Dr. Diego Hernandez of Bloomfield Vein & Vascular breaks down peripheral artery disease and its risk factors, plus how to manage the condition
Sponsored by Bloomfield Vein & Vascular, PLLC.
Peripheral Arterial Disease, or PAD, is a condition that develops over years and is caused by the buildup of plaque within the arteries that provide blood flow to the lower extremities. PAD is also known as hardening of the arteries and is often referred to as Peripheral Vascular Disease (PVD). The accumulation of plaque throughout the body is known as atherosclerosis.
Plaque is material that develops inside our blood vessels and tends to involve multiple arteries throughout our body. Despite understanding how plaque develops, we do not yet understand why some patients tend to develop symptoms in particular locations; for example, some people are unable to walk as a result of plaque within the leg arteries, whereas some people may develop a stroke because of plaque that is present within the carotid arteries, even though they might have plaque throughout the body. It is important to keep this in mind, because treatment of PAD involves not only dealing with the symptoms that it produces, but efforts to lessen the impact that plaque has in other parts of the body.
The risk factors for the development of atherosclerosis or PAD, are the same risk factors that lead to heart disease: smoking, diabetes, high blood pressure (hypertension), obesity, a sedentary lifestyle and a family history of vascular conditions. Age is also a factor, and we now understand that PAD tends to be a condition that mostly affects people over the age of 60. However, if you develop some of these aforementioned risk factors at a young age, you may develop PAD symptoms in your 40s or 50s, particularly if you have smoked previously.
It is important to discuss that there are two major types of blood vessels inside our bodies. Arteries carry oxygen rich blood away from the heart and distribute it all over the body. Veins are responsible for bringing oxygen depleted blood back to the heart. People often mistake veins for arteries, and so it is important that we keep this distinction in mind. PAD refers to a condition that only affects our arteries.
When plaque builds up inside the arteries that provide blood flow to our lower extremities, it causes insufficient flow, and the oxygen and nutrients that are transported within the blood are unable to reach parts of the legs, which can then cause symptoms.
Most commonly the symptoms of lower extremity PAD occur in the calf, but the thighs, buttocks and feet are other possible trouble spots. The most common type of PAD that we see is when symptoms happen with activity. As we walk, the muscles in our legs require more oxygen, which is being delivered by the arteries that supply those muscles. If the artery is blocked as a result of plaque, the buildup of this plaque makes it difficult for the body to increase blood flow to a muscle that is active, like when we walk for example. If the muscle does not get enough blood flow, it doesn’t get enough oxygen, which is the fuel that allows the muscle to work. When the supply of oxygen does not meet the demand of oxygen by the muscle, the muscle will cramp, causing discomfort or tightness, often feeling like a charley horse. When this happens, it causes us to stop walking, which then lessens the amount of oxygen needed by the calf or thigh muscles, allowing the symptoms to go away. However, the symptoms return if we walk again. This is known as claudication, which over time can worsen and can lead to increased difficulty walking, affecting your quality of life. Although claudication may remain stable for long periods of time, it is important to seek appropriate advice, so that you can understand the options available to you to treat this type of PAD and avoid the complications that might arise over time.
In extreme cases, PAD can lead to pain that happens at rest, without activity. This pain is only seen in the foot and represents a severe form of PAD, caused by an excessive amount of plaque buildup that restricts the flow of blood so much that our foot is unable to get enough oxygen, even without activity. This condition, known as rest pain, often leads to areas of skin breakdown or wounds, predisposes the toes and feet to infection, can lead to gangrene and might lead to an amputation. Unlike claudication, patients with rest pain or wounds associated with PAD, tend to have bad outcomes if not properly treated. But where you seek treatment matters, and guidance from a board-certified vascular surgeon can often make the difference between having a successful outcome or having complications. Not every practitioner who claims that they can treat PAD, is positioned to offer the comprehensive treatment that is necessary to deal with this condition.
There is a set of patients can be affected by PAD, and not know it. Diabetes causes changes in the perception of pain and the mechanics of walking, and often, a diabetic patient presents with very advanced PAD, typically with such extensive damage that an amputation might be the only solution. It is imperative that diabetics pay attention to their feet daily, monitoring for any areas of redness or irritation. Ideally, diabetics should have routine evaluations performed by podiatrists, who will perform thorough foot examinations and find issues before they develop into problems.
How do we currently manage PAD? Many patients with PAD wonder if they’ll have to undergo major surgery to treat their condition. According to Diego A Hernandez, MD, a board-certified vascular surgeon and the lead doctor at Bloomfield Vein & Vascular in Bloomfield Hills, major surgery is not always indicated and often there are a number of minimally invasive procedures available to treat PAD that can be just as effective.
Some people with early symptoms of PAD can manage the condition by making lifestyle changes recommended and monitored by Dr. Hernandez, such as reducing your blood pressure and cholesterol through diet, exercise and specific medications. The most important factor that can be modified is tobacco use and quitting smoking is essential in preventing the worst complications associated with this condition. In cases where your activities are limited by the inability to walk or you have developed pain at rest and/or a wound, undergoing a procedure to treat your PAD can restore quality of life and avoid a potential amputation.
Current options to treat PAD include surgery or minimally invasive approaches. The decision to pursue one of these two options is based on the specifics of your condition and on the extent of the blockages noted in the affected arteries. At Bloomfield Vein & Vascular, we favor treatments for PAD that are minimally invasive, which makes your recovery easier and faster than undergoing major surgery, which carries a higher risk of complications. All of the treatments for PAD are individualized and performed at our state-of-the-art facility, avoiding the need to go to the hospital. After evaluating your condition with a specific type of ultrasound, Dr. Hernandez can recommend a specific minimally invasive option, which involves either angioplasty, stenting, and/or atherectomy. Each one of these procedures has a specific role, and sometimes treatment of your condition may involve more than one of these options. All of these procedures, however, are performed through a small puncture in one of the arteries in your leg or foot.
During an angioplasty, Dr. Hernandez opens up the blocked artery using a catheter with a balloon attached to the tip. By using special x-ray equipment, he positions the balloon exactly where the blockage is at, and inflates the artery using the balloon, causing the artery to open up, treating the blockage, and making it easier for blood to flow through the artery. The balloon is then removed.
When your artery needs assistance beyond an angioplasty to stay open, Dr. Hernandez can also insert a stent into your artery. A stent is a metal mesh tube that remains in your artery and keeps it open. This procedure uses a special ultrasound unit that goes inside the artery, allowing Dr. Hernandez to measure the exact size of the vessel. This allows him to place the correct sized stent for the artery being treated, which improves the likelihood of a successful outcome. Dr. Hernandez also utilizes the latest generation of drug eluting stents, which helps to keep the treated artery open for longer periods of time.
An atherectomy uses a small, spinning tool to remove plaque build-up from a blocked artery. The burr spins so fast that the small fragmented plaque pieces are smaller than our own red blood cells, lessening the risk of large pieces breaking loose and causing complications. Like in angioplasty and stenting procedures, Dr. Hernandez inserts a catheter into your artery with the atherectomy tool attached. Using special x-ray equipment to guide the device into location and also using the special ultrasound unit to determine if the blockage is caused by plaque that will respond to the use of the atherectomy device, he uses this device to remove the plaque that is blocking the vessel, and then uses angioplasty or stenting to ensure the best outcome.
Left untreated, Peripheral Arterial Disease or PAD, has the potential to diminish your health and well-being and in some cases, lead to serious complications. Fortunately, with the appropriate guidance, you can successfully manage your symptoms and have a high quality of life.
If you are concerned you might have PAD, our skilled team at Bloomfield Vein & Vascular can help. Dr. Hernandez and his staff will complete a thorough evaluation of your arteries and overall health before making a diagnosis and recommending a treatment course. Learn for yourself how effective we can be in managing your PAD, with an experienced team that not only will tailor your treatment to your specific problem but can also manage it in an outpatient setting, in our state of the art office and without the need to go to the hospital.
Contact our office today at 248-481-2100, or visit us at www.bloomfieldveinandvascular.com and see what a difference it makes to be evaluated and treated by the vein experts at Bloomfield Vein & Vascular.
43700 Woodward Ave., suite 207, Bloomfield Hills