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Gregory K. Kumkumian, MD, FACC
Prevent Peripheral Arterial Disease
Johns Hopkins Community Physicians Heart Care - Bethesda

Prevent Peripheral Arterial Disease

Peripheral Arterial Disease (PAD) afflicts approximately eight million Americans and, according to the American Heart Association, approximately 12-20% of individuals 65 years of age or older. The same risk factors that increase the risk for suffering a stroke and developing coronary atherosclerosis increase the risk for developing PAD plaque build-up/narrowing in the legs, and kidney and carotid arteries. In fact, individuals with PAD are four to five times more likely to suffer a stroke or heart attack. Risk factors for developing PAD include obesity, hypertension, advanced age, diabetes, tobacco consumption and a family history of vascular disease.
Risk factor modifications are a key weapon in the treatment and prevention of PAD. These modifications involve changes in diet, weight loss and increased exercise. It is also very important to identify and treat individuals with hypertension, elevated lipid levels and diabetes. Smoking cessation is also an integral aspect in treating those with or those at risk for PAD.
PAD is the development of lipid and cholesterol rich plaques in the arteries that feed various parts of the body. As plaque builds up it can gradually cut off the blood supply to the legs, kidneys and to the brain. In some instances the plaque or narrowing can abruptly occlude blood supply to a leg, foot, kidney or to a region of the brain, thereby putting that part of the body at severe risk and, in some cases, leading to severe infections such as gangrene and ultimately amputation. At times these narrowings can lead to a stroke or kidney failure.
Diagnosing PAD is often a simple but often overlooked evaluation. The most common symptom and the first clue toward the existence of PAD is leg pain while walking. The first step is a simple blood pressure evaluation of the arms and legs known as an ankle-brachial index (ABI). This test is quite accurate at diagnosing PAD. ABIs and ultrasound studies that can identify blockages can easily be performed in an office setting. These studies and certain types of MRI/MRA and CT scan studies are used to identify blocked or narrowed arteries.
When severe PAD is the cause of significant leg pain or compromises flow to the kidneys and brain, medical management is often not sufficient. Often minimally invasive procedures, similar to angioplasty/stent procedures used to clear blocked arteries in the heart, are able to clear blocked arteries in the legs, kidneys and carotid arteries. Typically, small wires are used to cross narrowed arteries and then various techniques such as lasers, balloons and stents are used to clear the blockages.
These minimally invasive techniques allow for quick recovery and often allow patients to be sent home the day of their procedure. These techniques can often decrease the risk of stroke and eliminate leg pains caused by restrictive blood flow. In some instances these clearing procedures can reduce the risk of kidney failure and save limbs from amputation.

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