Transcription:
Treatment Options for Peripheral Arterial Disease

Melanie Cole (Host):  If left untreated, peripheral arterial disease can have serious long term affects. My guest today is Dr. William Robinson. He is a board certified specialist in surgery and general vascular surgery at UVA Health Systems. Welcome to the show, Dr. Robinson. Briefly explain, what is peripheral arterial disease or PAD.

Dr. William Robinson (Guest):    Thanks Melanie, it’s great to be here and be on your show. Peripheral arterial disease is atherosclerotic disease that leads to obstruction of the peripheral arteries. The peripheral arteries are any artery in the body other than the coronary arteries. So, peripheral arterial disease can involve many arteries in both the limbs as well as the chest and abdominal cavities. It can be both symptomatic and actually silent.

Melanie: So, it can be silent. Who as at risk for this disease? And then, how would you even know that you have it?

Dr. Robinson:  The risk factors for peripheral arterial disease are actually fairly well established and they overlap a good bit with the risk factors for heart disease. The major risk factors are: male gender, age – so with our aging population this is becoming an increasing problem. Other risk factors include smoking, hypertension, diabetes, and hyperlipidemia. Those are really the major risk factors that can lead to peripheral arterial disease.

Melanie: How is it diagnosed and what symptoms? Dr. Robinson, if you are somebody who walks on the treadmill and gets a pain in your legs – this claudication – people don’t know if it’s just muscular or if it’s something more.

Dr. Robinson:  That’s exactly right. The most common area that peripheral arterial disease affects is the lower extremity. In that example that you just gave, that would be sort of a classic symptom. What we call “claudication,” that is a cramping a pain in either the calf or sometimes the thigh or buttocks due to insufficient blood supply when the patient exercises or walks. That is one way to recognize that peripheral arterial disease may be present. In that case, you would need to see either your primary care doctor or a specialist in order to differentiate that from other causes of muscular pain that might occur with activity.

Melanie:  How is it diagnosed? Is this a simple procedure to diagnose whether there are arterial problems in the lower extremities?

Dr. Robinson: Actually, the diagnosis is made based on the symptoms and the examination by a physician and then sometimes supplemented with very simple testing. If you have symptoms that are consistent with peripheral arterial disease such as claudication and you are found to have abnormal pulses in the lower extremity, that would be sufficient for a diagnosis of peripheral arterial disease. In patients who are asymptomatic the diagnosis is made by measuring blood pressures in the leg, specifically at the ankle. If we see that they are reduced below a level that we would consider normal, that is sufficient for diagnosis of peripheral arterial disease.

Melanie:  If somebody is diagnosed with this – and, as you say, a simple blood pressure test in the lower extremities can help you determine – then, what do you do for them?

Dr. Robinson:  The treatment for peripheral arterial disease, really, first off, should be focused on prevention. The best way to treat it, as with many diseases, is to prevent it. The prevention is aimed at control of all those risk factors that I mentioned just a few minutes ago. That means having diabetes under good control, having hypertension under good control, having your fats and lipids under good control and not smoking. Those are the major things that can be done for prevention. Even after the diagnosis is made, those things remain the most important part of the treatment. Although the blockages will not be reversed by changing your diet or losing weight or getting better control of the diabetes, if those things are done, the disease will become less progressive and, therefore, less likely to lead to symptoms or complications. When we see patients with more advanced symptoms, there are definitely options for treating it. For example, in the lower extremities, if a patient has either claudication or more severe pain due to more severe peripheral arterial disease, we have a variety of options. Some of those options include endovascular therapy where we would be able to open the blockages with a combination of either ballooning or stents, for example. Other options would include surgical therapy in order to bypass around the blockage to restore blood to the lower extremity. It’s important that people realize that control of the medical risk factors and keeping a good, healthy active lifestyle is always the first line. Those treatments that I just mentioned, such as surgery--those should really be reserved for the most severe cases.

Melanie:  Dr. Robinson, even if you do the endovascular stenting and ballooning and you open these back up and they still get that claudication, does this limit their physical activity because it is kind of like a vicious circle. You want them to be active and you want them to exercise and sometimes it can be quite painful.

Dr. Robinson: That is an excellent, excellent point and actually an excellent question. You are exactly right. The first line is to have people exercise as much as they can and to control their medical risk factors. However, if they are at a point where they can’t get that exercise, that is what we call “claudication which is lifestyle limiting.” That is a severe form of claudication. In that case, we would often do either endovascular therapy or surgery in order to increase the patient’s ability to walk.  That can have benefits both on prevention for the future as well as preventing heart disease and other unwanted medical affects that come with inactivity.  It’s really a balance. You have to sort of make sure that all of the medical conditions are under control and the patient is being as active as possible but you have to offer therapy when the claudication or the pain is extremely limiting.  

Melanie:  In just the last few minutes, Dr. Robinson, and it’s great advice, give your best advice for prevention of peripheral artery disease and why someone should come to UVA for their treatment.

Dr. Robinson:  I think, really, the best advice for prevention, I think, is to never smoke. That is particularly important for any younger patients and older patients, too, because even if a patient has a long-standing smoking history stopping smoking even later in life will help prevent the progression to the most severe form of peripheral arterial disease which is actually what we call critical limb ischemia which can be a limb threatening condition. I can’t emphasize enough how important it is to stop smoking and to never have started smoking in the first place, actually. In terms of, if you do have advanced symptoms, I think that coming somewhere you can get comprehensive care and comprehensive options for addressing your particular PAD in the best way is why I would advise patients to come to UVA. Obviously, there are a variety of medical specialists who specialize in all of those risk factors, in controlling them and treating them as best as is possible. We have a variety of interventionists both in surgery and in other fields who can offer both endovascular therapy and surgical therapy. When you come to a place where all of the options are on the table, I think that helps a patient get a treatment plan that is best tailored to their particular disease and their particular goals.

Melanie:  Thank you so much, Dr. Robinson. So, beautifully put and such great information.  You’re listening to UVA Health Systems Radio. For more information, you can go to UVAHealth.com. That’s UVAHealth.com.  This is Melanie Cole. Thanks so much for listening.