- January 20, 2020
- Posted by: cmcdonald
- Category: Peripheral Artery Disease
Dr. Vincent Gallo is an Endovascular Specialist with American Endovascular specializing in treating Peripheral Arterial Disease and preventing loss of limbs. Dr. Gallo offers high quality, clinically focused care and is known for his strong ability to perform cutting-edge, non-surgical procedures even on patients who have failed other treatments. His comforting and compassionate endovascular center is located in Astoria, NY. Dr. Gallo recently answered some of the most commonly asked questions about Peripheral Arterial Disease and why it’s important to diagnose and treat the disease as early as possible.
Q: What is Peripheral Arterial Disease?
A: Peripheral Arterial Disease is a circulatory condition where the narrowing of arteries outside of the heart restrict blood flow to a person’s limbs, often the legs. Its equivalent is Coronary Arterial Disease, where a person presents with a heart attack or requires a stent or angiogram of the heart. PAD is very similar but occurs outside of the heart. It presents in a very similar fashion to Coronary Arterial Disease.
Q: What are Peripheral Arterial Disease symptoms?
A: The symptoms of Peripheral Arterial Disease can vary. You may first feel pain when walking, called claudication. You may only be able to walk a few blocks at a time before you feel cramping in your calf muscles.
Once that progresses you can get into a more extensive or severe form of Peripheral Arterial Disease, signified by pain at rest, called Critical Limb Ischemia. At that point, it gets somewhat more urgent or emergent.
From rest pain, it can progress to a wound or ulceration.
We try to catch the symptoms before the disease reaches the Critical Limb Ischemia stage. It’s very important to help patients to be aware of these symptoms and to be able to identify them. We can try to catch them early before it becomes an urgent or emergent situation.
Q: What are the causes of Peripheral Arterial Disease?
A: The causes of Peripheral Arterial Disease also vary. Very high-risk factors for developing Peripheral Arterial Disease include diabetes, high blood pressure, active or former smokers, and age. If patients are over 70 years old, they increase the risk of developing Peripheral Arterial Disease. If patients have Coronary Arterial Disease or have ever had a stroke before, they are at a higher risk level for developing Peripheral Arterial Disease.
Q: What are the signs of Peripheral Arterial Disease?
A: Some early signs could stem from something called claudication. When you walk or exercise you start to develop cramping within the back of your legs or in the calf muscles, which gets better with rest. Then when you start moving again and walking, the cramping comes back. This is a classic sign of early development of Peripheral Arterial Disease.
As the disease advances you could develop rest pain, pain within your legs or your feet, when you are not even moving around.
The more advanced stages of the Critical Limb Ischemia are when you develop wounds within the feet or toes that are not healing.
These are definitely signs that would alert you that there is some lack of blood flow getting to the lower limb resulting in a wound.
Q: How is Peripheral Arterial Disease diagnosed?
A: First is clinical awareness, just knowing the signs and symptoms is extremely important. Knowing that if you develop pain or if you have a wound that is formed and not healing—those are the first signs to help diagnose Peripheral Arterial Disease.
One of the most important ways of diagnosing this is clinical evaluation. If the patient presents with complaints of pain within their lower extremities when walking or even at rest, or has a wound within their feet or lower extremity that has developed or is not healing with conservative therapy, a clinical evaluation helps us diagnose Peripheral Arterial Disease.
Once we have that suspicion, there are diagnostic tests that we can perform. The simplest test is something called an ankle-brachial index. It measures pressure differences between the arm and the leg. The second test is an ultrasound, which looks at the arteries to see if there’s a decreased inflow. These are very easy, quick, and conservative ways of diagnosing Peripheral Arterial Disease, to help you to get treated in a quick and timely manner.
Q: What are the consequences of not addressing PAD quick enough?
A: One of the worst consequences that could form is potential amputation. If the patient has a wound that is progressing and not healing, this, unfortunately, can cause infection within the bone or progress to a systemic infection, where the infection spreads throughout the body. We try to make sure that the patient never reaches these last stages. We focus on amputation prevention.
When the patient starts to develop symptoms such as leg pain upon exercise or walking, or even pain when at rest, we try to find the cause. The last thing we would like is for the wound to progress, that’s why we try to catch these things early. Patient education and physician education is extremely important in diagnosing Peripheral Arterial Disease early–prior to developing a wound, and hopefully prior to considering amputation.
Q: What is the most common approach traditionally in treating PAD?
A: A traditional way of treating Peripheral Arterial Disease is first to optimize the patient medically, make sure that their diabetes is under control, they stop smoking, their blood pressure is under control, and they’re on the maximum dose of their cholesterol medications. We treat with anti-platelets to ensure their blood is thin enough to flow well to their lower extremities.
If those conservative methods aren’t working, or if a patient has a wound or pain at rest, then the patient may need something called re-vascularization. We open up the blood vessels in a minimally invasive fashion where we use a small IV through the groin or foot artery. Through microcatheters and wires, we restore blood flow to the area that is blocked so the wound can heal. This allows enough blood to reach the calf muscle or the foot, eliminating pain.
Q: Can you reverse Peripheral Arterial Disease?
A: Peripheral Arterial Disease is not something that occurs overnight. This is a long-standing process that is usually secondary to diabetes, high blood pressure, high cholesterol, or smoking.
We try to slow down the process by optimizing the patient medically. If there are blocked arteries, we open those to restore blood flow. Hopefully, this heals a wound or reverses the patient’s pain that’s occurring from the lack of blood flow reaching the foot or lower limb.
Q: Who is prone to getting PAD?
A: People aged 70-years-old or older; people who have diabetes, high blood pressure, hypercholesterolemia or high cholesterol; people who are former smokers or actively are smoking, and people who are on hemodialysis or have kidney dysfunction are at significant risk of developing Peripheral Arterial Disease.
Q: How common is Peripheral Arterial Disease?
A: It’s actually very common and under-diagnosed. A lot of patients attribute their symptoms to other things or associate it as being a normal part of the aging process.
Venous disease is actually under-diagnosed and is very common, especially in patients who have risk factors such as diabetes, high blood pressure, kidney disease. These are certain risk factors that require us to keep our antennas up.
We pay attention to patients who develop Peripheral Arterial Disease or who have Coronary Arterial Disease—to make sure that we check their feet, for example, and really pay close attention to the symptoms. We try to diagnosis this early before it develops Critical Limb Ischemia or a wound, to try to prevent amputation from occurring.
Q: How can a patient be an advocate for themselves? What should they ask their primary care physician for?
A: It’s extremely important that everybody knows these signs and symptoms to help treat this disease—and try to treat them early to prevent it from advancing. Patients who experience pain when walking or exercising in the back of their calf, which gets better with rest, or pain at rest or, even if they develop a wound or an ulcer that is developed or not healing, these are classic signs that patients should know about. They should make sure that their primary care doctors know about any of these signs or symptoms as soon as possible and schedule an evaluation at our office.
With Peripheral Arterial Disease you may experience pain, cramping, or wounds in your feet or legs.