Chronic Kidney Disease

Peripheral arterial disease (PAD) is a common and potentially severe vascular condition that derives from atherosclerosis. Basically, it is the accumulation of plaque within the arteries. This condition impacts millions globally every year because it diminishes blood circulation to limbs and organs, resulting in:

• Discomfort
• Limited functionality
• The potential for limb loss 

In recent years, the field has witnessed notable progress in medical technology and procedures, empowering healthcare professionals to effectively combat this ailment, with peripheral arterial stenting emerging as a pivotal intervention.

Understanding the Impact of Peripheral Arterial Disease

PAD occurs when the peripheral arteries, mainly in the legs, become narrowed or blocked by fatty deposits. Symptoms might include leg pain while walking, numbness, or the development of sores that do not heal. If left untreated, PAD can lead to critical limb ischemia, gangrene, and ultimately amputation.

According to a study published in the Journal of the American Heart Association, the prevalence of PAD in the United States is about 6.8 million among adults 40 years or older. The number escalates with age and is more common among those who have diabetes or smoke.

The Warning Signs of Peripheral Arterial Disease

Typically, one of the first and most common symptoms of PAD is leg pain while walking, a condition known as “intermittent claudication.” Individuals with PAD might observe that they can only walk a particular distance or for a certain amount of time before they begin to experience this cramping or discomfort, often in their calves.

Symptoms may vary and can include additional signs besides leg pain. Some people may even feel numbness or weakness in their legs, which can cause concern. Coldness in one leg compared to the other may also indicate PAD due to decreased blood flow. Sores on the toes, feet, or legs that don’t heal or take an unusually long time to heal are another symptom of PAD. In severe cases, these can progress to critical limb ischemia, a severe form of PAD causing ulcers or gangrene. Lastly, in males, erectile dysfunction may also be a sign of PAD.

However, some persons might not exhibit marked symptoms but could still have PAD, making early detection tricky, underlining the significance of regular PAD screening—especially if you have key risk factors like smoking and diabetes.

Stenting as a Solution for Peripheral Arterial Disease

For moderate to severe cases, one of the leading treatment options is peripheral arterial stenting. Stents, which are small mesh tubes, are placed in the artery to provide structural support from within. Peripheral arterial stenting is minimally invasive and is performed using a catheter threaded through the blood vessels to the site of the blockage.

Numbers that Speak

In a retrospective analysis conducted at a cardiovascular center, researchers delved into the recurrence patterns in 88 patients battling peripheral artery disease (PAD) in the lower limbs following their angioplasty and stenting treatments. They meticulously searched for links between PAD’s return and a host of factors unique to each patient: their backgrounds, whether they smoked, and if they had conditions like diabetes, high blood pressure, or abnormal cholesterol levels.

They found a recurrence, or restenosis, occurring in only 12.5% of cases, pointing to the significant role the chosen revascularization methods and the characteristics of the affected blood vessels play in the likelihood of PAD returning. Curiously, they noted that age, gender, the extent of the artery blockage, and other health issues like smoking, high blood pressure, and cholesterol levels didn’t markedly sway restenosis rates. These findings underscore the advantages of stenting over alternative methods in managing PAD, as it offers a minimally invasive approach with comparable or superior outcomes in preventing recurrence.

The Advantages of Peripheral Arterial Stenting

• Minimally Invasive: Compared to open surgical methods, stenting is less invasive, reducing risks and recovery time.
• High Success Rate: Stents provide immediate relief of symptoms and have high success rates in the long term.
• Low Complication Risks: Complications are rare and typically minor if they do occur.
• Improved Quality of Life: Patients experience a significant improvement in quality of life with increased mobility and decreased pain.

The Importance of Patient Education When It Comes to Peripheral Arterial Stenting

When it comes to peripheral arterial stenting, ensuring patients are in the know is key to getting the best results. That means laying out all the details about the procedure, what risks and benefits to expect, how to take care of yourself afterward, and any lifestyle changes that might help. Patients need to have a clear picture so they know what to expect and can stick to their doctor’s advice. 

Whether it’s staying on top of meds, keeping up with follow-up appointments, or tweaking their habits like quitting smoking or adjusting their diet, every bit helps for long-term success. Plus, when patients are well-informed, they can have more of a say in their treatment, working closely with their healthcare team to tailor their plans to fit them just right. So, educating patients is really the foundation for good outcomes and better care overall when it comes to peripheral arterial stenting.

In summary, peripheral arterial stenting provides a ray of hope for individuals facing PAD. By remaining well-informed, actively engaging in treatment protocols, and embracing necessary lifestyle adjustments, patients can significantly enhance their prospects for improved health and outcomes. To learn more or schedule a consultation with our professionals, contact us here. 

Peripheral vascular disease (PVD) also known as peripheral arterial disease (PAD) is a slow and progressive disorder characterized by a narrowing, blockage, or spasms in blood vessels in the body. While PVD may affect any blood vessel outside of the heart, the distal extremities (legs and feet) are most commonly affected.

Population data from the National Health and Nutrition Examination Survey (NHANES 1999-2000) reported that 24% of persons with CKD stage 3 or greater (creatinine clearance of <60 mL/min) had peripheral arterial disease as objectively defined by an ankle-brachial index (ABI) <0.9. The use of the ABI as the key diagnostic criteria significantly increased prevalence rates to nearly 35%, especially in more advanced chronic kidney disease.

HOW IS PERIPHERAL VASCULAR DISEASE DIAGNOSED?

• Ankle-brachial index (ABI). An ABI is a comparison of the blood pressure in the ankle with the blood pressure in the arm. To calculate the ABI, the systolic blood pressure (the top number of the blood pressure measurement) of the ankle is divided by the systolic blood pressure of the arm.
• Doppler ultrasound. This uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Your doctor may use the Doppler technique to measure and assess the flow of blood. Faintness or absence of sound may mean blood flow is blocked.
• Angiogram. This is an X-ray of the arteries and veins to detect blockage or narrowing. This procedure involves inserting a thin, flexible tube into an artery in the leg and injecting a contrast dye. The contrast dye makes the arteries and veins visible on the X-ray.

WHAT ARE THE COMPLICATIONS OF PERIPHERAL ARTERIAL DISEASE?

• Amputation (loss of a limb)
• Poor wound healing
• Restricted mobility due to pain or discomfort
• Severe pain in the affected extremity
• Stroke (3 times more likely in people with PVD)

HOW TO PREVENT PERIPHERAL VASCULAR DISEASE

• Quit smoking, including avoidance of second-hand smoke and use of any tobacco products
• Weight loss
• Limiting or quitting alcohol intake
• Medicine to reduce your risk for blood clots, as determined by your healthcare provider
• Exercise 30 minutes or more daily
• Control of diabetes, cholesterol, and high blood pressure

Once PVD is symptomatic there are more invasive treatments that may be indicated such as angioplasty or vascular surgery.

Due to the high prevalence of PVD in the CKD patient population, PRINE Health is launching PRINE Vascular. We have brought in a skilled interventional radiologist and seasoned Podiatrist. We are starting a sonogram program and will be screening patients in our offices with ABI measurements proactively. A new Vascular lab will be opening in September at Parker Jewish Institute.

Facts About Salt And Hypertension In The United States

High blood pressure (also known as hypertension) is associated with three leading causes of death, cardiovascular disease, stroke, and kidney disease. Hypertension is extremely prevalent around the world. About half of adults (45%) with uncontrolled hypertension have a blood pressure of 140/90 mm Hg or higher. This includes 37 million U.S. adults. In 2017, the American College of Cardiology and the American Heart Association published new guidelines for hypertension management and defined high hypertension as blood pressure at or above 130/80 mm Hg. Stage 2 hypertension is defined as blood pressure at or above 140/90 mm Hg.  One notorious contributor to hypertension is excessive dietary salt intake.

Salt and Hypertension

Salt is perhaps the most popular flavoring added to food. Unfortunately, there is a downside. Too much salt can lead to fluid retention and worsen hypertension. How much is too much? Well, we need salt. We need about 500 mg per day. Americans consume much, much more than that. We take in on average closer to 3,500 mg, more than 7 times what is necessary. The Dietary Guidelines for Americans by the FDA advise we stick to a diet of fewer than 2,300 mg per day (about one teaspoon).

Salt is ubiquitous and added to all sorts of foods you consume on a daily basis. Moreover, the is often a salt shaker around to add even more. If you already have hypertension you are at risk for extra salt worsening your hypertension. So, when you can help it, skip the salt!  Learn more about High blood pressure.