- April 29, 2020
- Posted by: cmcdonald
- Category: Peripheral Artery Disease
Dr. Kevin Herman is an Interventional Radiologist who specializes in Peripheral Arterial Disease and Critical Limb Ischemia. In this interview, he explains how Peripheral Arterial Disease can cause numerous health problems and potentially be life-threatening.
Q: What are the main causes of Peripheral Arterial Disease?
A: Peripheral Arterial Disease is a hardening of the arteries throughout the body. When we think about Peripheral Arterial Disease, we tend to talk about the blood vessels that are going to the legs. But there are also blood vessels that go toward the kidneys and brain – and certainly blood vessels within the heart.
We can usually break down the causes of Peripheral Arterial Disease into lifestyle choices, genetics, and protoplasm — which is a group of materials that make up cells. Hereditary factors include heart disease, high blood pressure, and high cholesterol, which can affect the vascular status of the blood vessels throughout the entire body. There are also lifestyle choices, predominantly diet, that can cause Peripheral Arterial Disease. Patients with Peripheral Arterial Disease usually consume foods high in fat. Long-standing smoking history is also a major cause of Peripheral Arterial Disease. Another significant risk factor for Peripheral Arterial Disease is diabetes, which can be caused by hereditary factors or by dietary choices that include foods high in sugar.
Q: Is Peripheral Arterial Disease dangerous or life-threatening?
A: Peripheral Arterial Disease can both be dangerous and life-threatening. One of the biggest concerns is that Peripheral Arterial Disease can be asymptomatic. This means a patient doesn’t develop any symptoms until the disease is in its later stages. However, one of the first signs patients do have if they’re suffering from Peripheral Arterial Disease is claudication – which is pain upon walking. As a vascular physician, [I recognize that] claudication can be a marker to examine other critically important organ locations, including the heart and the carotid arteries–which can be affected by the same exact disease process. Peripheral Arterial Disease can be significant and dangerous by causing heart attacks, strokes, and also other problems with the extremities.
Q: Does Peripheral Arterial Disease cause additional health problems?
A: Peripheral Arterial Disease can cause additional health problems including organ damage. For example, if a patient suffers from Peripheral Arterial Disease the kidneys can be significantly affected. Patients with severe Peripheral Arterial Disease and high blood pressure can end up on hemodialysis. In addition, the initial pain patients experience when walking can lead to more severe stages of chronic pain. Patients can also develop non-healing ulcerations and wounds if they have both Peripheral Arterial Disease and diabetes. Non-healing ulcerations and wounds can lead to significant disease processes, including amputation, which affects the patient’s quality of life.
Q: Is it possible to manage Peripheral Arterial Disease with lifestyle changes and/or medication?
A: If found early, lifestyle modifications including diet, exercise, and quitting smoking are crucial to slowing down and halting the progress of Peripheral Arterial Disease and the end-stage organ damage it causes. In addition, there are multiple medications available, specifically anti-platelet medications, which are basically thought of as aspirin. These medications should not be considered blood thinners, but they create anti-platelet activity that can also lower blood pressure. Keeping diabetes in check is also one of the most important aspects of Peripheral Arterial Disease management. We also know from multiple studies that cholesterol-lowering medication and diet have the most important effect on the vascular bed.
Q: How can a patient advocate for themselves if they have Peripheral Arterial Disease? What should they ask their podiatrist or primary care doctor?
A: When a patient is given a diagnosis of Peripheral Arterial Disease, it’s always interesting to find out the cause. The initial diagnosis of Peripheral Arterial Disease can be made by simply taking a look at the blood vessels on an ultrasound or Doppler test. However, I recommend complete blood work to take a look at a patient’s sugar, kidney function, and blood pressure.
In addition, we complete an entire lifestyle modification and risk factor profile for the patient – especially if the patient has a history of smoking. Oftentimes, patients who come in with the diagnosis of Peripheral Arterial Disease don’t need a procedure immediately. In fact, most patients who only suffer from claudication can easily be treated with medication and lifestyle changes. It’s those patients who are suffering from non-healing ulcerations, who are in end-stage disease, that need to see a vascular specialist.
As a physician, advocating for the patient is uncovering the baseline of this disease. This includes making sure that the right blood workup is done, that their diet is modified, their diabetes is under control, that they stop smoking, and that they are also seeing other specialists.
Q: Why is it beneficial to have Peripheral Arterial Disease procedures performed in an outpatient setting?
A: As we advance the field of endovascular medicine we can perform the same procedures, with the same risk profiles, in an outpatient setting. An outpatient setting can certainly be easier and more comfortable for the patient – from parking to our office environment. Sometimes being in a hospital setting can actually add risk to patients. That being said, there is a subset of patients who are so chronically ill and weak that the outpatient setting is not appropriate for them. However, in general, we can treat patients in an outpatient setting who are on hemodialysis or who have significant risk factors. In reality, keeping patients out of the hospital, especially nowadays, is really very important.