Dr. Billy Kim, a Vascular Surgeon with The Surgical Clinic, treats patients experiencing Peripheral Arterial Disease (PAD). Statistics indicate that 14-20% of adults in the developed world have a chronic lack of blood flow to the legs that is caused by atherosclerotic arterial disease. While there are different types of symptoms- diagnosed as Intermittent Claudication (IC) and Critical Limb Ischemia (CLI), the largest issues of death associated from PAD is associated with CLI.
The incidence of chronic lower extremity ischemia is increasing in the elderly population, and patients are faced with disability affecting their legs and increased chance of amputation. In addition, they are at increased risk of morbidity and mortality due to cardiac and cerebrovascular ischemic events. A lot of patients and the general population do not correlate the risk factors for heart and stroke disease with peripheral arterial disease. However, the same disease process of atherosclerosis affects all the arteries in the body.
IC is defined as pain in the leg muscles following activity. It is the earliest and most common presentation of chronic lower extremity ischemia. The pain is localized in the calf, thigh and buttock muscles, depending on the distribution of arterial disease and compromise. As the level of stenosis (tightness) and disease progress in severity, the patients start to develop pain at rest. Usually they complain of pain at night when their legs are elevated in bed, and the pain is relieved by dependency (such as walking or sleeping with their legs hanging off the bed).
In contrast to IC, ischemic rest pain typically affects the foot. As this progresses further, severe tissue hypoperfusion continues, resulting in ischemic ulceration and gangrene. CLI includes rest pain and tissue loss and is associated with an annual mortality rate of 20%.
The purpose of awareness, education, early evaluation and possible intervention is to modify the progression of chronic lower extremity ischemia and reduce the incidence of other adverse vascular events. This also includes identification of risk factors, lifestyle modifications, pharmacotherapy, and other forms of noninterventional treatment such as exercise rehabilitation and physiotherapy. To a lesser extent, invasive procedures would include percutaneous interventions and surgery.
At The Surgical Clinic, board-certified vascular surgeons are trained and equipped to assess, identify and provide various treatment options for our patients. This may include conservative risk and behavior modifications, pharmacologic agents. Depending on the severity of IC and CLI, the next steps may include invasive interventions which we will provide the full spectrum of treatment tailored to the needs of the patients.