Tuesday, April 17, 2012 - Noon
Peripheral artery disease (PAD) affects about 8 million Americans. It is estimated that 1 in 3 diabetics over the age of 50 are suffering from this condition. If left untreated, PAD can lead to severe damage to the limbs and organs. Vascular Surgeon, Dr. Lee Kirsksey answers your questions about PAD.
Symptoms of PAD
HubbsG: I am 66 and was aerobically active until a few years ago. my feet and hands are so cold that I have given up outdoor activities except in very warm weather. My vascular blood pumping has been checked by several doctors through palpitation. What type of doctor should I see concerning circulation in my feet and hands. My heart is fine according to my cardiologist.
Dr__Kirksey: You should see a vascular specialist, ie, vascular medicine, cardiology, vascular surgery and non-invasive diagnostic studies can be done to diagnose the cause of your symptoms.
Paul: Do night leg cramps indicate PAD?
Dr__Kirksey: Leg cramps, or more specifically, foot pain can be a sign of peripheral arterial disease, however, more commonly is related to nerve-related discomfort or electrolyte disturbances. Diagnostic tests, like an ABI, can distinguish the cause.
Warren: I have numbness in my legs and feet and pain in his leg when I walk allot. I have high blood pressure and high cholesterol. Can this be PAD?
Dr__Kirksey: Risk factors for peripheral arterial disease include high cholesterol, elevated blood pressure, diabetes, and smoking history. Your symptoms may be a result of peripheral artery disease and can be evaluated quickly with non-invasive vascular studies. Visit your vascular specialist to be evaluated and have these studies provided for you.
Diagnosis of PAD
kw83kw: How is PAD diagnosed? are the specific tests that I should ask about?
Dr__Kirksey: PAD can be diagnosed by physical examination, however, the more common way it is diagnosed is by recognition of symptoms which may include calf cramping with exercise, pain at rest, or the development of ulcerations of leg or foot. They are very simple tests called the ABI (ankle-brachial index) which can identify the presence of PAD.
Mesenteric Artery Disease
SaraB: I had superior mesenteric artery by-pass surgery 2 yrs ago. Since then I have been told that my inferior artery is occluded. A stent did not work on the superior. Is there anything that can be done for the inferior artery? I have been told no.
Dr__Kirksey: At the Cleveland Clinic, we are frequently consulted for second opinions regarding revascularization options. I would suggest obtaining your imaging studies and seeking a second consultation regarding the possibility of angioplasty, stenting or surgery.
Renal Artery Disease
Kipner: How long do stents to the renal arteries last? What do they do if they block up again?
Dr__Kirksey: The durability of stents within the renal arteries varies. Importantly, close monitoring with non-invasive vascular tests is important to identify recurrence of blockages. This allows them to be treated and to prolong the performance of the stents.
SpencerH: I had laser ablation of both varicose great saphenous veins approximately 2 years ago. Done by a very highly trained vascular surgeon. In one leg the varicosity returned with a vengeance in the same vein. In the other a new equally bad varicosity developed in a different vein. I am not amused. I am wondering what your observations would be. Thank you
Dr__Kirksey: New vessels or neovascularization can occur following endo-venous ablation, non-invasive ultrasound can diagnose recurrence of your venous insufficiency and determine what local treatment is appropriate for your varicose veins, including sclerotherapy.
WHENDYM: I have been in pain since 4/29 I went to the ER they told me I have superficial vein thrombosis in the left leg they gave me nothing. should I still be in so much pain still the swelling went down the pain has went up.
Dr__Kirksey: Superficial thrombophlebitis can be quite painful due to severe inflammation; typically treatment consists of warm compresses and anti-inflammatory medication, however, it may take several weeks for your symptoms to resolve. Schedule a follow-up appointment with your vascular specialist to assure complete resolution.
Lower Extremity (Legs) Peripheral Artery Disease
CHIRIACO: Are there new procedures you can recommend for those of us with lower extremity, full occlusions in which traditional angioplasty/bypass is not recommended?
Dr__Kirksey: There is rapid evolution of alternative treatment options for lower extremity arterial occlusions, including drug-eluting balloons and stents. Evaluation by a vascular specialist can determine your treatment options including bypass.
CHIRIACO: which medical facilities on the west coast would you recommend(if travel to Cleveland clinics isn't possible) that would implement these newest surgical interventions for lower extremity occlusions?
Dr__Kirksey: There are a number of good vascular programs on the West Coast - consult with your local physician.
Flames12: What procedures are available for a person with PAD who is suffering from a blocked artery in the lower left extremity--outside of angioplasty or by-pass on the arteries in the lower legs?
Dr__Kirksey: Angioplasty, stenting or bypass are the standard options for improving circulation to the lower extremities, eliminating symptoms and preventing amputation. To date, no medical therapies are available to improve symptoms.
karrwhit6: I had a graft and stent put in about maybe 10 yrs ago, I am wondering if It possible that these may return again, I having been having pain with walking and really need to rest, so I'm wondering if maybe I could PAD again, does it return if been treated once
Dr__Kirksey: Yes, bypass grafts can develop failure over time and it is important that they are monitored after placement. Visit your vascular specialist to have the appropriate testing and determine what can be done to alleviate your symptoms.
Nana4: Do you use laser therapy to treat blocked arteries in the legs?
Dr__Kirksey: In some types of lower extremity arterial insufficiency, lasers can be used to reopen blocked arteries and facilitate balloon or stent placement. Trials are ongoing at the Cleveland Clinic using this technology.
bmet12: My wife had a venous ulcer wound on her leg just above the ankle. This was treated surgically by using her saphenous vein on her other leg. It was successful. Within a year the same condition appeared on her other leg in the same spot. Very painful & life altering. Since they will not use her last saphenous vein, is there an alternative for her surgically? Is there another source for a vein? Thank- You, Paul.
Dr__Kirksey: There are a number of causes of lower extremity wounds including venous insufficiency and arterial insufficiency. This distinguishing the two can determine which treatment is most appropriate.
STEVENM: what could happen to make a femoral bypass surgery end up with an amputation on the opposite leg of surgery and a scrotectomy preformed on my groin destroying my sex life. They say it happens. I got gang green in my foot and on my privates. They say it isn't out of the normal for this type surgery to end up like this.
Dr__Kirksey: You would really need to consult with your specialist.
GeorgeB: If someone is told that he needs an amputation - are there times when a foot or limb can be saved instead of amputation? What are some things that can be done to prevent amputation?
Dr__Kirksey: There are many alternatives for revascularization prior to amputation. Initially, angiogenesis therapy can be offered in some cases where revascularization is not possible. Consult with your vascular specialist to determine what options are best for you.
Paul: What is the relationship between wounds and amputation? Is there anything to treat wounds or try to help save the limb?
Dr__Kirksey: Lower extremity wounds can develop as a result of venous or arterial insufficiency or a combination of the two. Management of the problem frequently requires a multi-disciplinary approach including wound specialists, vascular medicine, cardiologists, vascular surgery and podiatrists. At the Cleveland Clinic, we have an aggressive leg salvage program dedicated towards reducing the rate of amputation. We use proven traditional techniques and innovative new technology to achieve this goal.
girlz: Why are so many diabetics ending up with amputations?
Dr__Kirksey: Diabetics are two to three more times likely to develop heart attack, stroke, or limb amputation. There are a number of reasons for this; however, it is clear that diabetes directly affects the arteries of the body. Patients with diabetes should have careful foot care, and also risk reduction for the development of heart attack and stroke.
Stranger: Are there any PAD clinical trials at the Cleveland Clinic currently?
Dr__Kirksey: Yes, there are a number of PAD trials, looking at therapies ranging from angiogenic injections, drug-eluting balloons and stents, and advanced endovascular techniques. To determine candidacy for these trials or for additional information, please call the nurses in the Heart Resource Center, toll free at 866-289-6911.
PAD Risk Factors
Mily: What is the relationship of stress to the development of PAD
Dr__Kirksey: Some research indicates prolonged and unrelenting stress increases inflammation which can result in cardiovascular disease. Stress management options and information are available at the Cleveland Clinic and on our website - search stress management.
Jillyjill: Dr. Kirksey, can you please take a lit more about risk factors and managing them?
Dr__Kirksey: The first aspect of risk factor management is to identify the presence of risk factors for cardiovascular disease, including family history, long-term tobacco use, elevated cholesterol and hypertension (high blood pressure). Many of these risk factors are related to our diets and our exercise activity. Our specialized teams at the Cleveland Clinic evaluate how these risk factors can be optimized to reduce the risk for heart attack and stroke and to reduce the recurrence of disease after major operations.
Medications and PAD
JU873: is there any drug treatment recommended for PAD?
Dr__Kirksey: Drug treatments for peripheral arterial disease are largely directed at slowing the progress and to this point, are not effective at reversing arterial blockages. Effective medical management can reduce the risk of heart attack and stroke. Ask your vascular specialist if you are on the appropriate regimen.
Femoral Bypass Surgery
Lolohun: What is normal recovery time for femoral bypass surgery? Does one have rehabilitation or Physical Therapy?
Dr__Kirksey: In general, patients are hospitalized for 4 to 6 days, and require physical therapy after leaving the hospital to improve their rate of recovery. Importantly, some minimally invasive techniques have replaced femoral bypass allowing patients to leave the hospital on the same day as the procedure. Please see our website to learn more about these options.
PAD in Young Adult
Yram22: My daughter, who is 21 years old, has had ongoing face pain and pressure, dry eyes, and left sided paresthesias/sensations down her left arm, side, and leg for over a year now. The doctors did a CT scan and MRI of her head and neck and only found an ethmoid cyst. She recently had an episode like shortness of breath. Her left ear is now feeling hollow and dry and pain like her sinuses do, and she says her breathing feels funny, very dry now. Could this be PAD or a heart issue with pain radiating to her face? If so, what tests should she have? Thank you for your help.
Dr__Kirksey: PAD disease is uncommon in young adults, however, you should certainly have your daughter evaluated by her physician.
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