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Category: PAD

How can an Ultrasound Diagnose Vein Disease?

If your legs are tired, heavy or cramping, your vein specialist may recommend a diagnostic ultrasound. If that is the case, you may be wondering: how will an ultrasound uncover what’s going on inside my legs? Isn’t that kind of technology more common in Obstetrics offices?

Well, you’re partially correct: interventional radiologists use a different kind of ultrasound to diagnose conditions like Peripheral Arterial Disease (PAD.) The technology we use is known as a Doppler ultrasound. And in this post, we’ll teach you how it helps us detect many different kinds of vein disease.

What conditions can a Doppler ultrasound detect?

Doppler ultrasounds check your blood flow. They help us discover whether you have problems like narrowing, leaking or blockages in your blood vessels.

This type of ultrasound uses sound waves to check how well blood flows through your legs. Those waves bounce off your moving blood cells, giving your doctors a better picture of the speed and health of your blood flow. Doppler ultrasounds involve hand-held devices; screenings are pain free and non-invasive.

Using a Doppler ultrasound, vein specialists can detect disruptions in your blood flow, hardening of your arteries and even potentially life threatening conditions like Deep Vein Thrombosis (DVT), a blood clot that develops in the deep veins of your legs that rest well below the skin’s surface.

When should I get a Doppler ultrasound?

We may recommend an ultrasound if there are signs that your blood flow has been reduced. These symptoms can include changes in the appearance of the skin on your legs, leg pain that appears with movement, hair loss on your legs or even wounds that won’t heal.

If you’ve had a blood clot, or we suspect you have one, a Doppler ultrasound can quickly confirm this diagnosis.

We may also recommend a Doppler ultrasound if you’ve recently had a stroke or heart attack. That way, we can determine whether compromised blood flow or clots may be putting you at risk for a repeat problem.

What’s involved in a diagnostic ultrasound for vein disease?

You’ll typically lie down for your ultrasound. Your ultrasound technician may measure pressure in certain areas of your body by apply blood pressure cuffs at points like your ankles, calves or thighs.

Next, your technician will apply lubricant to the  ultarasound guide (called a transducer). Then he or she will move the device over your skin until we receive a good image of your blood flow.  A Doppler ultrasound typically takes up to 45 minutes. Once it’s done, you are usually free to get up and go back to your daily activities.

When you have an ultrasound in our Houston area vein clinics, your results will be reviewed and delivered to you by one of our highly trained team members. If a problem is detected, we will then take the time to discuss and explain your diagnosis, and walk you through all your possible treatment options.

 

What is Critical Limb Ischemia?

The American Heart Association has new guidelines for diagnosing and treating CLI (critical limb ischemia.) But in order to understand the guidelines, we must first understand the condition itself.

What is Critical Limb Ischemia?

Critical limb ischemia (CLI) is a severe blockage in the arteries of your lower extremities. It heartbeat icondramatically reduces blood flow to your lower limbs, making it a serious form of PAD (peripheral arterial disease). PAD and CLI are both caused by a buildup of plaque in your arteries. And that buildup leads to atherosclerosis, the hardening and narrowing of your arteries.

CLI is a painful, chronic condition. It makes your feet or toes hurt, even when you’re resting. If CLI is advanced, you may develop ulcers (sores that won’t heal) on your legs or feet. Some CLI patients even need to have an amputation.

Symptoms of Critical Limb Ischemia

The best known CLI symptom is ischemic rest pain, when your legs and feet hurt a lot when you stop moving. Ulcers on your feet and legs are also common. Other symptoms include:

  • Pain or numbness in your feet.
  • Shiny, dry and smooth skin on your legs or feet
  • Thickened toenails
  • A loss of or lessened pulse in your legs or feet
  • Gangrene (dry, black skin) on your legs or feet

Diagnosing and Treating CLI

The American Heart Association (AHA) emphasized the importance of diagnosing and treating CLI.

“Timely diagnosis and treatment is likely to preserve limb viability and improve quality of life,” Mark A. Creager, MD, past AHA president and director, explained to theheart.org. Reasons for a Vein Evaluation

Why? CLI affects an estimated 12 million adults in the United States, but diagnosing and managing the condition can be “challenging.” Moreover, strategies for perfusion assessment (testing your cardiovascular system’s ability to supply your tissue with enough blood flow) “remain limited,” according to Dr. Sanjay Misra of the Mayo Clinic. And evaluating limb perfusion is crucial because it speeds up the CLI diagnosis and prevents many invasive procedures.

What has Changed with the New CLI Guidelines?

Currently, the guidelines for diagnosing CLI tell physicians to look for ischemic rest pain, an ulcer, or the presence of gangrene for at least 2 weeks. Those symptoms, in combination with reduced blood flow (hypoperfusion) as measured by one of several tests (ankle-brachial index (ABI), ankle pressure, toe-brachial index (TBI), toe systolic pressure, transcutaneous oximetry (TcPo2), or skin perfusion pressure (SPP)) would indicate that a person has developed CLI.

Until now, vein specialists were been most likely to use the ankle-brachial index (ABI) to detect CLI. But under the new guidelines, the American Heart Association suggests that checking toe pressure will deliver a more accurate diagnosis.

Interestingly, the AHA also promotes experimental technologies for checking blood flow in your lower extremities, including a contrast-enhanced ultrasound like the kind we can provide in our Houston area vein clinics.

Regarding this kind of scan, the statement says: “New technologies offer potential opportunities to improve the precision and quality of CLI management,” helping detect and treat CLI at an earlier stage and reducing the number of amputations associated with this condition.

Sources: American Heart Association, health.ucdavis.edu, medscape.com

What is Claudication and Why Would I Have it?

Claudication is the medical term that describes muscle pain, cramps and/or a heavy tired feeling in your legs. The pain may radiate to your hips, feet or buttocks. It occurs with movement and disappears with rest, and is usually a result of reduced blood flow to your lower limbs. For this reason, claudication is a common symptom of Peripheral Arterial Disease (PAD.)

 

How Does Claudication Progress?

Without treating the underlying cause of your claudication, symptoms and flare ups will get worse over time. In the early stages of claudication, symptoms may also include:

·         aching

·         burning

·         heaviness

At first, claudication causes a dull, aching pain in the lower calf. The initial pain or sensation can also travel to, or develop in, other muscle groups, such as:

·         thigh

·         buttock

·         hip

·         feet

These symptoms usually appear with muscle movement, like walking or exercise, and resolve with a few minutes of rest. If, however, people continue exercising through the pain of claudication, they may experience:

·         numbness

·         severe cramps

·         difficulty walking

·         soft tissue damage

·         cold skin

Usually, claudication only affects one leg; if it impacts both, symptoms are usually worse in one leg than the other. Over time, these symptoms typically become more severe. The only way to improve your condition is to treat the underlying cause.

Treating Claudication and PAD

At Texas Endovascular, treating PAD with state of the art, minimally invasive procedures. Most of our treatments— which include Angioplasty, Stenting, and Atherectomy–don’t require an overnight hospital stay. Using these methods, we prevent the need for surgery in most cases, often allowing our patients to go home the same day as their procedure.

During your procedure, one of our Houston area vein specialists will insert a small IV and wire through your groin,  gaining access to a blood vessel. From there, we use imaging to guide that wire into a position where it can impact your affected artery. Depending on the progression of your PAD, we will use a balloon to widen the blood vessel (angioplasty) or a stent to hold it open; both options will increase blood flow to your lower extremities, and should relieve your claudication symptoms.

 

 

The Scary Truth about PAD and Limb Loss

Did you know that over 2 million people in the United States are living with limb loss, and vascular conditions like peripheral arterial disease (PAD) are the number one cause of those losses? If those statistics sound scary, consider this: current estimates suggest that, by the year 2050, an estimated 3.6 million people will be struggling to deal with a lost limb like a foot or leg.

While vascular conditions are responsible for the most amputations in this country, they aren’t the sole culprit: trauma; cancers; and birth defects also take a major toll on limbs.

A Closer Look at Limb Loss Statistics

In a year-long study by the Physical Medicine and Rehabilitation Clinics of North America, researchers

Deep Vein Thrombosis
PAD and other vascular disease are responsible for most of the amputations in the US

uncovered some frightening statistics:

  • Diabetics have a 10 times higher risk of amputation than individuals who don’t have diabetes.
  • Among diabetics, those of African American, Hispanic, and Native Americans backgrounds have an even higher risk of lower limb loss.
  • 82 % of amputations in the U.S. are the result of vascular disease, and this percentage is expected to rise as more Americans develop diabetes and PAD.

Diabetes, PAD and Limb Loss

What’s the connection between these big three problems? Let’s take a closer look. Diabetes is a condition in which your body’s ability to produce or respond to insulin is impaired.

When diabetes is poorly controlled, glucose can build up in the blood stream and contribute to the development of plaque, a substance that can narrow your arteries and reduce blood flow, usually to your legs and feet. In fact, that’s the definition of PAD—a condition that sets in when blood vessels develop atherosclerosis (built up plaque) inside the vessel walls. The plaque narrows the vessels narrower, slowing blood flow. If a blockage hardens it is more likely to burst and cause a blood clot to develop. A clot may completely block your artery, which cuts off blood flow to your legs and feet. If that occurs, a few things could happen.

Because of the reduction in blood flow that comes with PAD, the vascular condition is a risk factor for foot ulcers (deep wounds that just won’t heal), and foot ulcers frequently lead to foot and lower limb amputations, especially in diabetic patients. In severe instances, where all blood flow to the legs and feet is blocked, gangrene can take hold in your limbs and lead to an amputation before you even see an ulcer or any other warning sign.

Are you starting to get the picture? Each condition feeds into the next, putting individuals at major risk of losing vital limbs.

Who’s At Risk for PAD?

  • Anyone over the age of 50
  • Diabetics
  • Obese or sedentary individuals
  • Smokers
  • People with high cholesterol or high blood pressure

PAD Treatment Options

In order to treat PAD, you must first be properly diagnosed. Without a comprehensive vascular exam, available in our Houston vein clinic, it’s difficult to spot PAD—because symptoms can imitate other problems, PAD is often misdiagnosed or not caught at all!

Once you know that you have PAD, we can determine a treatment plan: interventions may be as simple as recommending lifestyle changes like a better diet and exercises. Depending on the progression of the disease, our vein doctor may recommend unblocking your arteries through one of our minimally invasive interventional radiology treatments.

Our goal as vein doctors is to protect your vein health and your limbs. Know the risks of PAD and, if you believe you may have this condition, come in for a consultation. One simple exam could keep you from becoming part of this country’s growing group of limb loss victims.

Sources: https://www.sciencedirect.com

Brush and Floss to Save Your Arteries

Do you brush off your dentist when he or she reminds you to floss every day? Is brushing a rushed, once-a-day, event? It turns out you could be hurting more than just your teeth. Here’s why:

Gum Disease Affects Your Heart Health 

Over time, poor dental hygiene can lead to gum disease like gingivitis. When gingivitis sets in, however, the bacteria from your gums doesn’t stay put in your mouth! As it turns out, that bacteria can release toxins that enter your bloodstream. Those toxins contribute to a buildup of plaque in your arteries. And when fatty plaque narrows your arteries, you may develop Peripheral Arterial Disease (PAD.) PAD limits the amount of blood flow reaching your legs and feet. It is a painful condition that makes it difficult to exercise or even walk. PAD can also increase your risk of forming blood clots.

How to Recognize Gum Disease

The best way to keep your gums from hurting your arteries is to protect those gums with proper care. Brush your teeth, twice a day, for two minutes at a time. Ideally, you should floss after every meal, but aim for at least once a day, before you go to bed, so food stuck between your teeth doesn’t linger overnight, causing problems.

And, even with a proper dental care routine, it’s important to learn the early warning signs of gum disease. If you notice any of the following symptoms, you should see your dentist right away:

  • Persistent bad breath
  • Red, swollen or tender gums
  • Gums that bleed when you brush your teeth
  • Gums that have pulled away from the teeth
  • Loose teeth
  • A change in the way your teeth come together when you bite down

Protecting Your Arteries From Gum Disease

If you have a confirmed case of gingivitis, you should take steps to protect your arteries, especially if you’ve been told you’re at risk for heart problems. If you’ve been diagnosed with gingivitis or another gum condition, it’s a good idea to schedule a diagnostic arterial scan to make sure problems in your mouth haven’t spread throughout your body.

Sources: National Center of Biotechnology Information, Ontology Journal

3 Signs Your Leg Pain is Actually PAD

At some point, everyone’s legs get tired. If you’ve walked a lot during the day, had a hard work out, or just been stuck on your feet, you may get muscle cramps or leg fatigue. And that would be perfectly normal. Sometimes, however, that discomfort in your legs could be something more serious: peripheral arterial disease, a condition in which plaque narrows your arteries, limiting blood flow to your lower extremities. Here’s how you can tell when your leg pain is a cause for concern.

Three PAD Warning Signs to Watch For

PAD-affected arteries before, during and after minimally invasive treatments
  1. The pain is constant. Normal leg pain only comes on once in a while. But if your legs hurt or you feel a burning sensation in your legs or rear end every time you walk or climb the stairs, it could be PAD.
  2. Your wounds don’t heal. Because PAD limits blood flow to your lower legs, it reduces the healing time for any cuts or injuries. If you have leg pain and an ulcer, that’s a likely sign that you’ve got PAD.
  3. Your lifestyle puts you at risk. Smokers, people with diabetes, or individuals with high blood pressure and high cholesterol are at higher risk of developing PAD. If you have these risk factors and experience regular leg pain, be sure to get checked for PAD.

 

PAD is a serious medical condition, but help is readily available, often without surgery. Using minimally invasive procedures, our Houston area vein specialists can help open up your arteries and restore blood flow to your lower extremities. But before we can help, you need an accurate diagnosis, so watch for warning signs and see your doctor right away if you have any cause for concern.

 

Sources: American College of Surgeons, galesburg.com

Move it Monday: 2 Workouts to Combat PAD

When you have peripheral arterial disease (PAD), your arteries narrow, reducing the amount of blood flow to your legs and feet. As a result, you may experience painful muscle cramps in your hips, thighs and calves. This pain is typically at its worst when you’re walking, climbing stairs or exercising.

But, while exercising may make you experience painful cramps, research shows that certain exercises will, in fact, help you manage PAD.

According to this study, supervised treadmill workouts are the most effective form of exercise for people with PAD. Study authors suggest: “exercise sessions should progress up to a target goal of accumulating 30 to 45 minutes of treadmill walking per session” and “exercise should be carried out at an intensity that elicits mild claudication pain within 5 minutes, and moderate to moderately severe claudication within 10 minutes followed by rest until claudication pain subsides.” In other words, the goal of this workout is to work to the point of pain until the pain takes longer to show up. In this way, PAD patients can experience longer periods of walking comfort in their real lives as well.

Alternatives to Treadmill Workouts

Of course, for some PAD patients, treadmill walking may be too difficult–or simply unappealing. Not to worry: the study suggests other forms of exercise that can also be effective. The authors suggested walking around your neighborhood as one obvious alternative to treadmill workouts. Seated exercise bikes can also help people with PAD, as can workouts that involve resistance training, with your body weight, bands or weighted dumbbells.

While exercise can help improve your ability to walk comfortably with PAD, it cannot cure the condition. Fortunately, in our Houston vein center, we can easily diagnose and treat your PAD. We star with a bedside test, called an Ankle-Brachial Index (ABI), which uses ultrasound and blood pressure cuffs to evaluate the circulation in your arms and legs. If this test is abnormal we may order further imaging tests such as Magnetic Resonance Angiography (MRA) or Computed Tomography (CT) to determine the extent of your problem and help us plan your treatment.

Once we determine the extent of your issue, treatment can begin. Our doctors will determine the most appropriate, and least invasive, treatment option that will help you find relief. So if you are experience leg cramps and suspect PAD may have set in, schedule an immediate consult to begin finding relief!

Sources: www.interventionjournal.com, Cardiology Today, www.healio.com/cardiac-vascular-intervention

 

6 PAD Symptoms to Know and Watch For

Peripheral Arterial Disease (PAD) is a disease caused by a narrowing of the arteries in your lower legs. Because many PAD symptoms mimic those of other conditions, this disease is often hard to diagnose. In order to prevent PAD from progressing, unchecked, in your body, it’s important to know and identify its symptoms. If you experience any of these problems, it’s important to see your Houston vein specialist right away.

6 Symptoms of PAD

Deep Vein Thrombosis
Tired, achy legs are actually a symptom of vein disease!
  1. Pain in Your Legs After Walking or Exercise. One of the most common symptoms of PAD, this pain or cramping occurs with movement because your lower extremities don’t get enough oxygen to support the increased activity.  Most often, PAD sufferers will experience this pain in their calf muscles, but it may manifest anywhere in the lower legs. Pain will typically not resolve until the PAD sufferer stops all physical activity.
  2. Wounds, Sores or Ulcers. This second symptom is also caused by a lack of oxygen reaching your lower limbs. When you cut yourself, and you don’t have PAD, proper circulation and blood flow will help your injury heal quickly. When you have PAD, however, even a small scrape can remain open and unhealed as the plaque in their arteries blocks blood flow to the wound. This symptom must be addressed immediately: left unchecked, a wound can lead to serious infection and even amputation.
  3. Skin Changes on Your Legs. Once again, poor circulation is behind this PAD symptom. Some of the physical changes that occur with PAD include skin that appears to be shiny, loss of leg and/or toe hair, and a blue-ish tinge to your skin. Your lower legs, especially your toes, may also feel cold, even when your feet are covered and should otherwise feel toasty.
  4. Muscle, Not Joint, Pain. We’ve already noted that leg pain and cramps are a symptom of PAD, but it’s important to note where that pain is located. Many people think of leg pain as a normal part of aging, and it CAN be–when that pain is happening in your joints. When it’s located in your muscles, however, that is a sign that something beyond normal aches and pains is going on.
  5. Dead tissue. Most people will identify their PAD before reaching this point, but if you have gangrenous or dead tissue on your toes, feet or legs and you haven’t been checked for PAD, get a diagnostic vein scan ASAP.

 

Sources: Mayoclinic.org

Got PAD? Get in Some Hot Water!

Peripheral arterial disease (PAD) is a condition that affects blood flow to your arms and legs. It can be painful, causing cramps and other discomfort, especially when you walk. As Houston area vein specialists, we often recommend light exercise to help people manage PAD pain. And now, a new study published in the American Journal of Physiology—Heart and Circulatory Physiology suggests that hot water therapy may be an equally effective tool for managing PAD pain. This could be great news for PAD sufferers who are not yet able to exercise!

What Causes PAD?

To understand why hot water therapy is effective against PAD, we have to explore why the condition  develops. PAD sets in when fatty buildup accumulates in your arteries, leaving you with reduced blood flow to your limbs. That reduced blood flow causes PAD patients to experience muscle pain while walking (called claudication.)  To manage this pain, patients are told to engage in supervised exercise, but there’s a catch: the PAD pains often make exercise too painful. That’s why this new research out of New Zealand is so exciting: they discovered that ongoing heat therapy will improve cardiovascular health in PAD patients, managing their muscle pain and making exercise a more likely possibility!

For their study, researchers followed two groups of adults with mild-to-moderate PAD pain. One group attended exercise sessions twice a week, during which they walked for up to 30 minutes on an indoor course and performed up to 60 minutes of circuit exercises. The other group engaged in three to five spa baths a week, submerging up to their shoulders in 102-degree water for 20 to 30 minutes. Before and after each session, researchers charted the participants’ walking ability, blood pressure, heart rate, blood volume, oxygen levels in muscle tissues, peripheral artery blood flow and function, and their overall quality of life.

What they found was exciting: both groups experienced improvements in their walking ability and blood pressure levels. In fact, the results for both groups were basically the same! In presenting their findings, the research team wrote: “Contrary to our hypothesis, there was no difference evident between the effects observed in heat therapy via spa bathing and a supervised exercise program. These findings indicate that heat therapy may be a useful alternative form of cardiovascular conditioning for individuals with PAD.”

 

 

Leg Pain? It Could Be Peripheral Artery Disease (PAD)

If you have unexplained leg pain, especially after you walk or exercise, you could be one of the eight to ten million people in the United States who suffer from Peripheral Artery Disease (PAD). This condition is often difficult to diagnose, leaving many sufferers untreated, which is a serious problem due to the danger that it can pose.

PAD symptomsWhat is PAD?

Peripheral Artery Disease is caused by a narrowing of the peripheral arteries. While it most commonly affects the legs, it can also be found in the stomach, arms, and even your head. Arteries begin to narrow when plaque, which is made up of cholesterol, calcium, fibrin, and fatty substances, builds on the walls of the artery. The disease restricts the amount of blood flow and raises blood pressure. In severe cases, a blood clot can form and completely stop your blood flow, which can result in a stroke or heart attack.

Risks & Symptoms of PAD

Many people who have PAD will not exhibit any symptoms until the disease has progressed. Others may mistake their PAD symptoms for another condition. To avoid misdiagnoses and missed diagnoses, it is important to learn the most commonly observed symptoms of PAD. They include:

  • Leg pain during exercise, and also when at rest
  • Leg numbness or weakness
  • Wounds (ulcers) of the legs, foot, or toes that do not heal easily
  • Legs or feet that are cold to the touch
  • Slow nail growth on toes or lack of hair growth on the leg
  • Some men experience erectile dysfunction

Patients are more at risk for peripheral artery disease when they:

  • Smoke cigarettes
  • Have diabetes
  • Are obese
  • Have high blood pressure & cholesterol
  • Are over 50 years of age
  • Have a family history of heart issues or strokes

How is PAD Diagnosed?

Peripheral artery disease is painless to diagnose and can be done in a variety of ways. The health care provider will perform a physical examination and determine if there is a weak pulse in the legs, which is a fairly common symptom. In addition, the doctor may perform:

Ankle Brachial Index: This exam will compare the blood pressure in the feet to the blood pressure in the arms. This will help the doctor determine if the patient’s blood pressure is an issue in one area or throughout the body.

UltrasoundSound waves allow the doctors to measure blood flow and visualize the artery to determine if there is a blockage.

Angiography: A colored dye is injected into the patient’s blood vessels. Using an imaging device, the doctor will be able to trace the blood flow and blood path to determine what might be causing the issue.

Blood Tests: A blood test will be used to determine if there are other issues, such as diabetes, that could be causing similar symptoms.