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Peripheral vascular disease treatment comes of age

April 2014
By Stephen P. Maniscalco, MD Board Certified Cardiothoracic and Vascular Surgeon

Cardiovascular Disease (CVD), including heart disease, stroke and high blood pressure, continues to be the number one cause of death in men and women in the United States, according to the Center for Disease Control.

Peripheral Vascular Disease (PVD), also known as Peripheral Artery Occlusive Disease (PAD), is a serious medical condition that can lead to pain, loss of mobility, amputation and be life-threatening if not detected and properly treated in a timely manner.

Fortunately, breakthroughs in healthcare technology and training, have vastly improved the medical community’s ability to assess, diagnose and treat PVD. Modern ultrasound, CT Scans and angiography equipment enable physicians to have a reliable way to assess obstructions and inflammation in and around arteries and veins. These obstructions could lead to stenosis, embolism or thrombus formation and cause acute or chronic ischemia or lack of blood supply.

A generation ago, most Thoracic Surgeons practiced in one of three primary disciplines: Cardiac Surgery (Coronary Artery Bypasses, Valve Replacement/ Repair Surgeries), Thoracic Surgery (surgeries of the lung and chest) or Vascular Surgery (surgeries of the aorta, carotid, or lower extremity). In the current era, a growing number of physicians become skilled in all three areas, so they have a more rounded and complete set of skills with which to treat patients.

Due to advances in technology allowing physicians to perform a wider range of non-surgical procedures, specialized training in CVD and PVD is important. For instance, occluded arteries can now be treated through the use of stents, balloons and other techniques, which will improve circulation without having to perform major open surgery. CVD and PVD specialists are also in a better position to more aggressively treat vascular disorders, because they are trained and equipped to handle potential complications and side effects that can occur during delicate circulatory procedures.

PVD symptoms & treatment

The narrowing of arteries can occur without a patient’s knowledge. Eventually, mild claudication (pain in one or more of the limbs), often associated with exertion, will be a signal that something is wrong. If left untreated, the condition can worsen, leading to increased discomfort, ulcers, necrosis or gangrene of the affected limb. In the case of a leg, for example, it is important to save the limb—not only for quality of life purposes, but to help the patient remain active and mobile as well.

This will prevent further issues that can develop from a more sedentary lifestyle. As physicians, we want to keep patients whole, ambulatory and out of a wheelchair. Diagnosing and treating vascular blockage is serious business. Fortunately, there are a number of non-invasive tests and procedures that can accurately locate and identify the problem, without invasive tests or exploratory surgery.

For example, restoring blood flow to an occluded iliac artery (the artery that connects the aorta to the leg arteries) used to be a major surgical procedure, requiring an abdominal, bilateral and groin incision as well as a four to seven day inpatient stay. The patient would then have restrictions for six weeks before returning to full activity.

Now the use of ultrasound or CT scan angiography can initially locate and diagnose the level of disease, followed by a formal angiography and intervention in the radiology suite. This can often accomplish the same result on an outpatient basis. The patient often returns to full activity in just days with minimal restrictions.”

Another advancement in the treatment of CVD and PVD involves recognition of factors that lead to these disorders. While there is little one can do about genetics and a family history of vascular disorders, overall health and lifestyle issues play important roles in treating and reversing the negative effects of circulatory problems. Smoking, diet, hypertension, dyslipidemia and diabetes mellitus are serious issues that can cause progressive damage. Patients over 65 years of age, obese and/or have a sedentary lifestyle are also at a greater risk of developing Type II diabetes, as well as CVD and PVD.

A vascular surgeon seeks to identify potential health hazards before they progress to a stage that causes discomfort, rest pain or tissue loss, such as amputation. They help the patient with understanding what factors can be modified and treated to limit further progression of the disease.

Diet and regular exercise are often key factors—even if the changes in lifestyle are relatively minor. The key for patients, especially those with higher risk factors, is recognizing these factors exist and working with their physician to make lifestyle changes that will improve their overall health and mobility.

In Summary

Major advances in the diagnosis and treatment of PVD/PAD have occurred in the past few years that have led to better understanding and treatment of the disease, as well as less invasive techniques to achieve increased blood flow in the lower extremities. These techniques are used daily to help patients keep active, mobile and out of pain.