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Pay Attention to Leg Pain

This article ran in the Winter 2019 Edition of the Virginia Hospital Center Magazine

Do you have pain in your calves when walking? Do you have swelling in your legs? If your first thought is, it’s time to see an orthopedist, or this is just what happens with age, the real underlying issue could be Peripheral Artery Disease (PAD).

PAD is a common vascular disease caused by plaque build-up in the artery walls, which narrows the arteries and reduces blood flow to the limbs. It is often under-diagnosed because the symptoms, such as pain with activity, swelling, skin discoloration and non-healing wounds, are attributed to other causes. And, up to half of people with severe PAD do not experience any symptoms.

“PAD is indicative of more serious problems to address,” says Jeremy Bock, MD, FACC, VHC Physician Group–Cardiology. “Arterial obstruction that affects the health of the limb is part of the same process that affects the health of the heart. There is a marked increase in cardiovascular disability and death in individuals who have known PAD.” “The three biggest risk factors for PAD are heart disease, diabetes and a history of smoking. It’s very important for anyone with these risk factors to be screened for PAD, so we can begin treatment to prevent the condition from progressing,” explains Dr. Bock.

Screening for PAD is non-invasive and painless. The first step is to do a simple Ankle Brachial Index test to measure blood pressure in the arms and legs and evaluate the pulse. If the pulse is lower in the legs, further evaluation is needed.

“We use advanced ultrasound technology that uses sound waves to ‘see’ inside the arteries and veins and produce images of the blood flow from the heart,” says Hassan Tabandeh, MD, FACC, RPVI, VHC Physician Group–Cardiology. “Ultrasound does not involve any radiation and no contrast media is used.”

If PAD is identified, medication therapy and wound care may be recommended. For individuals with more severe disease, minimally invasive, catheter-based procedures are performed to remove plaque in the arteries and restore better blood flow.

“The process of clearing away arterial obstruction is very precise and delicate, particularly when you get down to the level of the foot. I’m often working on very tiny occluded arteries, using microsurgery techniques,” says Dr. Bock.

Performed in Virginia Hospital Center’s state-of-the-art Louise Sands Olmstead Cardiac Catheterization Lab, the procedure takes about two hours, and most patients go home the same day. There are no incisions and no significant recovery is needed.

“If patients had leg pain when they came in to the Hospital, they notice it’s gone by the time they walk to the car,” says Dr. Bock.

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