pvd Archives - Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA

Claudication

Codeholic Admin — Mon, 13 Mar 2017 16:46:20 +0000

Claudication

Claudication is the cramp like pain that develops in the muscles of the leg when walking. The pain is the result of narrowing or blockages of the arteries in the legs. The damage to the arteries is called peripheral arterial disease (‘PAD’).

Why does it occur?

Peripheral arterial disease occurs due to damage of the arteries usually as a result of smoking, high cholesterol, diabetes or high blood pressure. The arteries narrow or block or months and years to reduce the blood supply to the legs. The cramping symptoms are worse on exercising because the narrowed arteries cannot meet the muscles demand for oxygen. When exercise stops the pain usually improves within 5 minutes.

What problems can it cause?

Most people who develop claudication will have symptoms that remain the same for many years. A few patients will improve and some will get worsening of their symptoms (especially if they continue to smoke).

Treatment Options?

Walking and living a healthy lifestyle (exercising, not smoking etc) will help reduce the risk of intermittent claudication.

All patients with claudication should have their cholesterol and blood pressure measured and should be encouraged to stop smoking. It is recommended that all people with claudication should have a variety of medications to protect their arteries form further damage.

Some people will benefit from structured exercise classes to improve how far they can walk. Others may be recommended to have endovascular treatments to improve the circulation:

Balloon Angioplasty

To open a narrowed artery, a catheter with a very small balloon on its tip is placed in the artery and is advanced to reach the narrowed or blocked artery. The doctor then inflates the balloon, pushing aside the plaque that has built up against the vessel walls. The doctor then inflates and deflates the balloon several times to open the vessel.

Atherectomy

Atherectomy is a minimally-invasive method of removing plaque to re-open arteries. Unlike angioplasty and stenting which are designed to squish plaque to the side, atherectomy involves cutting and removing the plaque from the artery, restoring normal blood flow.

Stenting

A stent is a small, metal scaffold that is placed inside an artery. Similar to balloon angioplasty, stents restore blood flow by pushing the plaque to the side but remain inside the artery forever. Stenting often follows balloon angioplasty as an additional treatment to help the vessel remain open.

Bypass

Surgical bypass treats narrowed arteries by directly creating a detour, or bypass, around a section of the artery that is blocked. During a bypass procedure, a physician creates a new pathway for blood flow using a graft. A graft can be a portion of a vein or a synthetic tube that connects above and below a blockage to allow blood to flow around it.

The above information is not all inclusive of the risks, alternatives and benefits. It is not meant to be a substitute for informed discussion between you and your doctor, but can act as a starting point for such a discussion. There are complications possible with any medical procedure. Overall, minimally invasive procedures have a lower complication rate than open surgeries.

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Non-Healing Wound/ Ischemia

Codeholic Admin — Mon, 13 Mar 2017 16:46:03 +0000

Non-Healing Wound/Ischemia

Critical Leg Ischemia

Critical leg ischemia is a lack of blood flow that endangers all or part of the leg and is usually defined as experiencing persistent and recurring pain while at rest, for more than two weeks, or ulceration or gangrene of the foot.

The pain of severe limb ischemia is felt in the toes and forefoot and is typically worse at night when cardiac output drops. Patients wake up in the early hours with severe pain, relieved by hanging the leg out of the bed allowing blood to flow down to the foot. Some patients take to sleeping in a chair. Many patients get up and walk around in the night that stimulates flow and reduces pain. During the day the patient may suffer short distance intermittent claudication. This pattern of symptoms: calf claudication by day and rest pain in the toes at night is strongly suggestive of critical limb ischemia.

Without treatment, critical limb ischemia will progress, causing worsening pain and debility. Ulcers develop on the lower leg and foot, and ultimately gangrene sets in. If the problem is left too late it can become impossible to salvage the leg and amputation may become the only way to save the patient’s life.

Duplex scanning is the first method used to assess the affected limb and establish where the main blockages are that are limiting the blood flow.

Treatment Options?

Some people will benefit from structured exercise classes to improve how far they can walk. Others may be recommended to have endovascular treatments to improve the circulation:

Balloon Angioplasty

Atherectomy

Stenting

Bypass

The post Non-Healing Wound/ Ischemia appeared first on Atabak Allaei, MD: Vascular & Image Guided Specialist | Los Angeles CA.

Peripheral Arterial Disease

Codeholic Admin — Mon, 13 Mar 2017 16:45:41 +0000

Peripheral Arterial Disease

Peripheral Arterial Disease (PAD)

PAD refers to plaque formation in the arteries of the arms and legs. It usually happens because your arteries harden and narrow. (That’s called atherosclerosis). Smoking, high blood pressure, high cholesterol, and not being active are the main causes.

If you have diabetes, you’re more likely to get a worse case of peripheral artery disease that improves less with treatment.

Symptoms

When atherosclerosis narrows the long arteries of the legs, your leg muscles don’t get enough blood flow. As a result, you may feel muscle pain. It usually comes on with exercise and stops when you rest.

It can affect different muscle groups, including:

Calf (most common)
Buttock and hip
Thigh
Foot (less common)
Some people feel burning or numbness. Others have severe blockages with no pain at all, usually because the body grows blood vessels that go around the blockages.

Other signs and symptoms of peripheral artery disease include:

Wounds that heal poorly
Legs are cooler than the arms
Shiny skin over the legs
Loss of hair on the legs
Fainter pulse in the feet

Diagnosis

The tests you’ll take to see if you have peripheral artery disease are simple and painless.

Doctors usually start by checking your “ankle-brachial index,” which compares your blood pressure at your ankle and upper arm. Those measurements should be about the same. If your blood pressure in your ankle is a lot lower, you may have peripheral artery disease.

If your case is severe, you may take a type of X-ray called an angiogram to see exactly where the blockage is. Your doctor will inject a dye into a blood vessel to help show what’s going on.

Treatment

You can do a lot to stop peripheral artery disease in its tracks, such as:

Exercising
Controlling your cholesterol and blood pressure
Not smoking
Eating a healthy diet
The drug cilostazol eases symptoms in many people. Pentoxifylline is another that can improve symptoms in people with poor circulation. Doctors may also prescribe aspirin or other anticlotting drugs.

For severe peripheral artery disease, your doctor may recommend surgery or less invasive procedures to bypass a blocked artery and restore blood flow. See treatment options here.

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