Peripheral Arterial Disease; previously known as ‘peripheral vascular disease’, refers mainly to lower extremity occlusive disease. The symptoms of this disease include; claudicating pain, rest pain, and/or non-healing wounds or sores.
Options for treatment of PAD traditionally include conservative medical management (such as walking exercise, cessation of smoking and lifestyle changes) or open surgery such as bypass or endarterectomy. However, with the recent advances in the endovascular field, there are many less invasive treatments available. These treatments include angioplasty, stenting, and artrectomy (excisional or laser). These options have recently been the first choice of treatment for PAD.
It is certainly true that endovascular treatment has replaced the traditional ways of treating the vast majority of patients. Mild to moderate claudicating symptoms in the legs can be well treated with walking regimen therapy, modifying life style; such as quitting smoking, eating a more healthy diet, control blood sugars if diabetic, control blood pressure, and avoiding stress. However, large number of patients with a focal lesion found on duplex studies may be a good candidate for simple angioplasty treatment the benefits of which can often last 2-3 years.
Indications for interventions in PAD includes disabling claudicating pain on walking generally these can be different from individual to individual but generally less than a block walking distance constitutes severe degree. Open sore or wound that is not healing due to PAD is another obvious indication. Rest pain is rare but another devastating indicator of critical PAD. Besides these indications, clinical judgment is often required to treat some advanced problems such diabetes induced critical PAD. These patients may not experience symptoms until they develop obvious signs of ischemia. Therefore, early referral can be a good tool to monitor this subset of patients.
Follow up with a vascular specialist after any kind of procedure is extremely important because stents, angioplasty, and bypass grafts do not last forever. This is a proven fact throughout numerous clinical studies and literature supports this idea as well. Therefore, procedures without follow up for many years can be very harmful for patients. In addition, recovery for re-do procedures in patients with stenosis or late recurrent disease are very difficult and often not possible.
Patients with mild to moderate claudicating pain should be referred to a vascular specialist for evaluation, monitoring, and treatment of this disease. When left untreated, PAD can escalate, causing severe complications. When caught early, conservative management and lifestyle changes (such as quitting smoking) can go a long way towards helping patients avoid more aggressive treatment. As always, follow-up after any procedure is the number one key to vascular health.
Dr. Lim accepts both inpatient and outpatient referrals.
For an Urgent Referral, please call 916-784-1836 and
we will get you in touch with Dr. Lim.
All other referrals; fax to 916-784-1880.
We have extended Dr. Lim’s availability in the Roseville Area to accommodate the growing need for a vascular surgeon.
As always thank you for your referrals.
About the author