Peripheral Arterial Disease

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Peripheral Arterial Disease

May 25, 2011
12:00 p.m. – 1:00 p.m. (EST)

  • Carmel Celestin, MD - Vascular Medicine Specialist

Peripheral arterial disease (PAD) affects about 8 million Americans and is associated with significant morbidity and mortality. PAD is a serious condition that can more than double your risk for heart attack or stroke, but often it can successfully treated by quitting tobacco, exercising and eating a healthy diet.

Cleveland_Clinic_Host: Today's Live Web Chat, "P.A.D." with Carmel Celestin, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Sal4CC: I hear the terms PVD and PAD used a lot when describing my disease. Is there a difference in these two terms? What is the difference between atherosclerosis and arteriosclerosis?

Carmel Celestin_MD: Hi, Sal4CC. This is a good question. They are basically the same. Technically, we are to use the word PAD when we are describing arterial disease of the legs (and other areas), but many still use the word PVD. Your other question is for the most part the same answer - they are pretty much the same, but atherosclerosis is the general term that we use. Arteriosclerosis involves the smaller vessels.

PjMurph445: What are the signs of PAD?

Carmel Celestin_MD: The classic signs of PAD are pain in the legs when walking a certain distance that goes away at rest. Many patients, however, will have no symptoms are atypical symptoms.

Marion12: Is it possible to develop PAD as a teenager of 13 yrs. old?

Carmel Celestin_MD: It is very rare to develop PAD in a 13 year old. There are unusual disorders that can affect the arteries in young patients aside from atherosclerosis (plaque build up in the arteries) that may be possible.

Karbear15: I am 57 years old with a family history of PAD. I am interested in knowing the things I can do to prevent PAD.

Carmel Celestin_MD: No matter your age, things that you can do to prevent PAD include maintaining a healthy lifestyle, controlling your blood pressure, keeping your diabetes under control, and abstinence from tobacco use. Knowing your cholesterol levels and keeping them within the normal range is also important.

Bbsweet323: Is it true that taking Vitamin C supplements with smoking and vascular disease, replaces the Vitamin C that nicotine destroys and which is needed to build and maintain good veins and arteries? My husband has smoked since he was a very young boy and still smokes 1 to 1.5 packs a day. He also has diabetes and vascular disease. I am looking for anything that will improve his chances. I know the best thing is for him to quit, but so far, no go.

Carmel Celestin_MD: There is no data to support vitamins helping vascular disease. There is strong data to suggest that smoking cessation is one of the best things to do to help it. It is difficult. Perhaps, he should spend some time with his primary care physician discussing ways to help in this area.

Steph359: What tests will show if my arteries are blocked?

Carmel Celestin_MD: First, your doctor should do a physical examination. This can be followed by a great test known as the ABI (ankle-brachial index), which checks the ratio of the blood pressure in your ankles against that of the arms. They should be equal. If not, this suggests that you have a blockage that is causing the blood pressure in your ankles to be lower. This can be further evaluated by checking the pressures at different levels in your legs to isolate where the problem is. In some patients, we do an exercise.

Sal4CC: What is the difference between a "Charlie horse" and pain from intermittent claudication?

Carmel Celestin_MD: "Charlie horse" is typically a pain that is constant for a while and then goes away and is not consistent with walking. Intermittent claudication is a pain in a certain part of your leg (s) that only occurs with walking and goes away with rest.

Bbsweet323: I am uncertain if I have peripheral arterial disease. I walk at least 5 days per week. I can walk for over an hour without any leg pain. Per my physician, I have a good pulse at the knees, but almost none at the ankles and I have night cramps in the calf areas. I am 79 years old, have never smoked, do not have Diabetes or high blood pressure.

Carmel Celestin_MD: Although you may have PAD, your symptoms do not sound typical for such. I would need a more complete history and examination to determine.

Brinboss: What is intermittent claudication?

Carmel Celestin_MD: Intermittent claudication is pain in the leg (s), whether it be the thighs and/or calves that occur after a certain distance of walking that goes away when you stop walking.

Marion12: Can EVLT be used safely if someone has PAD with Claudication? What are the risks involved?

Carmel Celestin_MD: EVLT can be used in someone with PAD given this involves the veins as opposed to PAD which involves the arteries. Risks involved with the procedure are to be discussed with the physician performing the procedure.

Carmicat17: Recently, my husband has been having hot flushes in his feet, sometimes in one foot, sometimes the other. Could this be a sign of vascular disease? It seems to occur after he has been sitting around then starts to walk around.

Carmel Celestin_MD: The symptoms of hot flushes may be a sign of vascular disease, although unusual. He would need to consult his doctor about this in order to get a full history and examination.

Sal4CC: At what point should I see a doctor to get tested once I think I am experiencing symptoms of PAD?

Carmel Celestin_MD: Once you feel that you are experiencing symptoms of PAD, you should discuss with your physician. This way, you can do further preventive measures to slow or stop the progression of the disease.

Brinboss: Is bicycle riding good for eliminating pain from claudication?

Carmel Celestin_MD: Any types of exercise that involve the legs are good for intermittent claudication. It may be that you will have a longer distance before getting the pain, but less likely to eliminate the pain.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Dr. Carmel Celestin who is taking your questions about P.A.D. To ask a question, type in the box below and then click 'Ask'.

Greg678: My 46-year-old family member has had bypass surgery on each leg. The surgeons declared his surgery a success, yet intermittent claudication has returned. How common is recurrent leg pain after a successful bypass? What do you recommend for rehab and management of this type of condition?

Carmel Celestin_MD: The person best able to give you an answer is your physician who will look at your complete history as there are many factors that contribute to recurrent leg pain after bypass including the timing, ongoing risk factors, if the pain is from something else.

Fanjean4: What is the age for someone to have PAD?

Carmel Celestin_MD: The risk of PAD increases with age. Usually a patient over 50 with risk factors such as diabetes and smoking are at increased risk and patients over the age of 70 without risk factors are at risk.

Squeeks: Is the plaque that builds in your arteries the same kind you get in your mouth?

Carmel Celestin_MD: They are not the same. Plaque buildup in the arteries involves things such as cholesterol particles which are affected by things such as diabetes, high blood pressure, age and smoking.

Samson42: My wife has an infection in her toe which has persisted for over a month. She had a Doppler exam of the right leg, but it was negative. Could this still be PAD?

Carmel Celestin_MD: It is difficult to say if this can still be PAD without a full history and physical examination. I would further discuss this possibility with your physician.

Greg678: My sister has restless leg syndrome (RLS). Is this related to peripheral arterial disease?

Carmel Celestin_MD: Although some patients with PAD may have symptoms that resemble that of restless leg syndrome, they are two different entities with no relation.

PjMurph445: When young persons in their 20s or 30s get PAD, is it because of an unusual hereditary problem with the structure of their arteries at birth, or a speeding up of the aging process?

Carmel Celestin_MD: There are various causes of PAD in a young patient. This includes a genetic predisposition to get PAD early, an underlying inflammatory problem that affects the arteries, or an anatomic issue of the arteries.

Jeannelee: I have been having chronic leg pain that occurs mostly at night. However, it can also occur while I’m sitting. This disrupts my sleep. I cannot get comfortable in bed, and I don’t like for my legs to touch each other because of the pain. Could this be PAD?

Carmel Celestin_MD: Your symptoms are not typical for that seen in patients with PAD.

Carmicat17: I have heard that ginkgo biloba helps blood circulation to the legs. Is that true?

Carmel Celestin_MD: Although gingko go has some blood thinning properties, there is no data that states that gingko helps the circulation in the legs.

Cleveland_Clinic_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

RichRand: I was told that my ABI test was inconclusive because I have diabetes. What does that mean?

Carmel Celestin_MD: Patients with diabetes tend to have hardening of the arteries, which make it difficult to compress the arteries and get pressures on the ABI exam. Therefore, we cannot get a ratio.

Danman3333: I was prescribed a drug with nitroglycerin. I thought that was what you took for heart pain, which I do not have. How does it help my leg pain?

Carmel Celestin_MD: Nitroglycerin, which is usually used for chest pain, does not help leg pain.

Jimmy6765: I was diagnosed with PAD 20 months ago. Exploratory surgery determined that bypass or a stent could not be done. I have been taking Pletal, Zocor, and aspirin along with exercise and have been able to walk a little farther. Are any other medications being used to help this disease? Will anything be available soon?

Carmel Celestin_MD: At this time, there are drugs being studied, but nothing in the near future that are promising for PAD. It seems that you are already on a very good regimen. If not on a cholesterol lowering drug, this would be helpful also, even with good cholesterol numbers.

Cleveland_Clinic_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

Groomsa: Are there any medications out for intermittent claudication?

Carmel Celestin_MD: There is one drug that can be used for intermittent claudication-cilostazol. Walking and lifestyle modifications, however, should be the primary treatment.

Groomsa: Are women at a higher risk for PAD?

Cleveland_Clinic_Host: I am sorry to say that our time Carmel Celestin, MD is now over. Thank you again Dr. Celestin for taking the time to answer our questions today about P.A.D. To make an appointment with Carmel Celestin, MD or any of the other specialists in our Heart and Vascular Institute at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.

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