CAUSE & EFFECTS
of ARTERIAL DISEASE
Atherosclerosis
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A narrowing and hardening of the arteries due to blood vessel plaque.
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Often a silent disease that worsens health by blocking blood flow in the arteries
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Loss of oxygen and nutrients from blocked arteries causes tissue injury (brain, heart, legs) and death.
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Peripheral Arterial Disease "PAD"
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Plaque within the blood vessel restricts blood flow, oxygen and nutrients.
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Complications of PAD in the leg includes pain with walking, slow-healing wounds, and potential loss of a limb.
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Complications of PAD in the neck and brain include a mini-stroke (resolves in minutes) or a permanent stroke.
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Complications of PAD in the heart vessels PAD include heart injury (ischemia, arrhythmia) and heart death (infarction).
​Life threatening conditions:
• Stroke
• Heart attack
• Limb loss and Gangrene
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Additional conditions include:
• Claudication (cramping leg pain when walking)
• Rest Pain (cramping feet at rest, relieved with standing or massage)
• Mini-stroke (low oxygen levels in the brain)
• Myocardial ischemia (low oxygen levels in the heart muscle)
• Ulcers (low oxygen levels to the skin, muscle, and nerves)
• Impotence (low oxygen levels to the genital organs)
*Disclaimer- The information provided is for informational purposes only.
Invited Guest on PAD and Health Disparities
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Peripheral arterial disease (PAD)
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preventing unnecessary amputations
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amputation and reduction (ARC) act concerns
PAD RISKS & MANAGEMENT
• Risk of PAD: PAD affects approximately 14% to 20% of adults
• Symptoms:
•Asymptomatic PAD - 75% have no significant symptoms (Asymptomatic PAD)
• Symptomatic PAD
• Intermittent Claudication (IC): leg pain with walking which stops with rest
• Critical limb ischemia (CLI): leg pain with walking and at rest
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• Marker: PAD in the legs increases risk for having PAD of the heart and brain
• Outcomes:
• IC PAD: 1 in 4 persons will have worsened symptoms a year after diagnosis
• CLI PAD:
• 5-year mortality risk is 50% to 70%
• 35% of deaths are from other PAD causes (heart attack, stroke)
• 1 in 3 persons have an amputation1 year after diagnosis
• Asymptomatic PAD - same outcomes as IC
• Diagnosis :
• History
• Physical examination
• Vascular laboratory testing
• Ankle–brachial index (ABI) with Toe-brachial index (TBI) examination (ABI with TBI repeat testing is the best predictor of worsening PAD)
• Other tests include ultrasound, CT scan, MRI, surgical arteriogram
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• Treatment : Prevention of risks for heart attacks and stroke
• medicine for high cholesterol (statins)
• medicine for high blood pressure
• medicine for diabetes
• medicine for reducing inflammation (Aspirin, Plavix® /Clopidogrel)
• Stop smoking
• Regular exercise program ± Medicine (Pletal®/Cilostazol)
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ASSESSMENT
• Vascular specialists are critical in diagnosing PAD from other causes of leg pain and symptoms (e.g. varicose veins, sciatica, autoimmune disorders).
• SANO routinely performs ABI with TBI and arterial ultrasound imaging
• SANO reserves CT, MRI, or surgery for obtaining other valuable information
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*Disclaimer- The information provided is for informational purposes only.
Open Surgery Techniques​
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Damaged arteries may be opened to remove plaque
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An incision is made over the damaged artery after dissection​
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Plaque is removed from the inner wall of the artery (endarterectomy)
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Material is sewn to the artery incision to widen it (patch angioplasty)
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A blood tube is used to connect an artery to another artery (bypass)
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Options for blood vessel treatment often include:
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Patch angioplasty (using vein, artery, or man-made material)
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Vein bypass (using vein to connect 2 artery areas)
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Prosthetic bypass (using man-made tube to connect 2 artery areas)
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Endarterectomy (removal of plaque and closing the artery incision)
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Benefits of Open Surgery
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Direct visualization and repair of the damaged vessels
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Less future interventions anticipated, compared to endovascular
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Long-term durability, compared to endovascular
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Concerns of Open Surgery
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Longer recovery time to heal incisions
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Higher risk of postoperative pain
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Increased risk of infection (e.g. pneumonia, incision site)
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Higher anesthesia risk with less-healthy patients
*Disclaimer- The information provided is for informational purposes only.
OPEN SURGERY &
TREATMENT OPTIONS
ENDOVASCULAR
TREATMENT OPTIONS
What is Endovascular Surgery?
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Surgery performed from inside the artery using wires, catheters, balloons. and stents
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There is rarely a need for use the large incisions seen in open surgery
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Hybrid procedures, involve endovascular and open surgery technique
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Endovascular Procedure Steps
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The blood vessel of the arm and/or leg are accessed with a needle
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Wires and catheters are used to dilate the needle access site
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Blocked arteries are identified using an x-ray screen and/or ultrasound in a specially equipped room
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Wires, catheters, Balloons, stents, and rotating devices may be used to open and widen the narrowed or blocked artery
Endovascular techniques commonly used (individualized to each patient)
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Angioplasty- A balloon is dilated in an artery to widen it
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Stenting- a cylindrical tube expands in the artery to widen it long-term
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Atherectomy- catheters rotate in plaque to widen areas in the artery
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Pharmaco-mechanical thrombolysis-catheters and medicine are used to dissolve recent blood clots
Why use Endovascular Surgery?
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Reduced hospital stay
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Quicker return to work and normal activities.
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May be performed with local anesthesia and minimal sedation.
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Decreases anesthesia risks in less-healthy patients
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What are the common risks?
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Overall rate of complications is less than 1%.
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Bleeding
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Infection
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Need for additional and possibly an open procedure
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Allergy to contrast
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Often requires a patient have normal or near-normal kidney function
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*Disclaimer- The information provided is for informational purposes only.