Johns Hopkins Community Physicians Heart Care - Bethesda
6410 Rockledge Drive
200
Bethesda, MD 20815
Peripheral Arterial and Venous Disease: Prevention, Identification and Treatment Strategies
Peripheral vascular disease afflicts millions of Americans yearly. Approximately 80 million Americans suffer with venous insufficiency and approximately eight million Americans are afflicted with peripheral arterial disease (PAD) – narrowed/blocked arteries in the legs, kidney and carotid arteries. Venous disease can cause significant leg swelling, pain and ulcers while PAD can progress to severe narrowing/blockages in leg arteries – which can cause leg pain with walking as well as poorly healing leg and foot infections.
Approximately 12-20% of individuals 65 years of age or older have PAD while 43% of men and 72% of women over the age of 60 have venous disease. Individuals with PAD are 4-5 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.
Diseases of the veins occur most frequently in individuals with a family history, who have standing occupations and in the elderly.
Risk factor modifications are key in the treatment and prevention of PAD. These 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 treatment.
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.
Venous disease most often is due to venous reflux or veins that do not adequately return blood from the legs back to the heart. This is due to leaking of the small one way valves which exist in all the veins in the body. This leaking often leads to swelling, pain and poorly healing ulcers.
Diagnosing PAD is often a simple but often overlooked evaluation. The most common symptom is leg pain while walking; however, approximately 50% of individuals with PAD do not have classic leg pain symptoms. The first step in diagnosing PAD 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. ABI’s 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.
Venous disease can be evaluated with a simple ultrasound/Doppler evaluation. This type of study can evaluate whether a clot (deep vein thrombosis) is present and whether venous reflux exists.
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 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 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.
