 | Joseph P. Galichia, MD is the founder and Medical Director of the Galichia Medical Group, PA. He is an internationally recognized pioneer in the field of interventional cardiology. In the 70's, Dr. Galichia studied in Zurich, Switzerland with the inventors of the balloon angioplasty technique for treating heart disease. As a result of his experience, he was able to bring this historic technique back to the United States where he was one of the first physicians to perform coronary angioplasty here. A noted medical spokesman, he appears on a weekly Newstalk segment on KWCH Channel 12 and has a weekly syndicated radio talk show on KNSS 1330 AM every Saturday live from 11:00 am to noon. Dr. Galichia may be contacted by sending an e-mail to service@galichia.com |
Health & Medicine
2003-08-01 09:57:00
What is PVD?
: What exactly is PVD and what are its symptoms?
ANSWER: Peripheral Vascular Disease (PVD) is a common form of atherosclerosis, or disease that causes blockages in arteries. Peripheral Vascular Disease refers to blockages in arteries outside of the heart, i.e. kidneys, legs, neck, brain and arteries in the arms. Most of these patients have generalized atherosclerosis involving all of the arteries in their bodies, including heart arteries or coronary arteries. Although, the majority of the problems occur in the lower extremities, these patients are at greater risk for heart attack, stroke and kidney failure. 48% of the patients have blockages in all major vascular beds. And 68% of patients with Peripheral Vascular Disease also have heart disease. PVD of the lower extremities is the most common form of Peripheral Vascular Disease. It effects 12% of the adult population and 20% over the age 70. It is more common in men than women under age 65, but over age 65, the incidents are equal. In our experience, 65% to 70% of patients are smokers. While most patients have symptoms, one third of all patients have no symptoms at all. The most common symptoms include pain in the hip, buttocks or calf brought on by walking and relieved with rest. This pain tends to be reproducible as patients often say they know exactly how far they can walk before they develop pain. This symptom is known as claudication in the medical literature. Most patients state that these symptoms interfere with their daily activities, as the disease progresses skin discoloration, non-healing ulcers and limb loss become major problems. Risk factors for PVD in addition to smoking include diabetes and advancing age beyond 65. Other risk factors include: high blood pressure, high cholesterol, sedentary life style, heredity, and known existing coronary artery disease. The diagnosis is made from the history of claudication or leg pain, decreased pulses in the legs, abnormal leg blood pressures, decreased walking ability, and abnormal doppler (wave form) studies of the legs. Ultimately, angiography or the injection of dye in the arteries is used to define where blockages occur and a possibility for treatment. Understanding all these components, including patients' symptoms and the anatomy of vascular abnormalities helps us to establish the best treatments. There are some fundamental treatments that all patients with Peripheral Vascular Disease should undergo. These include diet, daily walking, smoking cessation, and the management of diabetes or another underlying illnesses. Stopping smoking may improve the symptoms associated with this disease tremendously and as a first step treatment for all smokers. Walking until pain develops and then performing this exercise repetitively is another mainstay of treatment. The use of Aspirin and other platelet inhibitors such as Plavix also improve symptoms. A drug specifically designed for patients with PVD known as Pletal may help dramatically. The use of non-surgical procedures such as balloon angioplasty or arterial stent placement is a way of improving the anatomy and restoring the blood flow to the legs by decreasing the amount of blockage. We have been doing these procedures for over 20 years in the Galichia Medical Group and continue to be impressed by the short-term and long-term results. The use of stents, or small wire mash devices deployed in the arteries to keep them open after a balloon procedure has helped improve the chances of a good long-term result in these patients. As a last resort, surgery may also be a great value to improve symptoms and spare limb loss. Employing all of these modalities and opting for early non-surgical intervention greatly improves the outlook for these patients.
