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Treating peripheral artery disease can avoid amputation

Peripheral artery disease affects 8-10 million individuals in the United States; it can lead to the loss of limbs, and even death
Peripheral artery disease affects 8-10 million individuals in the United States; it can lead to the loss of limbs, and even death
Robin Wulffson, M.D.

The statement, blocked arteries, usually conveys an image of a heart attack or stroke; however, arterial blockage can occur anywhere in the body, including the limbs, where it is known as peripheral artery disease (PAD). In order to obtain the latest information on PAD, I consulted with Ronald Gim, MD, an interventional cardiologist who practices with the South Orange County Cardiology Group in Laguna Hills, California. He pointed out warning signs of PAD, which individuals were at the highest risk, and treatment options.

Dr. Gim explained that PAD affects 8-10 million individuals in the United States; it can lead to the loss of limbs, and even death. He cited a clinical study that was published last August; it reported that, worldwide, the number of individuals affected by PAD increased by almost 24% from 2000 to 2010. Similar to its coronary counterpart, PAD is a vascular (blood vessel) disorder that restricts the flow of blood through an artery. The narrowing is due to plaque buildup, which restricts the flow of oxygen to the limb. PAD can involve any blood vessel in the body; however, the condition is most common in the pelvis and legs.

One risk factor for PAD is age; the Centers for Disease Control and Prevention (CDC) estimates that from 12-20% of people over 60, and as many as 30% of people over 70, suffer from PAD. Men and women are equally affected; however, African-Americans and Hispanics are reported to have higher rates of PAD than Caucasians. Other risk factors for PAD are smoking, diabetes, high blood pressure, high cholesterol, and obesity. In addition, lifestyle factors, such as poor nutrition and lack of exercise, can also increase risk. Dr. Gim noted that many patients do not experience symptoms in the earliest stages of PAD. Often, leg pain or discomfort brought on by walking (claudication) is a common first symptom. This initial discomfort is not always painful, and may feel more like weakness, cramping, or tightness. He noted that the condition may also cause pain or discomfort in the hips, buttocks, thighs, knees, shins, or upper feet. Patients not uncommonly experience difficulty in walking, ulcers, sores, and in some cases, skin discoloration.

The condition tends to worsen in time, in advanced stages, patients may develop a chronic total occlusion (CTO); this is a total blockage of an artery that has lasted more than three months and is responsible for a significant decrease in blood flow. It significantly increases the risk of amputation when present in the lower leg. A CTO may occur in up to 40% of patients with symptomatic PAD. Dr. Gim stressed that it is important that treatment for suspected PAD begin as soon as possible; several options are available if the condition is detected early. These include lifestyle changes (such as quitting smoking and increasing exercise levels) and medications that reduce cholesterol, blood pressure, and blood clot formation.

Dr. Gim notes that invasive procedures such as bypass surgery, where a detour is created around a narrowed portion of an artery, and an endarterectomy, in which a vascular surgeon makes an incision in the limb and removes the plaque contained in the inner lining of a the artery. He notes that minimally invasive treatments, such as angioplasty and stenting are rapidly increasing in numbers. He said that he was particularly excited about one of the more recent advancements in technology: a catheter, which cap open up chronic total occlusions. Historically, a completely blocked artery required more invasive treatment; however, for many of his patients, he uses a device called the CROSSER CTO Recanalization Catheter, which forms a new canal within a blocked artery to restore blood flow. This catheter insertion is later followed by further treatment such as angioplasty or inserting a stent. He notes that the CROSSER Catheter has a specialized tip that transmits high-frequency vibrations directly to the location where plaque has built up. He refers to it as a “medical jackhammer.”

Dr. Gim described one of his patients, Debra, who had experienced increasingly severe leg pain when walking short distances over a number of years. The condition severely impacted her ability to perform her duties as an emergency department nurse. She had suffered from type 2 diabetes for a number of years and attributed her leg problems to that medical condition. She became aware of the fact that she had PAD when she was admitted to the hospital for a foot infection in the summer of 2012. The infection was at an advanced stage; it necessitated the amputation of two toes on her right foot. Dr. Gim determined that Debra was experiencing dramatically reduced blood flow as a result of PAD; thus, he was able to use the CROSSER Catheter to restore blood flow to her limb. This procedure prevented any further amputations on her right foot and leg. A few months later, he used the CROSSER Catheter o successfully clear a less severe blockage in her left leg. Following a medical leave, Debra returned to work full time. She notes that her balance and ability to walk longer distances has greatly improved.

Dr. Gim explained that in extreme cases of PAD, amputation of the leg may be necessary; it is performed when circulation is severely reduced and cannot be improved by any other treatment. With intervention, most PAD patients can avoid amputation of the leg or have it limited to only a small portion of the foot or toes. He expects limb loss due to PAD to rise significantly over the next several decades due to the increasing rates of diabetes and vascular disease. He stressed that any individual who is concerned about whether they have PAD or how to treat it should consult their primary care physician or a vascular specialist. To learn more about PAD, as well as treatment options, click on this link.