Vascular Surgery Gets Patients Back on Their Feet
With warmer weather comes the urge to get outdoors, to walk, jog, ride a bike and play ball, all the things we’ve been dreaming of all winter. But painful legs and feet may keep some indoors or on the sidelines.
That pain may be due to peripheral arterial disease (PAD), a common problem caused by a narrowing or blockage of arteries that reduces blood flow to arms and legs. Because your leg muscles don't receive enough blood, you can get painful cramps when walking or exercising.
David Luc of Centereach knows all about that pain. What started as a small ache on the back of his left leg about a year ago became progressively worse. “The pain would just engulf the entire lower portion of my leg and then move up my leg to the buttock,” said Luc, 65, who works at the Apple Store. “The longer I walked the more the pain intensified to the point I couldn’t walk. As soon as I stopped, the pain would dissipate.”
His doctor recommended that he see vascular surgeon Kara Kvilekval, MD. She showed him sonograms of his two legs, the right pumping blood throughout, the lower left having virtually no blood flow beneath the knee. Kvilekval decided to use a new technique called an atherectomy, described as a “roto-rooter” of the artery that scrapes plaque off artery walls. That was followed by a medicated balloon to open the blood vessel.
Within a day after the procedure, Luc’s lower left leg was feeling better. “The leg itself is absolutely perfect,” he said. “I can feel blood flowing through my ankle again. It’s like a light switch was turned on.”
Cornelius McDonnell of East Setauket was also slowed by PAD. A retired language teacher, the 96-year-old teaches two classes a week for other retirees at Stony Brook University. But last year he began having problems with his left foot. “I was getting such pains trying to walk,” he said.
McDonnell’s podiatrist recommended he see Ahmad Bhatti, MD, vascular surgeon. Bhatti discovered that McDonnell was not getting sufficient blood flow to his foot. Bhatti solved the problem by placing stents into arteries in McDonnell’s foot to restore the blood flow. “The whole process from being seen for the first time to walking out of the hospital was 48 hours,” Dr. Bhatti said. “That’s pretty remarkable to have your lifestyle change that fast.”
Within a few days the pain was gone, McDonnell said, and he is now back to his regular active schedule, teaching classes and riding his exercise bike.
Why PAD Happens
The most common cause of PAD is atherosclerosis, a buildup of plaque on the inside of arteries. Plaque is made of extra cholesterol, calcium, and other material in your blood that builds up in the walls of your arteries. Plaque buildup can be caused by high cholesterol or high blood pressure. Every part of your body needs oxygen rich blood. Plaque buildup prevents blood from flowing freely and starves the muscles and other tissues in the lower body. Symptoms include painful cramping in your hip, thigh or calf muscles after activity, such as walking or climbing stairs; numbness or weakness in the legs; sores on your toes, feet or legs that won't heal; and a change in the color of your legs
PAD can often be treated through increased exercise, quitting smoking, eating a healthier diet. In some cases, PAD may be treated with aspirin or other medications that prevent blood clots from forming, lower cholesterol levels, control high blood pressure or control diabetes.
In cases of severe PAD, surgical options include bypass surgery or angioplasty during which a catheter is inserted into the blocked artery and a balloon is inflated to improve blood flow. A small, expandable tube or stent may be placed in a blood vessel to help keep it open. Medications to dissolve blood clots that block an artery may also be used.
In addition to high cholesterol, risk factors for PAD include smoking, diabetes, obesity and high blood pressure. Those over 50 and those with a family history of PAD, heart disease or stroke are also at greater risk of PAD.
“PAD can range from silent to lifestyle limiting symptoms to gangrene and amputation to, in worst case scenarios, death,” Bhatti said. “It’s a very unrecognized and underdiagnosed problem. People often attribute their symptoms to old age, their spine or their conditioning. If you have any symptoms in your lower extremities, you should be evaluated by a vascular surgeon.” PAD is also a marker for blockages in arteries elsewhere in the body, such as the carotid and coronary arteries, which can lead to strokes and heart attacks.
Luc wishes he had had the procedure on his left leg earlier. “My advice is when you can’t walk very far because of pain, see a doctor right away,” he said, also praising the care he received while at Mather Hospital.
Now he’s ready to get out and enjoy the warmer weather. “I’m looking forward to walking without pain, getting back to the little things you never think of,” he said. “It will allow me to work out in the yard, especially now that it’s springtime.”