Thursday, January 28, 2010

Peripheral Vascular Disease (PVD) / Peripheral Arterial Disease (PAD)

What is peripheral vascular disease (PVD)?
Peripheral vascular disease (PVD) is a slow and progressive circulation disorder. It may involve disease in any of the blood vessels outside of the heart and diseases of the lymph vessels - the arteries, veins, or lymphatic vessels. Organs supplied by these vessels such as the brain, heart, and legs, may not receive adequate blood flow for ordinary function. However, the legs and feet are most commonly affected, thus the name peripheral vascular disease.

Conditions associated with PVD that affect the veins include deep vein thrombosis (DVT), varicose veins, and chronic venous insufficiency. Lymphedema is an example of PVD that affects the lymphatic vessels.

When PVD occurs in the arteries outside the heart, it may be referred to as peripheral arterial disease (PAD). However, the terms "peripheral vascular disease" and "peripheral arterial disease" are often used interchangeably. In the US, 10 million people have peripheral artery disease. PAD occurs in 5 percent of adults older than 50 and in 20 percent of adults older than 70. It is frequently found in people with coronary artery disease, because atherosclerosis, which causes coronary artery disease, is a widespread disease of the arteries.

Conditions associated with PAD may be occlusive (occurs because the artery becomes blocked in some manner) or functional (the artery either constricts due to a spasm or expands). Examples of occlusive PAD include peripheral arterial occlusion and Buerger's disease (thromboangiitis obliterans). Examples of functional PAD include Raynaud's disease and phenomenon and acrocyanosis.

What causes peripheral vascular disease?
PVD is often characterized by a narrowing of the vessels that carry blood to the leg and arm muscles. The most common cause is atherosclerosis (the buildup of plaque inside the artery wall). Plaque reduces the amount of blood flow to the limbs and decreases the oxygen and nutrients available to the tissue. Clots may form on the artery walls, further decreasing the inner size of the vessel and potentially blocking off major arteries.

Other causes of peripheral vascular disease may include trauma to the arms or legs, irregular anatomy of muscles or ligaments, or infection. Persons with coronary artery (arteries that supply blood to the heart muscle) disease are frequently found to also have peripheral vascular disease.

What are conditions associated with peripheral vascular disease?
The term "peripheral vascular disease" encompasses several different conditions. Some of these conditions include, but are not limited to, the following:

atherosclerosis - the build-up of plaque inside the artery wall. Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin. The artery wall then becomes thickened and loses its elasticity. Symptoms may develop gradually, and may be few, as the plaque builds up in the artery. However, when a major artery is blocked, a heart attack, stroke, aneurysm, or blood clot may occur, depending on where the blockage occurs.

Buerger's disease (thromboangiitis obliterans) - a chronic inflammatory disease in the peripheral arteries of the extremities leading to the development of clots in the small- and medium-sized arteries of the arms or legs and eventual blockage of the arteries. Buerger's disease most commonly occurs in men between the ages of 20 and 40 who smoke cigarettes. Symptoms include pain in the legs or feet, clammy cool skin, and a diminished sense of heat and cold.

chronic venous insufficiency - a prolonged condition in which one or more veins do not adequately return blood from the lower extremities back to the heart due to damaged venous valves. Symptoms include discoloration of the skin and ankles, swelling of the legs, and feelings of dull aching pain, heaviness, or cramping in the extremities.

deep vein thrombosis (DVT) - a clot that occurs in a deep vein, and has the potential to dislodge, travel to the lungs, occlude a lung artery (pulmonary embolism), and cause a potentially life-threatening event. It is found most commonly in those who have undergone extended periods of inactivity, such as from sitting while traveling or prolonged bed rest after surgery. Symptoms may be absent or subtle, but include swelling and tenderness in the affected extremity, pain at rest and with compression, and raised vein pattern.

Raynaud's phenomenon - a condition in which the smallest arteries that bring blood to the fingers or toes constrict (go into spasm) when exposed to cold or as the result of emotional upset. Raynaud's most commonly occurs in women between the ages of 18 and 30. Symptoms include coldness, pain, and pallor (paleness) of the fingertips or toes.

thrombophlebitis - a blood clot in an inflamed vein, most commonly in the legs, but it can also occur in the arms. The clot can either be close to the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis). It may result from pooling of blood, venous wall injury, and altered blood coagulation. Symptoms in the affected extremity include swelling, pain, tenderness, redness, and warmth.
varicose veins - dilated, twisted veins caused by incompetent valves (valves that allow backward flow of blood) allowing blood to pool. It is most commonly found in the legs or lower trunk. Symptoms include bruising and sensations of burning or aching. Pregnancy, obesity, and extended periods of standing intensify the symptoms.

What are the risk factors for peripheral vascular disease?
A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Risk factors for peripheral vascular disease include factors which can be changed or treated and factors that cannot be changed.

Risk factors that cannot be changed include the following:

age (especially older than 50)
history of heart disease
male gender
diabetes mellitus (type 1 diabetes)
postmenopausal women
family history of dyslipidemia (elevated lipids in the blood, such as cholesterol), hypertension, or peripheral vascular disease

Risk factors that may be changed or treated include:

coronary artery disease
impaired glucose tolerance
hypertension (high blood pressure)
physical inactivity
smoking or use of tobacco products
Those who smoke or have diabetes mellitus have the highest risk of complications from peripheral vascular disease because these risk factors also cause impaired blood flow.

What are the symptoms of peripheral vascular disease?

Approximately half the people diagnosed with peripheral vascular disease are symptom free. For those experiencing symptoms, the most common first symptom is intermittent claudication in the calf (leg discomfort described as painful cramping that occurs with exercise and is relieved by rest). During rest, the muscles need less blood flow, so the pain disappears. It may occur in one or both legs depending on the location of the clogged or narrowed artery.

Other symptoms of peripheral vascular disease may include:

changes in the skin, including decreased skin temperature, or thin, brittle shiny skin on the legs and feet
diminished pulses in the legs and the feet
gangrene (dead tissue due to lack of blood flow)
hair loss on the legs
non-healing wounds over pressure points, such as heels or ankles
numbness, weakness, or heaviness in muscles
pain (described as burning or aching) at rest, commonly in the toes and at night while lying flat
pallor (paleness) when the legs are elevated
reddish-blue discoloration of the extremities
restricted mobility
severe pain
thickened, opaque toenails

The symptoms of peripheral vascular disease may resemble other conditions. Consult your physician for a diagnosis.

How is peripheral vascular disease diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for peripheral vascular disease may include any, or a combination, of the following:

angiogram - an x-ray of the arteries and veins to detect blockage or narrowing of the vessels. 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.

ankle-brachial index (ABI) - a comparison of the blood pressure in the ankle with the blood pressure in the arm using a regular blood pressure cuff and a Doppler ultrasound device. To determine 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.

blood lipid profile - a blood test to measure the levels of each type of fat in your blood: total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and others.

Doppler ultrasound flow studies - uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Doppler technique is used to measure and assess the flow of blood. Faintness or absence of sound may indicate an obstruction in the blood flow.

magnetic resonance angiography (MRA) - a noninvasive diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRA is often used to examine the heart and other soft tissues and to assess blood flow.

treadmill exercise test - a test that is given while a patient walks on a treadmill to monitor the heart during exercise.

photoplethysmography (PPG) - an examination comparable to the ankle brachial index except that it uses a very tiny blood pressure cuff around the toe and a PPG sensor (infrared light to evaluate blood flow near the surface of the skin) to record waveforms and blood pressure measurements. These measurements are then compared to the systolic blood pressure in the arm.

pulse volume recording (PVR) waveform analysis - a technique used to calculate blood volume changes in the legs using a recording device that displays the results as a waveform.

reactive hyperemia test - a test similar to an ABI or a treadmill test but used for people who are unable to walk on a treadmill. While a person is lying on his or her back, comparative blood pressure measurements are taken on the thighs and ankles to determine any decrease between the two sites.

segmental blood pressure measurements - a means of comparing blood pressure measurements using a Doppler device in the upper thigh, above and below the knee, at the ankle, and on the arm to determine any constriction in blood flow.

What is the treatment for peripheral vascular disease?

There are two main goals for treatment of peripheral artery/vascular disease: control the symptoms and halt the progression of the disease to lower the risk of heart attack, stroke, and other complications.

Specific treatment will be determined by your physician based on:

your age, overall health, and medical history
extent of the disease
your signs and symptoms
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference
Treatment may include:

lifestyle modifications to control risk factors, including regular exercise, proper nutrition, and smoking cessation
aggressive treatment of existing conditions that may aggravate PVD, such as diabetes, hypertension, and hyperlipidemia (elevated blood cholesterol)

medications for improving blood flow, such as antiplatelet agents (blood thinners) and medications that relax the blood vessel walls

angioplasty - a catheter (long hollow tube) is used to create a larger opening in an artery to increase blood flow. Angioplasty may be performed in many of the arteries in the body. There are several types of angioplasty procedures, including:
balloon angioplasty - a small balloon is inflated inside the blocked artery to open the blocked area
atherectomy - the blocked area inside the artery is "shaved" away by a tiny device on the end of a catheter
laser angioplasty - a laser used to "vaporize" the blockage in the artery
stent - a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open
vascular surgery - a bypass graft using a blood vessel from another part of the body or a tube made of synthetic material is placed in the area of the blocked or narrowed artery to reroute the blood flow
With both angioplasty and vascular surgery, an angiogram is often performed prior to the procedure.

What are the complications of peripheral vascular disease?
Complications of peripheral vascular disease most often occur because of decreased or absent blood flow. Such complications may include:

amputation (loss of a limb)
heart attack
poor wound healing
restricted mobility due to pain or discomfort with exertion
severe pain in the affected extremity
stroke (three times more likely in persons with PVD)
By following an aggressive treatment plan for peripheral vascular disease, complications such as these may be prevented.

Prevention of peripheral vascular disease:
Steps to prevent PVD are primarily aimed at management of the risk factors for PVD. A prevention program for PVD may include:

smoking cessation, including avoidance of second hand smoke and use of tobacco products
dietary modifications including reduced fat, cholesterol, and simple carbohydrates (such as sweets), and increased amounts of fruits and vegetables
treatment of dyslipidemia (high blood cholesterol levels) with medications as determined by your physician
weight reduction
moderation in alcohol intake
medications as determined by your physician to reduce your risk of blood clot formation
exercise plan of a minimum of 30 minutes daily
control of diabetes mellitus
control of hypertension (high blood pressure)

A prevention plan for PVD may also be used to prevent or lessen the progress of PVD once it has been diagnosed. Consult your physician for diagnosis and treatment.

Wednesday, January 27, 2010

The National Kidney Foundation Opens New Office at Saint Mary’s Regional Medical Center

-Facility to educate northern Nevada residents about kidney disease-

RENO, Nev.– In an effort to expand patient services and provide greater resources to the local community, the National Kidney Foundation will open a new office in Reno, Nev. at Saint Mary’s Regional Medical Center. The new office, opening on Aug. 28 will provide northern Nevada patients, caregivers, medical professionals, and the public with programs on kidney disease and its two leading causes, diabetes and high blood pressure. The priority of the foundation and Saint Mary’s is to educate the public about kidney disease and organ donation, health screenings for those at risk, patient services, and policy initiatives; all in an effort to combat rising levels of chronic kidney disease in Nevada.

“Saint Mary’s is dedicated to providing the best possible care to those suffering from kidney disease and with the recent opening of our Saint Mary’s Center for Kidney Care, it is a natural fit have the National Kidney Foundation on our campus,” said Mike Uboldi, president and CEO of Saint Mary’s Regional Medical Center. “Having Nevada’s office of the National Kidney Foundation at Saint Mary’s enables us to offer those suffering from kidney disease yet another resource.”

Approximately 26 million Americans have some level of kidney disease and more than 425,000 Americans are currently undergoing treatment for kidney failure. In northern Nevada, more than 65,000 people have chronic kidney disease and more than 560 patients are receiving dialysis treatment, which is expected to double within ten years. In addition to these growing numbers, northern Nevada currently does not have a transplant center, making it difficult for patients to receive lifesaving transplants.

“One in eight people in northern Nevada have chronic kidney disease though a majority do not know it and over 200 await a lifesaving kidney transplant,” said Christopher Kelly, division president of the National Kidney Foundation. “From our new partnership with Saint Mary’s we look forward to helping those suffering from kidney disease by educating them about programs and other resources available.”

The northern Nevada Kidney Foundation office will be located on the fourth floor of Saint Mary’s Regional Medical Center and opens on Aug. 28. Those interested in learning more about the National Kidney Foundation and its programs can call 775-770- 6530 or visit


About Saint Mary’s
In 2009 Saint Mary’s celebrates 101 years of delivering compassionate, high-quality, affordable health services to northern Nevada. Founded in 1908 by the Dominican Sisters of San Rafael, Saint Mary's is a member of the Catholic Healthcare West family of hospitals and medical centers in Arizona, California, and Nevada. As a fully integrated, faith-based healthcare system with 380 licensed beds, approximately 2,300 employees, 850 affiliated physicians, and 300 volunteers, Saint Mary’s provides a wide variety of inpatient, outpatient, and community services to go Well Beyond for the community we serve. For more information, please visit

About Catholic Healthcare West
Catholic Healthcare West (CHW) is the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California. Founded in 1986, the CHW network of more than 10,000 physicians and approximately 53,000 employees serves a population spanning 22 million people at 41 hospitals across California, Arizona, and Nevada. CHW is committed to delivering compassionate, high-quality, affordable health care services with special attention to the poor and underserved. In 2008, CHW provided $967 million in charity care, community benefits, and unreimbursed patient care. For more information, please visit our website at


Gary Aldax
(775) 770-3038

Frankie Vigil
(775) 287-5924

Christopher Kelley
(415) 902-8115

Tuesday, January 26, 2010

Renown offering PVD/PAD screenings as part of American Heart Month

Renown Regional Medical Center announced today that they will offer Life Line Screening as part of February's "American Heart Month."

Life Line Screening is designed to help people identify their risk of stroke, vascular disease and osteoporosis before they suffer catastrophic illness.

The screenings will be held Wednesday, Feb. 10 from 9 a.m. to 5 p.m. in the Mack Auditorium at Renown. The cost is $129.

To pre-register, go to, or call 1-800-690-4100 to make an appointment. Call 982-4100 for directions.

The screening will provide:

Carotid Artery Screening – painless, non-invasive Doppler ultrasound used to visualize the carotid arteries, the arteries that bring blood to the brain. The majority of strokes are caused by plaque build up in these arteries.

Abdominal Aortic Aneurysm Screening – Ultrasound is used to visualize the abdominal aorta, the largest artery in the body, to measure the diameter of the aorta. This measurement can indicate if there is a weakening in the aortic wall which can cause a ballooning effect known as an aneurysm. Abdominal aortic aneurysms can burst. When they do, it is usually fatal.

Peripheral Arterial Disease Screening – PAD is also known as “hardening of the arteries.” Individuals with PAD have a 4 to 6 fold increased risk of cardiovascular disease. Risk is evaluated through a measurement called the “Ankle-Brachial Index,” which is obtained by reading the systolic pressure in the ankle and arm.

Osteoporosis Screening – Ultrasound is used to estimate the bone density of the heel. This can indicate if there is a reduction in bone density, which may indicate the presence of osteoporosis. The heel is used because it is similar in composition to the hip, where disabling fractures often occur.

Atrial Fibrillation is an abnormal heart beat (arrhythmia) that affects the atria - the upper chambers of the heart - and is the most common form of sustained arrhythmia. 2.5 million Americans have been diagnosed with atrial fibrillation, and for those over age 40, there is a one in four chance of developing the condition.

Friday, January 22, 2010

Vascular Screenings Check for Silent Problems

From: Keeping in Circulation

Most of us know something about heart disease, but many do not know that we need to take care of our arteries as well. These vessels create a "superhighway" of blood flow that takes oxygen-rich blood from the heart to every area of our bodies. It is the buildup of plaque (which is a combination of fat, cholesterol, calcium and other materials) in the arteries, which can lead to more serious health issues such as peripheral arterial disease (PAD), heart attack or stroke.

One way to monitor what is going on with your arteries is to have a vascular screening, which can aid in the early detection of vascular disease. This can be helpful, as many vascular diseases do not have noticeable symptoms as warning signs.

Vascular screenings check for a variety of issues related to the arteries, are painless, non-invasive and involve no radiation. The screenings typically check the:

Carotid arteries – This test uses Doppler ultrasound to check for plaque and assess the rate of blood flow in the arteries of the neck which bring blood to the brain.
Abdominal aorta – This test checks for an enlargement of the abdominal aorta, the largest artery in the body.
Peripheral arteries – This is a non-invasive blood pressure test called the ankle-brachial index (ABI) that looks at the systolic pressure (upper number of your blood pressure) in your arms and legs to check for diminished blood flow.
The screenings are most appropriate for those over age 50 with specific risk factors such as smoking, high blood pressure, high cholesterol, or a family history of heart attack, aortic aneurysm or stroke. If you have diabetes, you are at a particularly increased risk for PAD. The American Diabetes Association recommends that every person with diabetes age 50 and older have a screening for PAD.

Screenings are generally not offered as part of a regular physical examination and most health insurance companies will not cover the costs unless you have symptoms.

As the conditions for which these tests screen tend to be silent in the early stages, there can be benefits to screening when you are at risk. The good news is that there are hospitals and private companies that offer the screenings in the community at low cost and sometimes for free.

Look for a screening event provided in conjunction with your local hospital. Or, look for an event conducted by a private company that has a solid reputation and clearly explains the screenings offered and provides background information on its clinical team.

No screening for any disease is 100 percent accurate all the time. There is always a chance for a false finding. That is why it is important that you share your screening results with your health care provider, who can discuss the findings of the screening with you and make sure you have all of the follow-up that you need.

Dance for Diabetes: Podiatry School Gives Back

From: The Official Blog of Houston Podiatrist, Dr. Andrew Schneider

On January 16, 2010, Scholl College of Podiatric Medicine (SCPM) in conjunction with Rosalind Franklin University of Medicine and Science (RFUMS) hosted the 23rd Annual Dance for Diabetes at the Millennium Knickerbocker Hotel in Chicago, Illinois. This annual event helps raise money to donate to the American Diabetes Association (ADA) to help fund research on preventative medicine and education on Diabetes.

Scholl College of Podiatric medicine has been dedicated to raising money for the American Diabetes Association for the past 23 years due to its close professional tie to diabetes. Ask any podiatrist out there about diabetes link to their profession and they will go on for hours about how diabetes affects the lives of many of their patients.

In the past 20 years diabetes has become an epidemic in American society. Currently affecting more then 24 million people in the United States, Diabetes is projected to keep increasing in prevalence over the next decade if the Americans do not change their lifestyles. The reason for the huge increase in the number of people diagnosed with diabetes is strongly correlated to obesity rate of this country.

Diabetes is a disease that really affects the entire body but has special effects on the lower extremities which is why diabetics are frequent visitors to Podiatry offices. Diabetes leads to peripheral neuropathy which causes diabetics to lose sensation in their extremities. Peripheral neuropathy can lead to ulcerations of the feet which can lead to further complications such as infection.

Due to the fact that podiatrists see the devastating side effects of diabetes in their patients many of them become very passionate about raising awareness for Diabetes prevention and research. Undoubtedly this is why SCPM students and faculty work so hard every year to raise money through Dance for Diabetes to donate to the ADA. This year the college was pleased to announce that they donated $21,278 to the American Diabetes Association which is the second largest amount raised by the college in the last 23 years and the most donated since SCPM merged with RFUMS. Congratulations to the all the students and faculty at Scholl College of Podiatric Medicine for raising awareness for a cause that they feel so passionate about. Hopefully Dance for Diabetes will be a tradition that lives on for many years to come.

Thursday, January 21, 2010


From: The Clinical Services Journal

January 2010
Dr ROBERT MORGAN, consultant vascular and interventional radiologist at St George’s Vascular Unit, provides an overview of the burden of PAD, guidance on how to diagnose the condition, relevant risk factors, risk-factor modification and treatment options available.

Today, one in five in the 65 to 75-year-old age group in the UK1 has peripheral arterial disease (PAD), also known as peripheral vascular disease, on clinical examination. Healthcare professionals have a significant role to play in preventing the escalation of this disease by ensuring early diagnosis, providing patients with advice on risk-factor modification and managing patients with an appropriate treatment. Although prevalence of PAD in primary care practices is high, it is commonly under-diagnosed. This is due to many doctors not obtaining a relevant history for PAD and frequently overlooking subtle signs of the condition on physical examination.2

What are the symptoms?

Today, only a quarter of the one in five 65 to 75-year-olds have any symptoms at all. The “silent” nature of this condition, along with the overall increasing age of the population and the escalating incidence of risk factors for PAD, lead to concern that PAD may become one of the leading diseases of this century. One of the more common indicators of PAD is extreme leg pain caused by walking or exercising, as many as 40% of people with PAD never complain of this symptom2 – and those who do often mistake the discomfort for ageing pains and fail to seek treatment, allowing the condition to worsen. PAD is highly treatable in its early stages, but as the disease remains undiagnosed, the likelihood of facing complications greatly increases, as does the probability of suffering from a heart attack or stroke. Symptoms to look for and discuss with patients when making a diagnosis of PAD include:

• Fatigue or cramping in the leg muscles (claudication) when walking.
• Pain in the legs and/or feet that disturbs sleep.
• Ischaemic tissue ulceration (punched-out, painful, with little bleeding), gangrene.
• Pallor with leg elevation after one minute at 60 degrees (normal colour should return in 10 to 15 seconds; longer than 40 seconds indicates severe ischaemia).
• Absent or diminished femoral or pedal pulses (especially after exercising the limb).
• A lower temperature in one leg compared to the other
• Hair loss and/or poor nail growth (brittle nails).
• Dry, scaly, atrophic skin.

What is the cause?

The underlying cause of PAD is atherosclerosis – a common, progressive disease that involves the hardening and narrowing of the arteries. This is a result of fat, cholesterol and other substances building up in the walls of arteries and forming plaque (atheroma or fatty deposits). As the plaque deposits intensify, the arteries narrow and become less flexible, restricting blood flow. Narrowing of the coronary arteries due to atherosclerosis can result in angina, shortness of breath, heart attack and other symptoms. In PAD, the lower extremities are affected. When blood flow to the legs becomes limited or restricted, the propensity for developing infections, chronic foot ulcers, gangrene and leg lesions dramatically increases. In severe cases, amputation of the affected limb is required if other available treatments fail.

Risk factors

The most common risk factors for PAD include: diabetes, high blood pressure, high cholesterol levels, obesity, smoking and being older than 50.3 All of which are also risk factors for cardiovascular disease. People with diabetes are at the greatest risk for developing severe PAD and experiencing complications from the disease. In fact, people with diabetes are up to fifteen times more likely to endure lower-limb amputation than those without diabetes and problems with the feet are one of the most common causes of diabetes-related hospitalisation.4

Simple test for PAD

General practitioners can quickly and easily test for PAD. The most common test is the ankle/brachial pressure index (ABPI) at rest, a non-invasive process that compares blood pressure in the ankles with the blood pressure in the arms. Although an ABPI can help determine if someone has PAD, it cannot identify the location and degree of the obstruction in the artery. The non-invasive “Doppler Test” is also available and checks a specific artery for blockage. The test uses ultrasound waves to measure blood flow in arteries within the lower extremities. A physical examination and listening to the heart and lungs with a stethoscope will help detect early atherosclerosis. In patients with PAD, a whooshing or blowing sound (“bruit”) is heard over an artery. In complicated or difficult to diagnoses cases, patients should be referred to secondary care where other tests may be carried out to diagnose atherosclerosis or complications. These tests include:

• Arteriography.
• Cardiac stress testing.
• CT scan.
• Intravascular ultrasound (IVUS).
• Magnetic resonance arteriography (MRA).

Managing PAD in primary care

Non-surgical therapy for intermittent claudication involves risk-factor modification, exercise and pharmacological therapy. Details on each of these can be found below.

• Dietary modification, including eating a low-fat, low-cholesterol, and low-salt diet.
• Weight reduction if the patient is overweight.
• Stop smoking. There is a higher correlation between smoking and developing PAD than any other risk factor. All available strategies to help patients quit smoking, such as counselling and nicotine replacement, should be used. Stopping smoking reduces the severity of claudication, the progression of disease and the risk of heart attack and death from vascular causes. Studies have demonstrated lower rates of amputation in patients who stop smoking.5
• Hypertension is a significant risk factor for PAD. Antihypertensives should be prescribed to patients with PAD to reduce morbidity from cardiovascular and cerebrovascular disease.
• Diabetes. Controlling blood sugar levels could not only decrease the incidence of cardiovascular disease and heart attack, but also reduce the occurrence of PAD and PAD outcomes (claudication, peripheral revascularisation, or critical limb ischaemia and amputation).6
• Hyperlipidemia. Studies have demonstrated the benefits of lipidlowering therapy in patients with PAD. Controlling lipids has been shown to reduce disease progression and the severity of claudication.7
• Exercise. PAD can be effectively treated with a formal exercise programme. Research has shown that the greatest improvements in walking ability occur when the following occur: each exercise session is continued for more than 30 minutes, at least three sessions are undertaken per week, the patient walks until near-maximal pain is reached and the exercise regime is continued for at least six months.8
• Pharmacological therapy. Effective drug therapies for PAD include aspirin (with or without dipyridamole), clopidogrel, cilostazol and pentoxifylline. Aspirin and dipyridamole increase the pain-free walking distance and blood flow.9

Management in secondary care

In patients with severe PAD whose condition is not improving with riskfactor modification, exercise programmes and pharmacological therapy, invasive procedures may need to be carried out in the hospital setting. These procedures include angioplasty, stenting or surgery. Angioplasty is a non-surgical procedure that is used to widen arteries. During this procedure, a catheter with a balloon on its tip is inserted into the narrowed artery and inflated. Once the artery widens, the balloon is deflated and the catheter is withdrawn, often restoring blood flow. Until recently, there was uncertainty around the efficacy of angioplasty in combination with supervised exercise and best pharmacological therapy in the treatment of intermittent claudication. A recent study demonstrated that angioplasty in combination with exercise and pharmacological therapy improved walking distances and ABPI 24 months after the procedure compared with exercise and drug therapy alone in patients with stable mild to moderate intermittent claudication.10 Stenting can also be performed to help widen arteries. The stent is inserted into the artery, where it is expanded to hold the artery open and allow blood flow to resume. The procedure is minimally invasive, as the stent is guided into the restricted artery with a catheter that is inserted through a small opening in the artery. Drug-eluting stents have been developed to prevent plaque from growing around the stent due to inflammation and forming scar tissue (restenosis). In patients where large sections of an artery are narrowed, arterial bypass surgery may be required. Bypass surgery is usually successful, but can be risky for patients who suffer from co-morbidities such as diabetes or high blood pressure. With increased awareness of PAD among both patients and healthcare professionals, and proactive testing in primary care for those at risk, we can hope to reduce the significant burden PAD may place on the health system and prevent it from becoming a leading cause of hospitalisation during this century.


1 Fowkes F.G.R., Housley E., Cawood E.H.H., MacIntyre C.A.A., Ruckley C.V., Prescott R.J. Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991;20:384-91. 2 Hirsch A.T. et al. Peripheral arterial disease, detection, awareness, and treatment in primary care. JAMA 2001;286:1317-24. 3 PAD Risk Factors and Possible Complications. American Heart Association. presenter.jhtml?identifier=3020256 (accessed Jan 09). 4 von Wartburg L. Diabetes Health: “The Double Whammy: When Peripheral Artery Disease Complicates Peripheral Neuropathy” May 8, 2007. 05/08/5175.html (accessed Jan 09). 5 Girolami B. et al. Treatment of intermittent claudication with physical training, smoking cessation, pentoxifylline, or nafronyl: a meta- analysis. Arch Intern Med 1999;159:337-45. 6 Adler A.I. et al. UKPDS 59: Hyperglycemia and Other Potentially Modifiable Risk Factors for Peripheral Vascular Disease in Type 2 Diabetes. Diabetes Care 2002;25:894-99. 7 LaRosa J.C., He J., Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999;282:2340-6. 8 Stewart K.J. et al. Exercise training for claudication. N Engl J Med 2002;347:1941-51. 9 Regensteiner J.G., Hiatt W.R. Current medical therapies for patients with peripheral arterial disease: a critical review. Am J Med 2002;112:49-57. 10Greenhalgh R.M. et al. The adjuvant benefit of angioplasty in patients with mild to moderate intermittent claudication (MIMIC) managed by supervised exercise, smoking cessation advice and best medical therapy: results from two randomised trials for stenotic femoropopliteal and aortoiliac arterial disease. Eur J Vasc Endovasc Surg. 2008 Dec;36(6):680-8.

Wednesday, January 20, 2010

Boston Scientific, Abbott, Johnson & Johnson embroiled in off-label stents case

January 19, 2010 by MassDevice staff

Some of the biggest names in medical devices are embroiled in a whistleblower lawsuit accusing them of deliberately promoting the off-label use of biliary stents to treat cardiovascular conditions in hundreds of thousands of patients.

A few of the biggest players in the medical devices arena are accused in a whistleblowers lawsuit of promoting the off-label use of biliary stents to treat cardiovascular disease in hundreds of thousands of patients.

Former Guidant Corp. regional sales director Kevin Colquitt filed a "qui tam" lawsuit accusing Boston Scientific Corp. (NYSE:BSX), Johnson & Johnson (NYSE:JNJ) and its Cordis Corp. subsidiary and Abbott (NYSE:ABT) of encouraging physicians to use the biliary stents to treat blocked blood vessels. The stents are designed to treat bile duct cancers and are not approved or cleared for other uses by the Food & Drug Administration. The whistleblower lawsuit allows Colquitt to file suit on behalf of the government and to collect a third of any monetary judgment resulting from the case.

The lawsuit, filed in the U.S. District Court for Northern Texas and unsealed Jan. 18, alleges that Abbott (which acquired Guidant's stents business in 2006 as part of Guidant's acquisition by Boston Scientific), alleges that the companies promoted the use of the biliary stents to treat obstructions in peripheral blood vessels. The biliary stents faced a lower regulatory hurdle because they're designed for use in cancer patients who are not expected to survive for long. Although physicians are allowed to use devices for off-label treatments, the companies that make them are barred from promoting or encouraging such practices.

Colquitt, who joined Guidant in 2004, filed the lawsuit on behalf of the U.S. government and eight states (California, Florida, Illinois, Louisiana, Massachusetts, Tennessee, Texas and Virginia). The suit accuses the companies of Medicare fraud and filing fraudulent clearance applications with the FDA. The firms allegedly counseled sales reps to target doctors specializing in peripheral vascular disease, sponsored studies of the off-label use of the stents, actively marketed the devices to peripheral vascular specialists (largely ignoring the gastroenterologists and hepatologists who would use the devices for their approved applications), gave sales reps mandatory quotas and bonuses for off-label sales and instructed healthcare providers to falsely code reimbursement claims using codes for vascular stents, according to court documents.

"Indeed, virtually all of the approximate [sic] 150,000 stents implanted in patients each year to treat vascular disease are adulterated and misbranded biliary stents whose investigational use is not authorized by Federal standards based on Defendants' failure to establish that the devices are safe and effective under Federal law," according to the lawsuit. "The impact on beneficiaries' health and safety cannot be overstated as reflected in adverse events reported by healthcare providers. ... The adverse events reported include death, fractures of the devices after implantation, migration and dislodgement of the devices after implantation, arterial dissection and occlusion, arterial and stent embolizations, aneurysms, acute renal insufficiency, amputations, air embolisms, fistulization, strokes, late restenosis, allergic reactions, infections, clots, internal bleeding, and persistent vessel spasms."

Friday, January 15, 2010

Rise in Endovascular Therapy for PAD Parallels Improved Outcomes

Key Points:
Endovascular treatment for PAD has waxed as surgery has waned
Contemporary PAD patients tend to be sicker
Nonetheless, decreases seen in major amputations, mortality

From: TCTMD - The Source for Interventional Cardiovascular News and Education
By Kim Dalton
Wednesday, January 13, 2010

Over the past decade, as angioplasty increasingly displaced surgery for revascularization of peripheral arterial disease (PAD), rates of major amputation as well as mortality and other complications declined. The shift occurred despite patients presenting with more comorbidities, according to a study published online January 4, 2010, ahead of print in the Journal of Vascular Surgery.
To evaluate the shift in treatment of lower-extremity PAD and the impact of this trend on different patient groups, investigators led by Roman Nowygrod, MD, of Columbia University Medical Center (New York, NY), analyzed data from the National Inpatient Sample as well as New York State inpatient and outpatient databases on patients at least 40 years old who underwent either surgical or endovascular lower leg procedures or major amputations from 1998 to 2007.
Comparing 2007 with 1998, hospitalizations for invasive treatment of lower-extremity PAD decreased slightly, from 192 to 183 per 100,000 people aged ≥ 40 years. However, the proportion of open vs. endovascular revascularizations changed substantially, with the former declining 67% while the latter almost doubled. Meanwhile, the per capita volume of major amputations decreased by 38%.
Although most procedures were performed for critical limb ischemia, the overall rate of lower-extremity revascularizations in this group declined by 20%, from 93 per 100,000 in 1998 to 75 per 100,000 in 2007. Likewise, the incidence of interventions (endovascular or open surgical) for other PAD diagnoses decreased slightly, from 78 to 70 per 100,000. On the other hand, after a stable period from 1998 to 2002, interventions for claudication increased by almost 50% from 2003 to 2007.
The rate of procedures for critical limb ischemia declined steeply for octogenarians (from 317 to 240 per 100,000) and more moderately for patients aged 65 to 79 years (199 to 160 per 100,000), while interventions for claudication increased for all age groups (≥ 40 years). Meanwhile, outpatient interventions increased for all PAD diagnoses in all age groups.
Differing Fortunes of Open vs. Endovascular Intervention

While the proportion of open procedures decreased, use of endovascular revascularization increased substantially, quadrupling for critical limb ischemia and doubling for claudication.

Over the same period, rates of major amputations declined from 42% to 30% for critical limb ischemia, from 0.9% to 0.3% for claudication, and from 18% to 14% for other PAD diagnoses. Importantly, the improvement in patients with critical limb ischemia occurred despite the fact that they were twice as likely to have diabetes and 3 times more likely to have renal disease as those with claudication. In fact, comparable reductions in major amputations were seen in both diabetics (27%) and nondiabetics (32%).
Complications Decline for Both Revascularization Strategies
Over the study period, even as the prevalence of comorbidities such as CAD, COPD, renal disease, and (among claudicants) diabetes increased, operative mortality rates decreased for both revascularization procedures, as did postoperative cardiac complications, bleeding, and stroke. In addition, the incidence of infection declined with endovascular revascularization.

The mean length of hospital stay also declined over the decade, from 9.5 days in 1998 to 7.6 days in 2007. In addition, 35% of patients were discharged within 1 to 2 days in 2007, compared to only about 16% in 1998.
“Our analysis of national inpatient and outpatient state data supports the trend toward increasing treatment of PAD by endovascular intervention,” the authors write, predicting that given the safety of the minimally invasive approach, the percentage of outpatient procedures is likely to continue to grow.
The investigators caution that “although the decline in amputation rates seems likely due in large part to the increased use of endovascular interventions, other variables are clearly operative, including improved endovascular technology, better diabetes management and foot care, and improving and more ubiquitous application of medical therapies.”
In addition, the study findings are based on administrative data and thus subject to certain limitations, the authors note. For example, the absence of anatomic characteristics and condition variables precluded a careful analysis of treatment groups. Also, the inability to track patients over time meant they could not distinguish primary from secondary interventions, readmission, or complications.
Endovascular Trend Justified
“This is a very important paper,” William A. Gray, MD, of Columbia University Medical Center (New York, NY), told TCTMD in a telephone interview. “It both validates trends that we have perceived in the [vascular] community and justifies the increased use [of the endovascular approach] that it documents.”
“It’s not surprising that an easier, more accessible procedure is increasing,” Dr. Gray observed. “But that is nicely balanced by the fact that outcomes appear to be improving too—fewer mortalities, morbidities, shorter length of hospital stay. There are also fewer admissions for critical limb ischemia—likely because claudicants are being treated earlier. And treatment of claudicants may be leading to fewer patients with end-stage PAD.”
Though the study only reports hospitalization trends, “it speaks to the improvement in surveillance and care that these patients have been getting over the past decade, which is quite striking. This translates into a lot of saved limbs and lives,” Dr. Gray said, adding that it also reflects changes in the training of vascular surgeons, who are increasingly receiving instruction in endovascular techniques from fellow surgeons, as documented in a recent study in the Journal of Vascular Surgery.

Egorova NN, Guillerme S, Gelijns A, et al. An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety. J Vasc Surg. 2010;Epub ahead of print.

Drs. Nowygrod and Gray report no relevant conflicts of interest.

Pathway Medical Technologies Receives FDA 510(k) Clearance For JETSTREAM G3™ Atherectomy System

From: Medical News Today

Pathway Medical Technologies, Inc., an innovator of endovascular treatments for peripheral vascular disease (PVD), announced that the U.S. Food & Drug Administration (FDA) has granted the company 510(k) clearance to market JETSTREAM G3™, its newest peripheral revascularization catheter for the treatment of PVD. With a new distal cutter and enhanced aspiration efficiency, JETSTREAM G3 offers a significant improvement in cutting and removing disease as compared to previous versions. JETSTREAM G3 is used for treating the entire spectrum of disease found in the PVD patient, including hard and soft plaque, calcium, thrombus and fibrotic lesions.

"JETSTREAM G3 is the next step in atherectomy treatment for peripheral vascular disease. These enhancements incorporate a new state-of-the-art cutter that will enable physicians to treat PVD more quickly, safely and effectively than any of the existing technologies," said Pathway Medical Technologies President and CEO Paul Buckman. "Over the past twelve months Pathway has made significant advances to our atherectomy system. We believe that JETSTREAM G3 now represents the definitive treatment for all lesion morphologies, including calcium and total occlusions. We are fully committed to the continued development of innovative medical devices for the treatment of vascular disease."

"The JETSTREAM device is a highly effective technology for the treatment of occlusive and thrombotic peripheral arterial disease," stated Tom Shimshak MD, an interventional cardiologist and Director of the Cardiovascular Laboratory and Medical Director of the Cardiovascular Institute, Wheaton Franciscan Healthcare, All Saints, Racine, Wisconsin. "The advances in the cutting tip and increased power in the JETSTREAM G3 device will be particularly desirable for long, diffusely diseased segments, including calcification, chronic total occlusions and traditional 'no-stent' zones."

JETSTREAM is a peripheral revascularization catheter designed to remove all kinds of artery-clogging plaque in the lower limbs of patients. This innovative and minimally invasive solution clears blockages in the peripheral vasculature, restores blood flow and effectively treats PVD. JETSTREAM consists of a sterile, single-use catheter and control pod and a reusable, compact console that mounts to a standard I.V. stand. The catheter has an expandable cutting tip that safely debulks and preemptively removes both hard and soft plaque, as well as calcium, thrombus and fibrotic lesions. Excised tissue and thrombus are continually aspirated from the peripheral treatment site through ports in the catheter tip to a collection bag located on the console. The distal portion of the catheter also possesses infusion ports that provide continuous infusion of sterile saline during the atherectomy procedure. Active aspiration is a safety feature that minimizes the risk of distal embolization.

With simple set up and an ergonomic design for easy operation by trained clinicians, JETSTREAM maximizes treatment effectiveness and offers renewed hope for non-surgical candidates and the benefits of a minimally invasive treatment option, including faster recovery and decreased systemic complications.

Tuesday, January 12, 2010

Leg cramps could indicate peripheral arterial disease

Saturday, January 09, 2010


Has this happened to you? A distinct pain or cramp strikes your legs when you walk. When you stop for a few minutes, the pain goes away. But when you start walking again, it comes back.

You might chalk it up to getting older and respond by cutting back on walking. But that would be the wrong reaction. Instead, you should see your doctor, because your pain may be claudication, which is often a symptom of peripheral arterial disease (PAD). It's a potentially serious but treatable circulation problem.

When someone develops PAD, the extremities - usually a person's legs - don't get enough blood flow to keep up with demand from the muscles. The result can be pain that develops when the demand increases, such as when walking or exercising. The arteries that supply blood to the limbs are damaged, usually by a buildup of plaque that blocks or narrows them.

Treatment restores blood flow

Treating peripheral arterial disease with angioplasty and stenting is often effective for patients who have moderate to severe narrowing or blockage in one or more blood vessels.

Angioplasty involves inserting a catheter (a small, hollow tube) with a tiny balloon on its tip into an artery. Using a type of X-ray that projects moving pictures on a screen, the catheter is guided through the blood vessel to the area that's narrowed or blocked.

When the catheter is in place, the balloon is inflated to flatten the blockage into the blood vessel wall, while at the same time stretching the artery open to increase blood flow.

Following angioplasty, there's a risk that the artery will become narrowed or blocked again at the same site. To help prevent this, a stent is usually put in place after the balloon is deflated and withdrawn. A stent is a tiny mesh tube that remains in the artery to prop it open. The artery wall grows over the stent to keep it in place.

Treating pain and reducing risk

Treatment of PAD has two major goals. One is to reduce symptoms, such as leg pain, so that physical activities can be resumed. The other is to stop the progression of atherosclerosis (buildup of plaque in arteries) to reduce the risk of heart attack and stroke.

PAD patients should control their cholesterol, blood pressure and blood sugar, if they also have diabetes. Lifestyle changes are important, too. If you smoke, quitting is the single most effective way to reduce risk. Exercise helps condition muscles to use oxygen more efficiently, and a healthy diet can help to control other risk factors, such as cholesterol and blood pressure levels.

If you think you may have PAD, see your doctor for an evaluation.

Sunday, January 10, 2010

Deficiencies in foot care of diabetic patients on renal replacement therapy

Diabetic patients with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) are known to be at very high risk of foot ulceration causing significant morbidity and mortality. We surveyed the foot care of all diabetic patients in our area having RRT for ESRD over a three-month period. Of the 55 patients included, 36 (65.5%) had not been seen in a diabetes clinic and 32 (58.2%) had not been seen by a podiatrist in the preceding year. Of all patients, 36 had previous documented evidence of high-risk feet yet only 21 (58.3%) of this group had been seen by a podiatrist in the year before. Active ulceration was known to be present in seven patients. Ulcer duration was between 16 and 66 (mean 33) weeks. Three patients with active ulceration had not been seen by a podiatrist and four had not been seen in diabetes clinic in the previous year. In view of the worrying deficiencies in foot care in this group, we suggest increasing podiatry and diabetes team access for RRT patients at the site of their dialysis and advocate early multidisciplinary foot clinic referral for patients with ulceration.

~Practical Diabetes International~

Friday, January 8, 2010

Angina In The Legs? Time To Alert Patients And Physicians

ScienceDaily (Jan. 4, 2010) — Edmonton researchers recommend that people over age 40 be screened for peripheral artery disease (PAD), which puts people at high risk for serious medical complications including heart disease, stroke, and possible lower limb amputation.

It contributes to thousands of deaths every year yet nobody knows for sure how many Canadians have PAD.
"PAD is under diagnosed and under treated," Heart and Stroke Foundation researcher Dr. Ross Tsuyuki told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
"PAD is caused by a narrowing of the arteries that supply blood to the legs. The pain some PAD patients experience is the lower limb equivalent of the chest pain from the heart," says Dr. Tsuyuki. Since the leg artery narrowings seen in PAD usually imply similar narrowings in heart and brain arteries, PAD is a strong marker for heart disease and stroke.
"PAD is as serious as heart disease and its prevention and treatment is similar," says Dr. Tsuyuki. "It's unique in that it manifests in the legs but is just as urgent."
He warns that the index of suspicion for family doctors should be high, however often it's not. Many people with PAD have no, or very mild, symptoms. Only about half of people experience pain walking. Once the diagnosis of PAD has been made, physicians should also consider if significant artery narrowings are present in the heart and brain.
Dr. Tsuyuki and his team at the University of Alberta sought answers by studying 362 volunteers over age 50, chosen from 10 pharmacies in Central and Northern Alberta and in physician offices. After extensive screening and testing, the results found 17 PAD cases, a prevalence of five per cent.
Importantly, 80 per cent of the people diagnosed with PAD were previously unaware they had this condition. This is important because knowledge of the presence of PAD mandates more aggressive treatment, not only to treat leg symptoms, but also prevent heart attacks and strokes.
"These figures emphasize the importance of PAD screening to detect disease and guide treatment," says Dr. Tsuyuki. "The study also points to the value of community pharmacies as an efficient way to screen for this condition."
The researchers followed up with the people diagnosed with PAD three months after the screening and found that 88 per cent visited their family physician following the screening and half then received lifestyle or pharmacologic interventions.
Screening for PAD is a simple procedure that compares the blood pressure in the leg to that of the arm. A ratio of leg pressure to arm is less than 0.90 indicates the presence of PAD.
Heart and Stroke Foundation spokesperson Dr. Beth Abramson says that physicians should aggressively treat any high blood pressure and cholesterol in their patients with PAD and manage diabetes if it is present. "People don't recognize that leg cramps while walking may be due to circulation problems that put them at risk for heart disease and stroke," she says.
Dr. Abramson says people should talk to their doctor if they have difficulty with walking and develop pain or discomfort in the calves or legs that get better with rest. "This symptom -- called claudication -- is angina in the legs and puts you at risk of heart attack."
She says that heart attacks are often due to disease resulting from narrowing of arteries of the heart and that people should be aware that this disease can be widespread throughout the body. "If we see narrowing of the arteries in the legs, it's often in the heart as well, hence the heart/leg connection."
While PAD may have no symptoms, here are some signs and symptoms to look for:
Leg pain during exercise (most common symptom).
Open sores that don't heal.
Feeling of coldness or numbness in one or both legs.
Pain in the toes at night.
You are at higher risk of developing PAD if you:
Smoke or previously smoked.
Have diabetes.
Have high blood pressure.
Have high blood cholesterol.
Have heart disease or have had a stroke.
By being physically active and smoke-free, PAD patients can reduce their symptoms, improve their mobility and quality of life, and potentially prevent heart disease and stroke

Screening the Legs for a Serious Condition

January 8, 2010
Screening the Legs for a Serious Condition
Diane Fennell

Researchers in Canada are recommending that people over age 40 be screened for peripheral arterial disease, or PAD, a condition of the legs and feet that is associated with a higher risk of complications such as heart disease, stroke, and lower limb amputations. People with diabetes are more likely than those in the general population to develop PAD, which affects roughly 8–12 million Americans.

The condition, which is characterized by a narrowing of the arteries that supply blood to the legs, typically causes cramping, pain, or tiredness in the legs, particularly when walking or exercising; numbness, tingling, or coldness in the lower legs or feet; and infections in the legs or feet that heal slowly. In some people, however, symptoms are very mild, and in others there may be no symptoms at all.

Ross Tsuyuki, PharmD, MSc, and his colleagues at the University of Alberta looked at 362 people over age 50 who had visited pharmacies and doctors’ offices in Central and Northern Alberta. After extensive screening, 17 people, or 5% of the participants, were diagnosed with PAD. Significantly, 80% of those diagnosed had not previously been aware that they had the condition.

According Dr. Tsuyuki, “The pain some PAD patients experience is the lower limb equivalent of the chest pain from the heart. PAD is as serious as heart disease and its prevention and treatment is similar. It’s unique in that it manifests in the legs but is just as urgent.”

Screening for PAD is a painless and relatively simple procedure that involves comparing the blood pressure in the leg to that in the arm. The American Diabetes Association (ADA) recommends that people who are over 50 and have diabetes be screened for PAD even if they have no symptoms and that people under 50 who have risk factors such as smoking, high blood pressure, high cholesterol, or a history of diabetes longer than 10 years also receive screening.

To learn more about Dr. Tsuyuki’s research, read the article “Angina In The Legs? Time To Alert Patients And Physicians.” And for more information about PAD, see “When Your Legs Ache: Peripheral Arterial Disease and Diabetes.”

Thursday, January 7, 2010

Online Community for Dialysis Patients

My Access Site is an online community to bring together dialysis patients and their supporting friends and families. It takes on a bird’s eye view of a city that features a "Soap Box" to voice your opinions and rate your dialysis clinic/staff members, "Cafe" to meet others out there and start discussions on various topics, and the "Art Gallery" to share your creations, among other features like education and community resources.

Visit us at

Monday, January 4, 2010

Lower Leg Amputation

Statistics show in the United States, infected foot ulcers are the most frequent admitting diagnosis for hospitalization of patients with diabetes. In 2003, there were about 111,000 hospital discharges for lower extremity ulcers. There are more than 90,000 lower extremity amputation procedures performed on patients with diabetes in the U.S. annually, which equates to one every six minutes. The mortality rate after amputations is about 40% at one year and 80% at five years. Five-year mortality rates after new-onset diabetic ulceration are between 43% and 55% and up to 74% for patients with lower-extremity amputation. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin’s disease.
By Mark Hinkes, DPM