CHICAGO - Do you have unexplained pain, cramping or tiredness in your legs or hip muscles when walking or climbing stairs, that seems to go away with rest but returns when you start exercising again?
If you are 50 years of age or older, it is very possible that you may have peripheral artery disease (PAD). By the age of 65 years, 8 to 12 percent of the U.S. population has it.
Muscles need proper oxygen-rich blood flow to work properly. If plaque builds up in your limb arteries therosclerosis) your blood vessels narrow and you may experience PAD symptoms. To avoid serious complications related to PAD, confirm your condition by getting a complete evaluation and care from a vascular surgeon. It is important to make the diagnosis of PAD, which has implications for your overall health and medical care.
“Many people think that vascular surgeons only do surgery, which could not be further from the truth,” said Michael S. Conte, MD, professor and chief, division of vascular and endovascular surgery and co-director of the University of California at San Francisco Heart and Vascular Center.
Vascular surgeons provide specialized care that includes diagnosis, medical management and therapy, lifestyle modifications, and comprehensive, long-term follow-up to PAD patients and patients who have other artery or vein conditions.
“It is important when choosing a vascular surgeon that you look for one who is Board certified by the Vascular Surgery Board,” noted Joseph L. Mills, MD, professor of surgery at the University of Arizona Health Sciences Center, Tucson, and chair of the Vascular Surgery Board of the American Board of Surgery. “Board certification assures the patient that the surgeon has met the highest standards of education, training and knowledge in the specialty of vascular surgery. The board-certified vascular surgeon has comprehensive expertise in the diagnosis and long-term care of patients with disease and disorders of the blood vessels –specifically the arteries, veins and lymphatic system outside of the brain and heart.”
Dr. Conte said vascular surgeons can provide patients with informed recommendations on all available, safe and effective treatment options depending on symptom severity and other risk factors.
Other vascular specialists, he said, are more limited in their scope of training and practice; however vascular surgeons can select the right treatment and the right time for each individual.
“The focus of the vascular surgeon is to provide the care patients need rather than merely performing a procedure directed at treating a specific blockage in an artery,” added Dr. Mills. “This allows them to restore and preserve function, reduce disability, and avoid limb and life-threatening complications. In severe cases they also have the medical expertise to perform minimally invasive endovascular therapy (like balloon angioplasty or stents) or open surgery.”
Dr. Conte noted that if a vascular surgeon sees a PAD patient early enough, they often can design lifestyle modifications (less smoking, more exercise, and improved diet) and preventive medications to reduce the further risk of cardiovascular disease.
“We educate patients about signs to look for if PAD should get worse and let them know that compliance with treatment is critical,” added Dr. Conte. “For example, some patients with severe PAD can progress to develop open wounds and gangrene if the arterial disease is not discovered early enough, or if an initial treatment plan is ineffective. Those with diabetes are at particularly high risk.”
“There are some patients with advanced PAD, who can hardly walk a distance of a block without pain or even some who have constant pain or a non-healing sore or a black, painful toe may need invasive procedures to improve blood flow,” said Peter Gloviczki, MD, professor of Surgery at Mayo Clinic, Rochester, Minn. and president of the Society for Vascular Surgery®. “Vascular surgeons will provide the best and most suitable effective treatment for these patients, to save their limb from a major amputation.”
Vascular surgeons agree that there are several factors that increase your chances of getting PAD and developing further disease. In addition to age, diabetes, and smoking these include a family history of cardiovascular disease, high blood pressure, high cholesterol, or extra weight; or if you have abnormal lab results such as high levels of homocysteine, which is an amino acid in your blood.
To determine if you are one of the eight million people in the United States who have PAD, your vascular surgeon will perform a complete history and physical examination, including common non-invasive tests to see if there is plaque or any blockage in your arteries.
These tests can include ankle-brachial index, which is a painless exam that compares the blood pressure in your feet to the blood pressure in your arms to determine how well your blood is flowing in the legs. Another common screening method is duplex ultrasound imaging that allows for imaging of the arteries and simultaneous measurement of blood flow. You also may be asked to take blood tests to check for other markers of PAD and cardiovascular disease.
Many vascular surgeons have said that out of 20 to 30 patients they see in a day, perhaps only three to five will have an invasive procedure recommended to them. “We would much rather see a patient early in a disease process, rather than later when the severity may have accelerated and require a major procedure or when options may already have been lost,” according to Dr. Conte.
Remember that your vascular surgeon is your complete vascular specialist. To find out more about the vascular treatments and procedures, as well as what vascular surgeons can provide for you, please contact vascularweb.org.
About the Society for Vascular Surgery.
The Society for Vascular Surgery® (SVS) is a not-for-profit professional medical society, composed primarily of vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. SVS is the national advocate for 3,650 specialty-trained vascular surgeons and other medical professionals who are dedicated to the prevention and cure of vascular disease.