the mall or grocery store, or in your neighborhood.

Walking exercises the muscles in the calves, thighs, and buttocks. These are large muscle groups that have a high level of oxygen demand. When you are walking, the oxygen demand of those muscles increases. Chemical messengers are sent to the blood vessels to tell the smooth muscle in the lining of the arterial wall to relax, open up, and allow more blood flow. That improves the blood flow to everything below the waist when you are walking. Also, it encourages new connections between the microvessels.

Cardiovascular fitness helps your body deliver blood carrying oxygen and nutrients to your most important organs, including your heart and your brain. Studies show that it can help improve your cognition, memory, mood, and sleep. It can also help alleviate stress, increase energy levels, strengthen your bones, and lose body fat.

Getting Started With a Walking Program

It is a great idea to plan ahead if you are struggling with your walking routine. Keep track of how long you can walk and how far you can get. As you progress you should be able to walk for longer periods of time and greater distances.

Structured Walking Program Example

  • Warm up with light stretching of your calf and thigh muscles.
  • Start walking at a pace that is fast enough that you may have slight discomfort.
  • Stop and rest until that discomfort or pain goes away.
  • Repeat this routine several times slowly building up your walking time, about 3 to 5 times a week.
  • Cool down. Slowly walk for 5 minutes followed by light stretching of your calf and thigh muscles.

Do You Have Pain or Cramping When You Walk?

Have you noticed that you choose to walk less and park closer to stores because walking causes you discomfort? Do you wake up at night because your legs hurt? Do you use a cane, walker, or scooter to assist you with mobility because your legs feel weak?

You Might Have PAD

What is PAD, you ask? PAD, which stands for peripheral artery disease, is caused by cholesterol and other fatty substances that block the blood vessels going to your lower legs and into the feet. Due to the decreased blood flow to the muscles and other tissues, it is common to experience pain and cramping. It is frequently seen in people over the age of 50, people who have smoked or still do, people living with diabetes, people experiencing diabetic neuropathy (nerve damage which causes numbness, tingling, and pain), or people that have high blood pressure.

Other indicators for PAD include wounds or ulcers on the legs or feet that do not heal in an appropriate amount of time. Also, if the skin is discolored or if the hair is growing at a slower rate, that could indicate that you may be at risk. If you are experiencing any of these symptoms you are advised to talk to your primary care physician.

Does Walking Help Peripheral Artery Disease?

If you are experiencing the symptoms of PAD, a structured walking program can help. Weight-bearing exercise works by improving your circulation through the growth of new blood vessels. Those vessels can help ease the pain but it does not happen overnight, just like your PAD did not happen overnight. A walking program is beneficial to all PAD-affected patients but especially to those pre-symptomatic patients and those already treated for PAD through revascularization procedures, like those done at Modern Vascular.

Walking is a simple form of exercise that isn’t too intense. It is great for slowly increasing physical activity because it is easy to start and stop. If you are experiencing pain when you are walking you should try to rest until the pain subsides before you continue to walk. As we had mentioned before, it is good for cardiovascular fitness. Improving cardiovascular fitness can improve the severity of the symptoms. When you are trying to introduce more physical activity into your routine to improve health conditions that you may have you should consult with a doctor to make sure that it is not causing more harm to the parts of the body that are experiencing pain.

Exercise Guidelines For Patients With PAD

The American Heart Association studied the optimal exercise routines for patients that are suffering from peripheral artery disease. Accordingly, they are able to offer recommendations to patients with lower-extremity PAD. These are the PAD exercise guidelines that are available from their study.

  • An exercise program with supervision is recommended for patients that have claudication.
  • Before possible revascularization, a walking program should be discussed.
  • An exercise program and behavioral changes can help improve the ability to walk and functional status in patients that have peripheral artery disease.
  • Different exercise strategies like cycling, upper-body ergometry, and low-intensity walking that don’t get to the level of moderate or maximum claudication can be beneficial.

There is evidence that supports exercise as a means to improve the condition of peripheral artery disease that goes all the way back to 1966. There has been a number of clinical trials since then that continue to support that evidence. Most of the studies conducted on PAD walking performance used treadmills, so treadmills can be considered a good tool to use for a PAD walking program.

Please consult with a doctor if you think that you have peripheral artery disease. Do not over-exert yourself if you are experiencing PAD symptoms without first speaking to a doctor. To determine if you may be at risk for peripheral artery disease, you can take the Modern Vascular PAD Risk Assessment Quiz.

Tips for managing peripheral artery diseaseWatch “Tips for Managing your PAD” Video
Dr. Juan Carlos Correa the managing physician at Modern Vascular in Kansas City

Diabetic Coordination of Care

It is estimated worldwide that every 30 seconds a leg is amputated and 85% of those are due to a diabetic foot ulcer.1 Treatment of diabetic patients that come to Modern Vascular cannot happen without coordination of care between our interventional radiologist and the endocrinologists and podiatrists who regularly treat diabetic patients.

Coordination of Care for Diabetes Patients with PAD Reduces Amputations

One example of such collaboration that occurs regularly is among San Antonio-area physicians Dr. Firas Akhrass, an Endocrinologist, Dr. Russell Stanley, a Podiatrist, and an Interventional Radiologist that used to manage Modern Vascular’s original San Antonio clinic. How do these doctors work together to reduce diabetic-related amputations?

How do an Endocrinologist, a Podiatrist, and an Interventional Radiologist work together?

All three participated in our Webinar, but here’s a preview of their talk:

Interventional Radiologist

From an Interventional Radiologist’s point of view, patients do not magically realize they need an interventional radiology procedure of their own accord. They need education on PAD, its symptoms, and its treatments, and that often comes with the help of the other physicians treating them for diabetes and related complications. “These doctors are able to identify symptoms of PAD, and know when to escalate treatment to prevent amputation. This coordination of care is important in saving limbs and restoring lives.” Recommendation by your physician is the most common way to find out you may be at risk for PAD, but another tool available to anyone is this easy self-assessment quiz to check for significant risk factors.

Podiatrist

Dr. Stanley, a Podiatrist, notes common indicators that his patients should be evaluated for PAD are discoloration in the skin, bruising, mottling of small blood vessels distally, foot ulcers (holes in the skin), skin temperature, and sometimes ischemia. Patients often don’t feel pain from PAD symptoms, due to diabetic neuropathy. The most important thing to note is that left untreated, any of these symptoms can lead to worsening problems and future amputation. Patient awareness is paramount, he says: “Having patients be able to identify that there is a problem, they need help, and it’s not going to get better and self-resolve, is of utmost importance.” When referring patients to Modern Vascular, Dr. Stanley is always pleased to receive reports of progress, including from patients who received an interventional radiology procedure, as they often report a return to normal neurological sensation, decrease in swelling, and nocturnal cramping. “This is the result of a team approach for patient care,” he adds.

Endocrinologist

Dr. Akhrass, an Endocrinologist, treats many patients with type 2 diabetes who have a wide range of symptoms. While lifestyle changes – such as a healthy diet and regular exercise – and medication help many people keep their diabetes under control, he notes that he also looks for symptoms such as leg pain, color change, and pain while walking. Patients with these symptoms get a PVD (Peripheral Vascular Disease) screening in his office. That said, Dr. Akhrass adds that caution is recommended: “it is better to screen for PVD before symptoms are present than after.” If a PVD screening indicates the patient may have PVD, Dr. Akhrass refers patients to treatment at Modern Vascular. Specialists do not evaluate and treat patients in a vacuum; when endocrinologists and podiatrists coordinate care to include interventional radiologists like those at Modern Vascular in the management of type 2 diabetes, it can result in life-altering – and limb-saving – interventions.

Sources

  1. Diabetic amputations may be rising in the United States / AJMC
Diabetes and PAD

The Connection Between Diabetes & Peripheral Artery Disease

Knowledge of diabetes, its risks, and symptoms are very important to everyone who may be susceptible to this disease or have loved ones who are. Just as important is awareness of how to recognize and what to do about the most serious effects of diabetes, particularly those who risk lower limb amputation from Peripheral Artery Disease (PAD).

What to Know About Diabetes and PAD

Diabetes is common, but it gets more common to those over 65 – one in four people in that age group will develop the disease.1 Add to that, people with histories of smoking, obesity, or diabetes in the family, and overall more than 34 million Americans have diabetes, according to the Centers for Disease Control.2 What’s more, one in five diabetes sufferers don’t even know they have it.3

Diabetic foot infections cause the most hospitalizations

20 percent of all hospitalizations are due to diabetic foot infections4, including ulcers. One reason they go untreated too long is that due to PAD – which is commonly attributed to diabetes (20% of cases5), diabetics often do not notice an injury or ulcer to their lower limb until well after it has happened.

Diabetes and Peripheral Artery Disease Facts and Statistics Infographic

Diabetic Foot Care: Avoiding Diabetic Amputations

Lower limb amputation is a serious risk for those with Diabetes. Currently, as many as 25 percent of the diabetic population have a chance of losing some part of their foot or leg due to PAD. To put that number into sharper focus, someone undergoes an amputation every 20 seconds6 – an event that is becoming more frequent. Amputation is not merely the loss of a toe, leg, or a foot; it is life-changing, with at least a third of amputees never walking again, and with that comes the risk of nursing home placement and increased mortality rates7. The financial burden is heavy as well; the estimated lifetime medical costs for an amputee can grow to more than $500,000.8

Awareness and treatment lower the rate of amputations

Being aware of symptoms and having regular checkups with primary doctors and podiatrists helps spot dangers early and prevent symptoms from progressing to the point of amputation. In addition, Interventional Radiology (IR), a minimally invasive, image-guided procedure is becoming a more common way to treat vascular disease. Vascular procedures like IR are already reducing amputation rates due to PAD by 20 percent9, and these procedures are becoming more common as awareness grows. Concerned about your risk? Take this easy interactive quiz.

Diabetes Awareness Month is about more than awareness of the disease itself, but also of how to treat its most severe effects, and as a result, saving limbs and the hope for an untold number of patients to continue their normal lives. It is a great opportunity to learn more about the disease and develop a better understanding of the treatment options that are available. September is peripheral artery disease month, another opportunity to learn about a disease that is prevalent in people that are living with diabetes.

Sources

  1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2011. Atlanta, Georgia, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011
  2. Centers for Disease Control, 2020
  3. Centers for Disease Control, 2020
  4. Frykberg RG, Wittmayer B, Zgonis T. Surgical management of diabetic foot infections and osteomyelitis. Clin Podiatr Med Surg. 2007;24:469–82. [PubMed] [Google Scholar]
  5. Wu, S., Driver, V., Wrobel J., and Armstrong D., Foot Ulcers in the Diabetic Patient, Prevention and Treatment. Vascular Health Risk Management. 2007 Feb; 3(1): 65-76
  6. A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU), NIH, 2018
  7. Frykberg RG, Arora S, Pomposelli FB Jr, LoGerfo F. Functional outcome in the elderly following lower extremity amputation. J Foot Ankle Surg. 1998;37(3):181-5; discussion 261.
  8. Blough DK, Hubbard S, McFarland LV, Reiber GE, Smith DG, Gambel JM. “Prosthetic Cost Projections for Servicemembers with Major Limb Loss From Vietnam and OIF/OEF.” Journal of Rehabilitation Research and Development 2010;47(4):387-402
  9. Mentias A, Qazi A, McCoy K, et al. Trends in Hospitalization, Management, and Clinical Outcomes Among Veterans with Critical Limb Ischemia. Circ Cardiovasc Interv 2020 Feb 13
Dr. Leschak Interventional Radiologist for Modern Vascular, Best Peripheral Artery Disease Treatment Specialist 2020-USA(1)

What is Interventional Radiology?

Interventional Radiology (IR) uses minimally invasive, image-guided procedures to treat vascular disease. These treatments pose minimal risk to patients, reduce recovery time and lower costs versus open vascular surgery. Interventional radiologists are medical doctors with 6 or 7 years of additional training following medical school. Interventional radiologists are certified in both diagnostic radiology and endovascular procedures (treatments).

How do endovascular procedures differ from open vascular surgeries?

  • Endovascular procedures are conducted in dedicated outpatient clinics rather than in a hospital setting.
  • Interventional radiologists specialize in minimally-invasive procedures while vascular surgeons perform open procedures as well.
  • Endovascular procedures tend to be shorter and have reduced recovery time, usually discharging the patient on the same day.
  • Patients are under moderate sedation during an endovascular procedure while open vascular surgeries usually require general anesthesia.
  • Endovascular procedures are less expensive than open vascular surgery.
  • Vascular surgeons are trained to treat a variety of vascular conditions which may include offering endovascular procedures. Conversely, some interventional radiologists, including those at Modern Vascular, choose to develop specialized skills in a specific IR treatment.

Types of endovascular procedures

The strategies for treating vascular disease vary based on the severity and the type. Endovascular procedures are not as invasive as other procedures and are much more innovative. The following procedures are common for vascular interventional radiologists to perform.

  • Balloon Angioplasty – A very narrow catheter that has a balloon on the tip of it is inserted into the femoral artery of the patient, which is located in the groin. It is guided to the part of the artery that is blocked with the help of x-rays. The balloon is then inflated and deflated a few times with the goal of eliminating the obstruction.
  • Stent Placement – If an artery gets closed again after a balloon angioplasty a stent may be placed within the artery in order to keep it unobstructed. Stents are tiny tubes that help support the opening of an artery. They are placed over the balloons, which are inflated in order to cause the stent to expand, then the balloon is deflated and removed, leaving the stent in place.
  • Additional Endovascular Procedure Techniques – Interventional radiologists are well-suited to find solutions to new and complex issues that arise. Generally, these problems require more invasive procedures and therapy, but interventional radiologists are always finding new ways to overcome these challenges.
Balloon Angiography and Stenting

Long-term patient relationships with interventional radiologists and vascular surgeons.

Both interventional radiologists and vascular surgeons have long-term patient relationships and will continue to see patients for follow-up care after treatment. Modern Vascular patients are asked to visit their IR physician for follow-up care 2-4 times per year post-procedure.

Interventional radiology is used to diagnose and treat peripheral artery disease.

Modern Vascular specializes in Peripheral Artery Disease treatment and pedal loop reconstruction. Through its unique training program, doctors who are already skilled and knowledgeable about vascular disease become experts in pedal loop reconstruction and other endovascular approaches to returning blood flow to the feet, placing Modern Vascular doctors among the few who revascularize arteries below the knee, all the way to the pedal loop.

Take The Peripheral Artery Disease Assessment

Watch this video to learn more.

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, more than half of patients with PAD do not experience any symptoms 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.

Skip to content