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| BACKGROUND | DIAGNOSIS | TREATMENT | SURGERY |
GLOSSARY OF TERMS
Peripheral Arterial Disease (PAD) is a disorder that occurs in the arteries that causes the artery wall linings to slowly become narrowed due to the built up cholesterol or plaque. PAD progresses overtime at variable rates in each individual depending on the area of circulation effected and one’s health and family history.
Atherosclerosis is commonly referred to as hardening of the arteries because it causes a loss of elasticity. This is caused by the accumulation of a fatty substance called atheromatous plaque on the inside of the walls of arteries. This plaque consists of macrophage white blood cells and low density lipoproteins (LDL).
Embolism is a sudden obstruction of a blood vessel by an embolus, an abnormal particle (as a piece of cholesterol, calcium or blood clot, or air bubble) circulating in the blood that hinders blood flow.
Thrombosis is the formation of a blood clot (thrombus) within a blood vessel that remains attached to its place of origin on the vessel wall.
Hypertension is abnormally high arterial blood pressure that is usually indicated by an adult systolic blood pressure of 140 mm Hg or greater or a diastolic blood pressure of 90 mm Hg or greater, that is typically the result of thickening and inelasticity of arterial walls.
Hypercholesterolemia is the presence of excess cholesterol in the blood.
Arteritis: inflammation of the arterial vessel wall
Claudication is pain induced by insufficient blood flow during exercise.
Homocysteine is an amino acid found in the plasma of the blood, high levels are associated with vascular disease.
Erythrocytosis is a dramatic increase in the number of circulating red blood cells.
Thrombocytosis is an abnormal increase in the number of blood platelets.
ISCHEMIC FOOT
BACKGROUND
MECHANISM
Critical Limb Ischemia (CLI) is an advanced stage of Peripheral Arterial Disease (PAD) and is the end result of atherosclerosis.
Atherosclerosisunderlies most chronic PAD cases, yet it can also be due to an acute condition such as an embolism or thrombosis.
Ischemic Foot refers to a lack of adequate arterial blood flow to the foot. People with ischemic foot are diagnosed as having arterial insufficiency meaning there is not enough arterial blood reaching the foot to provide the oxygen and nutrients required for proper cell function.
CLI affects the medium to large size arteries.
CAUSE
In addition to atherosclerosis in association with CLI, other causes include: hypertension, hypercholesterolemia, cigarette smoking, and diabetes. Less frequent causes of CLI include Buerger’s Disease and other forms of arteritis.
PATIENT PROFILE
PAD affects both men and women, but occurs slightly more in men. Individuals with high blood pressure who are 50 years or older are at increased risk to develop PAD. When blood pressure remains high, the lining of the artery walls becomes damaged and vulnerable to atherosclerotic plaque build-up. Smoking is the number one risk for developing PAD.
SYMPTOMS
The result of insufficient blood supply to the foot can manifest itself in a variety of ways depending upon how severe the impairment to circulation.
Early symptoms may include: cold feet, purple or red discoloration of the toes, or muscle cramping after walking short distances.
Later findings may include a sore that won’t heal (ischemic ulcer), pain at night while resting in bed, or tissue necrosis to part of the foot (gangrene).
Narrowed arteries that cannot supply sufficient blood flow to exercising leg muscles may cause claudication, which is brought on by exercise and relieved by rest.
Ischemic rest pain is classically described as a burning pain in the ball of the foot and toes that is worse at night when the patient is in bed. The pain is exacerbated by lying down because of the loss of gravity-assisted blood flow to the foot.
DIAGNOSIS
BLOOD ANALYSIS
Blood tests are performed to look at general health and to assess risk factors that affect the progression of the disease, including fasting blood cholesterol levels, blood sugar, kidney and liver function, and homocysteine levels.
DOPPLER/DUPLEX ULTRASOUND EXAMINATION
A measurement of blood flow and the identification of sites of vessel blockage is accomplished with the use of a hand-held Doppler probe. This allows the examiner to listen to the blood flow. The most accurate and detailed test, is a Duplex Ultrasound exam. This provides an ultrasound image of the vessel to determine whether there is any blockage or structural damage and is also able to record quality of blood flow as well as localised blood pressure.
TREATMENT
SMOKING CESSATION
Immediate and complete tobacco use cessation is absolutely essential. We require this not only of patients with Ischemic Foot, but of all patients with circulatory disorders. Individuals who smoke not only put themselves at risk for developing vascular disease but also undermine attempts at treatment.
Cigarette smoking in particular is known to cause erythrocytosis, plasma volume contraction, and thrombocytosis. These are all conditions which lead to dramatically increased risk of venous and arterial thrombosis.
We understand the difficulty many smokers face in quitting and we work with our patients to overcome this personal challenge. We offer several strategic methods to help them end their addiction and improve their vascular health.
MOST TREATMENTS TODAY
The primary goals of most treatments of circulatory disorders today are to attempt to relieve symptoms and prevent further complications. At present, the majority of treatments act superficially in treating a patient’s symptoms and avoid dealing with the root of the problem.
Standard therapies typically include exercise programmes to try to increase blood supply to the affected tissues and the use of antibiotics to help in treating non-healing ulcers. Such therapies alone do not deal with the underlying cause of a patient’s illness. This is the reason the vast majority of treatments do not succeed.
ACHIEVING NEW HEIGHTS IN VASCULAR CARE
At Vascular General, we have developed innovative therapeutic procedures for the treatment of all circulatory disorders of the lower extremities that have consistently produced dramatically successfully results.
Due to the long duration and frequent reoccurrence of open sores or ulcers in the lower extremities, the microorganisms involved in the infection expand exponentially in number and develop into colonies that have a type of protective shield or layer of armor which is resistant to antibiotics. This is why all too often ulcers appear to be non-healing and do not respond to antibiotic medication.
The finding that low dose electric current can disrupt the protective layer shielding microbial colonies is well documented in the scientific literature. Our application of low dose electrotherapy in combination with antibiotic medication has time and again yielded the knockout punch to the life-threatening microbial colonies infecting chronic wounds.
SAVING LIFE AND LIMB
Within a few weeks of our treatments, persistent open wounds that never seem to close and were for so long a constant danger to life and limb, are cleaned from infection, closed, and allowed to heal.
Our innovative use of low dose electrotherapy is not only a vital weapon in the battle against the spread of open wound infection but also a tool for the repair of such damages to the vascular system as inflammation of the vessel wall, ischemia, atherosclerosis, and thrombosis.
SURGERY
In more advanced stages of Diabetic Foot, surgery may be recommended to bypass the blocked artery or vein or to clean out the area of blockage.
Minimally invasive procedures are performed with an endoscope (a small, flexible tube with a light, optical lens, and probe, forceps, suction device, or other instrument for surgery on the end), they include:
ARTERIAL STENT PLACEMENT: a procedure in which a wire-reinforced stent is placed in the artery and left in to keep it open
BALLOON ANGIOPLASTY: dilation of an obstructed artery by the passage of a balloon catheter through the vessel to the area of disease, inflation of the catheter balloon tip compresses the plaque against the vessel wall
ENDARTERECTOMY: surgical removal of the inner layer of an artery when thickened and obstructed
THROMBOLYSIS: catheter-assisted administration of highly concentrated anticoagulant medication to remove or break up a clot
BYPASS SURGERY: If the disease is very advanced, or if it occurs in an artery or vein that is difficult to reach with a catheter, bypass surgery may be necessary. A bypass graft may be performed in such serious cases. This surgical procedure uses either an artificial tube or one of the patients own arteries or veins to bring improved blood flow to the affected area.
