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Treating Peripheral Arterial Disease

 

What is Peripheral Arterial Disease?

Iliac Aneurysm and StenosisPeripheral arterial disease (PAD), is a serious condition that results from accumulation of plaque in arteries, most commonly occurring in the pelvis and legs. PAD occurs when plaque buildup causes a narrowing of the artery, constricting normal blood flow to the body’s tissue and organs. If left untreated, PAD can result in loss of a limb, increased risk of heart attack, stroke, amputation and death.

PAD affects 8 to 12 million Americans, and up to 20 percent of those over age 65. Often the first symptom is leg pain that occurs when walking or exercising that disappears when the person stops the activity (known as intermittent claudication). Other symptoms may include numbness, tingling and coldness in the lower legs and feet.

As the disease progresses, individuals may develop wounds that do not heal, which can cause ulcers and gangrene. This critical limb ischemia ultimately results in amputation. In fact, more than 150,000 amputations are attributed to PAD each year in the U.S.

Amputation is a devastating event in the life of a patient. It is followed by loss of hope, confidence, ability to go to the bathroom and eventual despair and premature death.

Risk factors for developing PAD include:

  • smoking
  • high blood pressure
  • high cholesterol
  • diabetes
  • heart disease
  • obesity
  • physical inactivity
  • age over 50
  • family history of vascular disease

Today, new minimally invasive interventional procedures are helping people regain their mobility while also delaying disease progression and preventing amputation.

In particular, LASER vaporization of blockages is effective in patients who are poor candidates for traditional surgery and angioplasty. Some studies have shown that 95 percent of critical limb patients undergoing laser treatment retain their limbs with fewer side effects than other treatments. Many patients even regain the use of their leg and experience significant improvement in the quality of their lives.

Types of PAD Patients

Patients with lifestyle limiting leg pain

 

Patients referred to Westside Medical Associates for PAD are thoroughly evaluated to determine if they are candidates for minimally invasive interventional procedures. Patients undergo a complete assessment of their peripheral arterial disease through the use of non-invasive techniques. In critical cases, treatment can be scheduled for the same day to maximize the opportunity to salvage a limb.

Today, individuals are much more active than previous generations, and the pain of PAD can severely limit their lifestyle. Playing 18 holes of golf is always better than 9! The inability to exercise can lead to increased cardiovascular problems and contribute to a general failure in health. By effectively treating PAD with minimally invasive techniques, patients are able to resume an active lifestyle and better maintain overall health.

Most patients can be treated on an outpatient basis and recovery time is minimal. Very often, blockages of nearly 90 percent can be reduced to 10 percent or less in leg arteries, eliminating the need for additional treatment. Patients whose pain has been eliminated are more likely to resume and maintain an exercise regimen – good for their legs and heart.

Patients with critical limb ischemia at risk for limb loss

Patients with the most severe form of PAD, critical limb ischemia, are at high risk of losing a leg to amputation. Of the 150,000 people who undergo a PAD-related amputation in the U.S. each year, sadly half are never evaluated with an angiogram prior to surgery for possible alternative treatment.

In addition, traditional surgical treatments, such as bypass, often are not an option because the patients are poor surgical candidates or the disease has advanced so far that anastonosis at distal vessel is not possible. On the other hand, the effectiveness of traditional balloon angioplasty may be hindered by its limited long term patency record, which is now improved by the new stent designs and "wheeping balloons" that enter the artery with anti-restenotic drugs at the time of angioplasty.

With new techniques and tools, the barriers to revascularization that existed in the past for these patients have, in many cases, been eliminated. Interventional PAD treatment can not only save a patient’s limb, but ultimately their life, as the average life span following amputation is only 15 months.

Pad Procedure

On the Leading Edge of PAD Treatments

Westside Medical of Los Angeles Associates combines the latest technologies and leading edge techniques to maximize results with minimally invasive procedures. Expertise includes clearing blockages in the smallest blood vessels - even those below the knee previously thought to be untreatable.

Hooman Madyoon, MD, FACC, FACP, a co-founder of Westside Medical Associates, is a pioneer in the use of these new interventional technologies for treating cardiovascular and peripheral arterial diseases. Dr. Madyoon started treating PAD with non-surgical techniques back in early 1990s. He was one of the first cardiologists in the U.S. to apply such valuable experience in treating smaller vessels in the coronary circulation to the treatment of larger vessels in the rest of the body. Dr. Madyoon was also one of a handful of investigators in California who was selected as the principal investigator to participate in the National Institutes of Health Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), and in the groundbreaking Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial. Throughout his journey Dr. Madyoon, alongside of other pioneers, had to overcome many obstacles and roadblocks but remained committed to the patients and the principle of minimally invasive non-surgical therapy. Today, many surgeons are learning these techniques and have joined the interventional cardiologists and radiologists in this campaign to save lives and limbs.

Patients suffering from peripheral arterial disease will directly benefit from Dr. Madyoon’s expertise and Westside Medical Associates’ full service approach to diagnosing and treating PAD. Because of our on-site 64 Slice CT and 3-Tesla MRI, the only facility outside of a university center with such capabilities, patients can undergo an angiogram to pinpoint the problem, and then have a clear plan of treatment personally outlined by Dr. Madyoon that includes not only the preferred endovascular approach, but the necessary medical and/or surgical therapies. Dr. Madyoon regularly consults with a group of excellent surgical colleagues at Cedars-Sinai Medical Center. Together, they will provide you with the best and latest treatment options.

Many patients can benefit from new minimally invasive interventional procedures for treating peripheral arterial disease. This potentially limb-saving treatment approach offers lower risk, fewer side effects and quicker recovery than traditional surgical and angioplasty procedures, especially in the hands of the highly experienced interventional cardiologists at Westside Medical Associates.

Close Contact with Referring Physicians

At Westside Medical Associates, Dr. Madyoon and colleagues are committed to remaining in close contact with referring physicians. Phone calls and faxes, keep referring physicians updated on their patient’s condition, and written reports are sent in an expedited manner. Dr. Madyoon also is available around the clock for telephone consultations with physicians managing complex cases. Once patients have completed PAD treatment and recovered, they are returned to the referring physician for continued care.

 



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Office Hours: Monday - Friday 8:30 - 5:00pm
Office Location: 99 N. La Cienega Blvd. Suite 203 Beverly Hills, CA 90211