By: Hunterdon County Democrat
February 14, 2010, 11:06AM
Scott Collins, 45, of Lambertville visited Dr. Andrey Espinoza, interventional cardiologist at Hunterdon Medical Center, last summer in an act of desperation. After suffering from peripheral arterial disease for the past seven years, Collins had grown accustomed to the pain and numbness in his legs that prevented him from walking more than 50 yards without having to take a rest.
Once his legs reached 100% arterial blockage, Collins began to accept the idea that he would likely be a candidate for amputation.
Peripheral arterial disease occurs when plaque builds up on the inside walls of blood vessels, causing a blockage of blood flow to the extremities, and is often associated with high blood pressure, diabetes, heart disease, stroke and aging.
After a short visit with Espinoza, Collins learned that a new device, Pathway Medical Technologie’s Jetstream, could fix his problem. Interventional Cardiologists at Hunterdon Medical Center is now treating patients using a newly FDA cleared device that clears away and removes potentially deadly artery clogging plaque in leg arteries for those suffering from peripheral arterial disease, a chronic condition that affects nearly 12 million Americans.
Collins came back for his procedure and the moment they finished their work, he knew that they had changed his life.
“I was still lying on the table, but I knew the procedure had worked,” Collins said. “My leg began to itch. I hadn’t felt anything in that leg for years.”
Working from his three-story home as an antique reseller is enjoyable again, Collins said, adding he has found freedom in what he deems his “new legs.”
“This treatment represents an innovative and minimally invasive solution to clear blockages in the peripheral arteries, restoring blood flow and effectively treating the disease without surgery,” explained Espinoza, who is the first physician to treat a patient using the device at Hunterdon Medical Center.
The Jetstream Atherectomy System is the first on the market capable of treating an entire spectrum of disease found in the PAD patient, including hard and soft plaque, calcium, thrombus and fibrotic lesions with consistent clinical results. The Jetstream catheter is equipped with tiny rotating blades and a vacuum that cuts through accumulated plaque in the legs and then vacuums away the debris left behind.
This treatment has the potential to reduce procedure time and minimize vessel trauma, which can mean fewer complications for patients. Removing the plaque that has been cut loose also minimizes the potential for that plaque to travel back through the leg’s arteries and cause another blockage.
PAD usually affects adults from age 60 to 80, but patients can be younger. Further, while people with elevated cholesterol, smokers or those with a history of heart disease can develop PAD, many people do not realize they have blocked arteries. Unfortunately, despite the large number of sufferers, traditionally invasive treatments for PAD, such as bypass surgery, coupled with a lack of consumer education, means that PAD is responsible for more than 150,000 leg amputations each year and only about 400,000 patients receive the endovascular intervention they need. In addition, many patients are poor surgical candidates for whom surgery can be life threatening.
Jetstream is now in use at more than 100 centers across the country, including New York-Presbyterian Hospital in New York, St. John Hospital and Medical Center in Detroit, Cardiovascular Consultants of Washington in Seattle, Wellstar Kennestone Hospital in Atlanta and Leesburg Regional Hospital in Leesburg, Florida, and has been used to successfully treat more than 600 patients suffering from PAD to date.
Jetstream offers renewed hope for patients and the benefits of a minimally invasive treatment option, including faster recovery and decreased systemic complications.
For more information on cardiac services at Hunterdon Medical Center call Registered Nurse Nicole Camporeale, heart and vascular care coordinator at Hunterdon Medical Center, at 908-237-5440 or visit hunterdonhealthcare.org.
Monday, February 15, 2010
Thursday, February 11, 2010
KDOQI To Update Diabetes Guideline
From: Renal Business Today
Draft of Updated Guideline Expected by January 2011
02/09/2010
NEW YORK—The National Kidney Foundation announced Feb. 9 plans to update its KDOQI Clinical Practice Guideline for Diabetes and Chronic Kidney Disease, which were first published in 2007.
“A revised diabetes and chronic kidney disease guideline will include recent studies focusing on the management of hyperglycemia such as the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial; we are aiming to complete the update process within a year, to ensure that practitioners and patients benefit from new knowledge as soon as possible,” said KDOQI Chair, Michael Rocco, MD of Wake Forest School of Medicine in North Carolina. “A draft is expected to be available for public review by January 2011.”
The work group is currently being assembled by Co-Chairs, Drs. Katherine Tuttle and Robert Nelson, who will return to their leadership positions.
“Our understanding of the diagnosis and management of diabetic kidney disease (DKD) is evolving rapidly and we want to ensure that the KDOQI guidelines reflect current knowledge. Moreover, findings from several recent trials suggest that certain drug treatment strategies widely believed to be beneficial for diabetic patients may in fact offer little benefit and may, in some settings, even be harmful,” said Tuttle, who is Medical and Scientific Director of Research at Providence Medical Research Center in Spokane, Wash.
“Emphasis on DKD prevention is reinforced by current evidence demonstrating long-term benefits of healthy lifestyle changes to reduce risk of type 2 diabetes, the root cause of most DKD,” said Nelson, who Staff Clinician at the National Institute of Diabetes and Digestive and Kidney Diseases. “By updating the guidelines to incorporate such new information, we seek to ensure that KDOQI remains an essential resource to clinicians in the management of their patients with and at risk for diabetic kidney disease.”
The KDOQI Evidence Review Team is currently assessing the literature before the work group begins writing. This process will be followed by a public review of the draft before its final publication next year.
“A thorough review of current literature inevitably identifies new questions that need to be addressed. Since investigators pay close attention to the research recommendations published with KDOQI guidelines, an update of these recommendations is fundamental to the guidelines update process. Guideline development and research data generation are iterative processes that should feedback to inform and update one another on an ongoing basis,” said Jeffrey Berns, MD of University of Pennsylvania School of Medicine and KDOQI’s Vice Chairs for guidelines.
Draft of Updated Guideline Expected by January 2011
02/09/2010
NEW YORK—The National Kidney Foundation announced Feb. 9 plans to update its KDOQI Clinical Practice Guideline for Diabetes and Chronic Kidney Disease, which were first published in 2007.
“A revised diabetes and chronic kidney disease guideline will include recent studies focusing on the management of hyperglycemia such as the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial; we are aiming to complete the update process within a year, to ensure that practitioners and patients benefit from new knowledge as soon as possible,” said KDOQI Chair, Michael Rocco, MD of Wake Forest School of Medicine in North Carolina. “A draft is expected to be available for public review by January 2011.”
The work group is currently being assembled by Co-Chairs, Drs. Katherine Tuttle and Robert Nelson, who will return to their leadership positions.
“Our understanding of the diagnosis and management of diabetic kidney disease (DKD) is evolving rapidly and we want to ensure that the KDOQI guidelines reflect current knowledge. Moreover, findings from several recent trials suggest that certain drug treatment strategies widely believed to be beneficial for diabetic patients may in fact offer little benefit and may, in some settings, even be harmful,” said Tuttle, who is Medical and Scientific Director of Research at Providence Medical Research Center in Spokane, Wash.
“Emphasis on DKD prevention is reinforced by current evidence demonstrating long-term benefits of healthy lifestyle changes to reduce risk of type 2 diabetes, the root cause of most DKD,” said Nelson, who Staff Clinician at the National Institute of Diabetes and Digestive and Kidney Diseases. “By updating the guidelines to incorporate such new information, we seek to ensure that KDOQI remains an essential resource to clinicians in the management of their patients with and at risk for diabetic kidney disease.”
The KDOQI Evidence Review Team is currently assessing the literature before the work group begins writing. This process will be followed by a public review of the draft before its final publication next year.
“A thorough review of current literature inevitably identifies new questions that need to be addressed. Since investigators pay close attention to the research recommendations published with KDOQI guidelines, an update of these recommendations is fundamental to the guidelines update process. Guideline development and research data generation are iterative processes that should feedback to inform and update one another on an ongoing basis,” said Jeffrey Berns, MD of University of Pennsylvania School of Medicine and KDOQI’s Vice Chairs for guidelines.
Monday, February 1, 2010
Men More Likely to Suffer from Diabetes Complications
From: Diabetes News Hound
Men are more likely to suffer from diabetes-related health problems, according to the American Diabetes Association. That’s due, in part, to the fact that a third of men with Type 2 diabetes, the more common form of the disease, don’t even know they have it, according to a recent article from TodaysTHV.com.
Type 2 diabetes is commonly referred to as “adult onset diabetes” even though it can affect people of all ages. People who have Type 2 diabetes become insulin resistant, meaning their body produces insulin, but doesn’t use it properly. Therefore, many with this form of the disease take pills or even inject extra insulin in order to regulate the amount of sugar in their blood.
Some of the side-effects or complications that men may suffer from include retinopathy, a problem in the eyes that can lead to blindness if left untreated, impotence and amputations. They can also experience peripheral vascular disorder, or PVD, which is a pain in the thigh, calf or butt during exercise that is linked to a dramatic increased risk for heart disease and stroke.
Men are more likely to suffer from diabetes-related health problems, according to the American Diabetes Association. That’s due, in part, to the fact that a third of men with Type 2 diabetes, the more common form of the disease, don’t even know they have it, according to a recent article from TodaysTHV.com.
Type 2 diabetes is commonly referred to as “adult onset diabetes” even though it can affect people of all ages. People who have Type 2 diabetes become insulin resistant, meaning their body produces insulin, but doesn’t use it properly. Therefore, many with this form of the disease take pills or even inject extra insulin in order to regulate the amount of sugar in their blood.
Some of the side-effects or complications that men may suffer from include retinopathy, a problem in the eyes that can lead to blindness if left untreated, impotence and amputations. They can also experience peripheral vascular disorder, or PVD, which is a pain in the thigh, calf or butt during exercise that is linked to a dramatic increased risk for heart disease and stroke.
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
dyslipidemia
hypertension (high blood pressure)
obesity
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
impotence
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.
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
dyslipidemia
hypertension (high blood pressure)
obesity
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
impotence
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 www.kidneynca.org.
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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 www.saintmarysreno.org.
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 www.chwHEALTH.org.
Contacts:
Gary Aldax
(775) 770-3038
gary.aldax@chw.edu
Frankie Vigil
(775) 287-5924
frankie.vigil@rrpartners.com
Christopher Kelley
(415) 902-8115
chris.kelley@kidney.org
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 www.kidneynca.org.
-------------------------------------------------------------------------------------------------------------------------------------------
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 www.saintmarysreno.org.
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 www.chwHEALTH.org.
Contacts:
Gary Aldax
(775) 770-3038
gary.aldax@chw.edu
Frankie Vigil
(775) 287-5924
frankie.vigil@rrpartners.com
Christopher Kelley
(415) 902-8115
chris.kelley@kidney.org
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 www.lifelinescreening.com, 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.
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 www.lifelinescreening.com, 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.
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.
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