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PVD: A hidden disease you should know about

Dr. Justin Levisay February 25, 2009 12:00 PM This chat has ended. Thank you for participating.
Dr. Justin Levisay (NorthShore) - 11:51 AM:
Welcome to today’s chat on peripheral arterial disease (PAD). I am relatively new to the NorthShore University system having recently relocated from San Diego. I have completed training in multiple areas of vascular disease including cardiology, interventional cardiology, vascular medicine, and endovascular treatment of PAD. PAD affects the arteries outside of the heart and brain. It’s a condition similar to coronary artery disease in which blockage of heart arteries may lead to chest pain or a heart attack. Depending on where PAD is present, different symptoms may occur. PAD occurs most commonly in the arteries of the pelvis and legs, which may lead to leg or hip pain, erectile dysfunction in men, or in severe cases, ulceration and infection of feet and legs. Often times, these symptoms are subtle and underdiagnosed being mistaken for arthritis or other commonly occurring diseases. For many decades, the treatment of peripheral arterial disease remained relatively stagnant.

Margaret (Skokie, IL) - 11:59 AM:
Are there different types of PVD? What kinds are there?

Dr. Justin Levisay (NorthShore):
PVD can affect many differet arteries, incuding arteries of the legs, kidneys, arteries to the intestines and the carotid arteries which go to the brain. It can also affect the arteries that go to the upper extremities, like your arms.

Shelly (Glenview.IL) - 12:00 PM:
Does PVD cause non-diabetic blood clots in the legs and ulcers of the foot?

Dr. Justin Levisay (NorthShore):
Diabetes is definitely a risk factor for peripheral arterial disease but many people have peripheral arterial disease in the absence of PAD. There are other risk factors for PAD inlcuding high blood pressure, high cholesterol and smoking to name a few.

Shelly (Glenview.IL) - 12:02 PM:
If a blood clot in the leg caused damage to the arterial valve, what treatment is available?

Dr. Justin Levisay (NorthShore):
Arteries don't have valves, you are probably referring to a vein. Often times clots in veins can damage valves and result in swelling of the legs or varicose veins. There are new treatments for this, the most recent of which is laser therapy.

Sam (Evanston, IL) - 12:04 PM:
Is PAD related to heart disease? Are they the same?

Dr. Justin Levisay (NorthShore):
PAD is definitely related to heart disease in the sense they share the same risk factors. Approximately 50% of people who have PAD will have coronary artery disease as well. Anyone who has received the diagnosis of PAD should definitely have testing done to determine if they have coronary artery disease as can lead to a heart attack which may be fatal.

Margaret (Skokie, IL) - 12:06 PM:
What are the primary symptoms of the disease?

Dr. Justin Levisay (NorthShore):
It depends on where there is an arterial blockage. Commonly when it occurs in the legs it can cause symptoms of pain and cramping in the muscles when walking, in the calves thighs and buttocks. It can also cause hip pain which is commonly mistaken for arthritis. PAD can cause erectile dysfunction in men, blockages in the kidney arteries, difficult to control high blood pressure and poor kidney function. Also, blockages of the carotid artery can lead to stroke or 'mini strokes.'

Shelly (Glenview.IL) - 12:09 PM:
How often do you recommend a carotid artery test if 20% was found to be blocked with an initial test.

Dr. Justin Levisay (NorthShore):
First off I would recommend that if any carotid blockage was found that you be on excellent medical therapy including a cholesterol lowering drug such as Lipitor, Zocor or Crestor. With regards to follow up testing I would recommend a repeat carotid ultrasound in 2-3 years to make sure there is no progression. A 20% blockage is not considered to be severe. It's a relatively mild blockage.

Margaret (Skokie, IL) - 12:12 PM:
Is PVD a genetic disease? If so, are there any tests to see if I'm at risk?

Dr. Justin Levisay (NorthShore):
That's a great question, there is definitely a genetic predisposition to arterial disease and the risk factors that cause it. There have been certain genetic abnormalities that have been identified. However, at present, there are no widely available tests to look for genetic risk factors. This is an area of very active research and I expect there will be tests available within the next five years.

Martha F. (Hobart, IN) - 12:13 PM:
Can you talk more about the risk factors associated with the disease and how PVD can be prevented?

Dr. Justin Levisay (NorthShore):
The most important risk factors include age, male sex, diabetes, high blood pressure and cigarette smoking. Obviously the easiest to modify is to quit smoking. PVD can be prevented by modifying these risk factors with good medical care.

Martha F. (Hobart, IN) - 12:15 PM:
How does physical activity affect your chances of getting PVD?

Dr. Justin Levisay (NorthShore):
Physical activity will not necessarily prevent you from developing PAD. It is excellent in helping reduce blood pressure, obesity and high blood sugar. If you do in fact have PAD in the legs, regular physical activity can improve symptoms tremendously and possibly avoid the need for surgery.

Sam (Evanston, IL) - 12:17 PM:
Does that mean PAD and heart disease share the same preventative measures?

Dr. Justin Levisay (NorthShore):
Absolutely. Vascular disease is a systemic process. Taking measures to reduce the risk of heart disease, you are also reducing the same risks that cause PAD. These include control of high blood pressure, diabetes, high cholesterol, regular physical activity and not smoking.

Margaret (Skokie, IL) - 12:18 PM:
What kind of tests are there to diagnose PVD, are they invasive?

Dr. Justin Levisay (NorthShore):
There are multiple ways to diagnose PVD. PVD can be easily diagnosed often on the basis of a physical examintion. Also, PAD or PVD can be diagnosed by a non-invasive ultrasound. More recently imaging with CT scans and magnetic resonance angiograms have begun to provide fantastic non-invasive imaging of arteries and veins. Invasive diagnosis is usually the last imaging test to be performed.

Jane (Palatine, IL) - 12:21 PM:
And how often do you recommend a carotid artery test if 60% was found to be blocked with an initial test?

Dr. Justin Levisay (NorthShore):
Jane, where there any symptoms to the test being performed?

Claire (Evanston, IL) - 12:22 PM:
My father is a truck driver. He is diabetic and has high blood pressure. I don't believe he's being screened for PVD. Is it your recommendation that he ask his doctor to have him screened?

Dr. Justin Levisay (NorthShore):
I think it would be reasonable to ask his doctor to perform a full vascular physical examination to check for the presence of decreased pulses which is a sign of PAD. I would also recommend that if he has symptoms of any kind that he have an ultrasound evaluation of his arteries. It's quick, painless and inexpensive.

Jeremy (Evanston, IL) - 12:24 PM:
How old should I be before I start worrying about PVD?

Dr. Justin Levisay (NorthShore):
The incidence of PVD begins to rise at approximately age 45, but becomes much more common in people 65 and older. If you don't have any risk factors for the development of PVD, it's very unlikely you need to worry about it all. Still, regular checkups with a primary care physician are always recommended and should be a part of any general wellness plan.

Jane (Palatine, IL) - 12:25 PM:
I'm seeing references to PAD and PVD. What's the difference?

Dr. Justin Levisay (NorthShore):
Great question. PAD (peripheral arterial disease) is specific to arterial blockages which are more common. PVD (peripheral vascular disease) refers both to arterial and venous problems.

Martha F. (Hobart, IN) - 12:27 PM:
If someone is currently suffering from pain in their legs with activity, how would you find out if it is related to PVD or something else?

Dr. Justin Levisay (NorthShore):
Another great question. Not all pain with activity is related to PVD. Pain can also be related to arthritis or neurologic problems. It is often relatively easy to distinguish between these causes by having a good history taken and physical examination performed by your doctor. Generally this will point your doctor in the right direction with regard to further testing.

Margaret (Skokie, IL) - 12:29 PM:
If PVD is left untreated can it be fatal?

Dr. Justin Levisay (NorthShore):
PVD is rarely fatal by itself in the arteries of the leg. It can however lead to amputation or skin breakdown which can then lead to fatal infection. By far the most common reasons for people with PVD to have a fatal event are related to the high concordance of coronary artery disease and stroke associated with PVD. This is why it's so important to be involved with a vascular physician who can screen and treat not only PAD, but also coronary artery disease and disease of the carotid arteries.

Grace (Wilmette, Illinois) - 12:31 PM:
Welcome to the area. Given an 'all-clear' on a carotid artery scan, could PVD cause balance problems in an 86 yr. old female w/high BP but otherwise in good health?

Dr. Justin Levisay (NorthShore):
It seems pretty unlikely to me that PVD would cause balance problems in this situation. It is possible however that there is disease within the arteries of the brain itself which is commonly caused by high blood pressure. I would recommend an evaluation with a neurologist to help sort these issues out.

Margaret (Skokie, IL) - 12:33 PM:
If the symptoms of PVD are so easily confused with other diseases, why aren't PVD screenings more widespread?

Dr. Justin Levisay (NorthShore):
Great question. It is certainly an often overlooked problem. We are trying to raise awareness in the community in the same way that it was for coronary artery disease and heart attacks. Part of the problem in the past may have been the limited options for treating PVD.

Jane (Palatine, IL) - 12:35 PM:
Can a person with normal cholesterol levels still have PAD?

Dr. Justin Levisay (NorthShore):
Yes. Particulary if they have other risk factors or are smokers.

Margaret (Skokie, IL) - 12:36 PM:
Can pains from a "charlie horse" be confused with the symptoms of PVD?

Dr. Justin Levisay (NorthShore):
The definition of 'charlie horse' is a little unclear. But if I remember from childhood, that kind of cramping pain could easily be associated with PVD. Particulary if associated with physical activity like walking or climbing stairs.

Sam (Evanston, IL) - 12:38 PM:
What are the treatment options available for PVD?

Dr. Justin Levisay (NorthShore):
There are multiple treatements. If the PVD is in the legs and depending on the severity, I will generally attempt a trial with medications to relieve the symptoms. If it is severe disease or medical therapy fails to improve symptoms, remaining options include minimally-invasive procedures involve balloons and sometimes stents or a surgical bypass using a vein or artificial graft. With regards to PVD in the kidneys it is treated almost exclusively with balloons and stents. Disease of the carotid artery can be treated surgically or with a balloon/stent.

Dan (Glenview, IL) - 12:42 PM:
I am 31 with type 2 diabetes and high blood pressure (both of which I manage with medication). Lately when I wake up I have a tingle on my feet that usually goes away within 5 minutes of being up and walking around. Could this be a sign of PVD?

Dr. Justin Levisay (NorthShore):
Given your diabetes and high blood pressure, tingling could be associated with PVD. Also, and perhaps a more likely explanation, it could be peripheral nerve damage related to your diabetes. This is very common in diabetics, particulary in those with poor control. I would recommend that you follow up with your primary care doctor and have both the pulses of your feet examined and also a neurologic exam to make sure there is no nerve damage.

Shelly (Glenview, IL) - 12:45 PM:
Does one have to take Coumadin forever if blood clots formed in the legs? What is the difference between that and Plavix?

Dr. Justin Levisay (NorthShore):
Coumadin is generally recommended for patients who have had a blood clot in a vein of the leg for at least six months afterward. If there is a reoccurence of a vein clot thereafter Coumadin is generally recommnded lifelong. Coumadin and Plavix are very different drugs that work in different ways. Coumadin affects the clotting factors produced in the liver and requires frequent monitoring as different patients have a variable response to Coumadin. Plavix affects platelet function which is another part of the clotting system. It does not require frequent blood tests to monitor its effectiveness. There have been large studies which show patients with established arterial disease of their heart, legs or carotid arteries have a significant benefit from taking Plavix. There is no proven benefit to taking Plavix for venous clots.

Jeremy (Evanston, IL) - 12:49 PM:
Does PAD lead to infarctions or heart attack?

Dr. Justin Levisay (NorthShore):
The term PAD doesn't include disease of the heart arteries which is known as coronary artery disease. As previously stated the two often go hand-in-hand. Coronary artery disease leads to heart attacks.

Kristin Philbin (Moderator) - 12:50 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

Martha F (Hobart, IN) - 12:50 PM:
Once you know you have PVD, can progression of the disease be stopped or reversed ?

Dr. Justin Levisay (NorthShore):
Progression of the disease can certainly be stopped with good medical therapy. This includes cholesterol lowering drugs and control of blood sugar and blood pressure. There is little evidence to suggest that we can cause a significant regression of blockages once they occur at this time. We can however stop progression and stabilize disease which is already present.

Jane (Palatine, IL) - 12:52 PM:
How do you know if there is venous involvement, as well as arterial (PVD)? Do diagnostic tests and/or angiogram inherently include involvement of the veins as well as arteries?

Dr. Justin Levisay (NorthShore):
Generally there are very different symptoms between venous and arterial disease. There are specific tests including ultrasound and angiograms which can both target either veins or arteries depending on which disease the symptoms are consistent with. In general, angiograms are not necessary for venous disease. Ultrasound provides an excellent result.

Dan (Glenview, IL) - 12:54 PM:
Is restless leg syndrome related to PVD at all? Is RLS often the misdiagnosis for PVD?

Dr. Justin Levisay (NorthShore):
There is no known association between RLS and PVD. Restless leg syndrome is a diagnosis which has increased dramatically over the past years. I'm not aware of a significant number of cases of RLS actually being related to PVD. However, it is possible. If you don't have the traditional risk factors for PVD, your diagnosis of RLS is likely correct.

Shelly (Glenview, IL) - 12:56 PM:
Is there any other treatment for daily swollen ankles besides wearing compression stockings?

Dr. Justin Levisay (NorthShore):
There are multiple causes of swollen ankles so it's a bit hard to answer this question. If swollen ankles are solely the result of "venous insufficiency" there are treatments available beyond compression stockings.

Jane (Palatine, IL) - 12:58 PM:
This is a great forum and I hope you do it again. Will this chat be available to access again in the future, or can we make copies of the questions and your answers?

Dr. Justin Levisay (NorthShore):
Jane, yes this chat will be archived for reference. You can access it by going to www.northshore.org/chat . There you can see a schedule of all our upcoming chats as well as archives of previous chats. Thank you for participating today!

Margaret (Skokie, IL) - 12:59 PM:
Is PVD curable? Or does it have to be managed for the rest of your life?

Dr. Justin Levisay (NorthShore):
Unfortunately there is no "cure" but if you read back to a previous question (Martha at 12:50), there are ways to control and limit/alleviate symptoms.

Kristin Philbin (Moderator) - 1:01 PM:
Thank you again for participating in our chat today. For more information please visit our Peripheral Vascular Disease pages.

Also, a transcript of this chat will be available shortly.

Dr. Justin Levisay (NorthShore) - 1:02 PM:
I'd like to thank everyone for participating today. It was an excellent chat and I really enjoyed it. If you have further questions or would like to schedule an appointment, please call 847-570-2250. Thanks again, and be healthy!
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