MDNews - San Antonio

IN THE MEDICAL COMMUNIT Y, SEPTEMBER IS DEDICATED TO BRINGING AWARENESS OF PERIPHER AL ARTERY DISE A SE ¡PAD¢ AND ITS PROCESS. C U R R E N T T O P I C S 1 3 Peripheral Artery Disease BY DANIEL TAMEZ, MD, VASCULAR SURGEON, PERIPHERAL VASCULAR ASSOCIATES PATIENTS AT HIGH risk include those who su•er from diabetes, hypertension and hyperlipidemia, have a history of smoking, and have a family history of atherosclerosis. PAD has other terminolo- gies such as peripheral vascular disease, atherosclerosis, hardening of the arteries and bad circulation. Since the inception of my career as a vascular surgeon in 1982, I have encoun- tered that leg pain and various symptoms of lower extremity complaints are usu- ally misdiagnosed and misunderstood by the medical profession. Patients with leg problems and symptoms comprise nearly 40 to 50 percent of oªce visits in our vascular practice. I believe peripheral vascular surgeons perform the most thor- ough assessments of the patient because of our extensive training and knowledge in the field. IDENTIFYING PAD The Mayo Clinic lists 48 common causes of leg pain. Consequently, the diagnosis can be diªcult to obtain. The most common that I see are circulatory, back problems radiating to legs, bone and joint problems involving hips, knees, ankles and feet, diabetes with centra l and periphera l neuropathy, chronic and acute venous disease, edema secondary to systemic diseases, and finally fibromyalgia and other connective tissue diseases. Listening to the patient for a complete history will result in a diagnosis 90 per - cent of the time. We focus on keywords patients use to reduce possible etiologies of their complaints. A complete, hea d-to -toe physica l examination will add to the accuracy of the diagnosis. This increases identification of the problem to 95 percent. This examina- tion includes a thorough evaluation of all pulses of the extremities, abdomen and neck, blood pressure in both arms, and auscultation for bruits and murmurs. TAILORING TREATMENT As vascular surgeons, we have the capa- bilities and training to cover the entire spectrum of treatment: conser vative management, endovascular intervention with balloons, wires, and stents, open surgical procedures such as bypass or end- arterectomy, and a hybrid approach that involves both endovascular techniques and open surgery. There is no need for an invasive procedure such as an arteriogram. Arteriograms are usually reserved for patients with disabling claudication, which means that a patient can hardly walk, rest pain of the distal legs and feet, and/or skin changes such as ulcers or gangrene of the feet or toes. The conservative approach is always the recommended choice in treating vascular problems. Primum non nocere — . First, do no harm. Any intervention in the arterial system can have a complication. The patient and family can a lso be instructed on di•erent modes of therapy once a diagnosis is made. Cessation of smoking, a regular wa lking program, emphasis on foot care and proper footwear, and occasionally a prescribed medication will improve the distance a patient with PAD can walk (claudication). A diagnosis of PAD could also signify problems involving the hea r t ( hea r t attacks), carotid arteries (stroke), and in intestina l/rena l a r teries (mesen- teric insufficiency and rena l failure). Consequently, PA D diagnosis should ensure that the patient is considered as a whole person, not just his or her issues in the lower extremities. To learn more about Peripheral Vascular Associates or to schedule an appointment, visit pvasatx.com or call 210-237-4444. ■ Perspectives on M D N E W S . C O M /// M D N E W S S A N A N T O N I O ■ 2 017 1 3

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