Peripheral vascular disease, or peripheral arterial disease, is a circulatory problem that affects the width of the body’s arteries and reduces blood flow to the limbs.
Patients who develop this disease do not receive sufficient blood flow to their limbs; usually their legs.
This disease can often be successfully treated by quitting smoking, adopting healthy eating habits, and exercising.
Although peripheral vascular diseases may cause mild or no symptoms, an estimated one in ten will experience leg pain while walking. Intermittent claudication is classified by cramping or muscle pain in the legs or arms that is triggered by activity, but disappears shortly after resting. For the convenience of our patients and guests, Colorado Foot Institute offers free, high-speed wireless internet access.
Peripheral arterial disease (PAD) results from narrowing or blockage of the arteries of the legs.
PAD symptoms are leg cramps (usually after exercise), pain in your feet in bed at night or, in severe cases, tissue loss or gangrene. This procedure takes about an hour and can be performed via a single needle in the groin under local anaesthetic. Sometimes, a surgical bypass operation may be required to redirect blood flow around a blocked artery in the leg. This procedure requires a few days admission to hospital and is performed under a general anaesthetic. The stigmata of aging skin include wrinkles (rhytides), furrows, sagging, and sunken cheekbones (Fig. Photo (sun) damage is the most common and most pervasive change of aging (white) skin, commonly identified as solar lentigines and actinic keratoses (see Fig.
Solar or traumatic purpura (also known as senile purpura) is a common and benign condition of extravasated blood in the dermis characterized by ecchymotic, purpuric patches on the forearms, arms, or legs of older persons.
Pruritus (itching) is a common condition of advanced age, affecting nearly one half of older adults (older than 60 years) at some time, usually without a rash. Seborrheic dermatitis is a common type of eczema characterized by scaly, red plaques on the scalp, face, and central chest.
Other causes of leg ulcers in the elderly are neuropathy, trauma, neoplasia, infection, panniculitis, and pyoderma gangrenosum. Vascular insufficiency can represent venous insufficiency or perhaps even venous thrombosis, valvular incompetence, or arterial insufficiency. Varicosities (varicose veins) occur commonly with venous insufficiency, characteristically as tortuous vascular channels on calves, thighs, and popliteal fossa. Common skin conditions in the elderly include: actinic damage, benign and malignant growths, pruritus, eczematous dermatitis, purpura, and vascular insufficiency.
Intrinsic and extrinsic factors affect the structure and function of the skin and contribute to disorders of aging skin. Coronary angioplasty, also referred as percutaneous coronary intervention (PCI), is a medical procedure used to open clogged heart arteries. Coronary angioplasty can improve some of the symptoms associated with blocked arteries, such as chest pain and shortness of breath, or can be used during a heart attack to quickly open a blocked artery and minimize heart damage. Angioplasty involves temporary inserting and expanding a tiny balloon at the site of your blockage to help widen a narrowed artery.
When medications or lifestyle changes aren’t enough to reduce the effects of artery blockages, or if you have a heart attack, worsening chest pain or other symptoms, your doctor might suggest angioplasty. Once they artery is widened, a device called a stent is usually placed in the artery to act as scaffolding to help prevent it from re-narrowing after the angioplasty. At the blockage, the balloon is inflated and the spring-like stent expands and locks into place inside the artery. The stent remains in the artery permanently to hold it open and improve blood flow to your heart. Once the stent is in place, the balloon catheter is removed and more images (angiograms) are taken to see how well blood flows through your newly widened artery. After your stent placement, you may need prolonged treatment with medications to reduce the chance of blood clots forming on the stent material.
C-reactive protein (CRP) is a glycoprotein produced by the liver, which is normally absent from the blood.


In addition to restricting blood flow to the legs, this disease may also affect the heart and brain.
Diagnosing and treating the condition early on can prevent it from becoming worse, and reduce the risk of stroke and heart disease.
The areas in which pain is experienced depend on the location of the narrowed or clogged artery. First, is to alleviate the symptoms so you may continue about your daily physical activities. For instance, quitting smoking is extremely important as it pertains to reducing complications associated with blockage. Medication may be prescribed to help lower cholesterol and blood pressure, prevent blood clots, and to help treat pain or other symptoms. High blood pressure can contribute to the advancement of peripheral vascular disease and sometimes ACE inhibitors and beta blockers are prescribed to lower blood pressure levels.
Some patients may also have diabetes, in these cases, it is critical that blood sugar be controlled. Since peripheral artery disease is associated with narrowed blood vessels, it is important to prevent clots from occurring. Mechanik is Board Certified in Foot Surgery and Board Certified in Reconstructive Rear Foot and Ankle surgery. Mechanik then went on to complete a twenty-four month post-graduate Residency training program in Foot and Ankle Surgery and a twenty-four month surgical Fellowship training program in Lower Extremity Musculoskeletal Surgery. Mechanik is a Fellow of the American College of Foot and Ankle Surgeons and a  Diplomate, American Board of Foot and Ankle Surgery. Mechanik will examine your medical history and perform a complete physical examination if you are experiencing symptoms of peripheral vascular disease. If treatment is required, I aim to open the narrowed or blocked arteries with endovascular techniques such as a balloon angioplasty or a stent.
The condition usually follows minor trauma and commonly affects those who take aspirin or other blood thinners (Fig. Typically, they are greasy brown hyperkeratotic plaques that appear stuck to the skin surface; they can appear anywhere, except for palms and soles, and tend to congregate on the trunk. Patients with chronic renal or hepatic insufficiency, anemia, thyroid disease, diabetes mellitus, drug allergy, or underlying malignancy might have itch with or without a rash. Treatment should include weight reduction when warranted, compression stockings to reduce edema, leg elevation as much as possible, and reduction of prolonged standing.
Risk factors include immobility, fecal or urinary incontinence, diabetes, glucocorticoid use, and poor nutrition. Evaluation and treatment are usually straightforward, and diagnostic testing is usually not necessary. Given the increasing number of elderly patients in the United States, disorders of aging skin are becoming a significant part of general dermatology.
Angioplasty is usually combined with implantation of a small metal coil called a stent in the clogged artery to help prop it open and decrease the chance of it narrowing again. First, you’ll have an imaging test called a coronary angiogram to determine if your blockage can be treated with angioplasty.
Placed around a balloon at the tip of the catheter and guided through the artery to the blockage. The presence of acute inflammation with tissue destruction within the body stimulates its production.
This substance is considered a marker of low-grade vascular inflammation, which is a key factor in the development and rupture of atheromatous plaque. You may be able to alleviate this pain by positioning your legs so they hang off of your bed, or by walking around the room. Second, we aim to stop the advancement of atherosclerosis throughout the body to reduce the risk of stroke and heart attack.
Being prescribed to this medication is a good indicator that it’s time to quit smoking. A clot that occurs in an already affected blood vessel may be enough to block it completely. He has the medical and surgical skills to treat your foot conditions.  He and his family are natives of the Denver area.


There are various tests that may also be necessary to confirm the diagnosis of peripheral vascular disease. This chapter reviews the more common disorders of aging skin, such as actinic (photo) damage, pruritus, eczematous dermatitis, purpura, and venous insufficiency. Asteatotic eczema, or winter itch, often affects aging skin, usually as itchy, scaly, cracked, red plaques on the extremities, most commonly the legs.
Affected areas require regular lubrication with emollients and topical corticosteroids if eczema occurs. Lipodermatosclerosis is an uncommon sequela of chronic venous insufficiency and is characterized by subcutaneous fibrosis with firm, indurated plaques on the legs.
An understanding of the changing structure and function of aging skin helps to address the disease processes and their treatment. Stents can be coated with medication that’s slowly released to help prevent arteries from re-clogging. Elevated CRP levels predict future coronary events, stroke, peripheral vascular disease, and type 2 diabetes mellitus.
Scholl College of Podiatric Medicine which is part of the Rosalind Franklin University of Medicine and Science, a national leader in medical education.
If you are experiencing any of the symptoms listed above it is advised you schedule an examination in a timely manner, as this condition can be life threatening if it is not treated with haste. Their presence reflects appreciable sun exposure and can portend an increased risk of sun-induced skin cancer. For patients with a rash, the treatment is the same, plus treatment of the skin disease (usually a secondary eczema) with topical or systemic corticosteroids. Treatment includes shampoo for the scalp, such as those containing zinc pyrithione, selenium sulfide, or ketoconazole, and a mild topical corticosteroid. If venous or stasis ulcers develop, they are typically shallow and irregularly shaped and usually occur just above the medial malleolus. Patients with stasis dermatitis and chronic leg ulcers have an increased risk for contact dermatitis, based on the likely use of multiple topical medications.
All patients need an adequate diet, with vitamin supplementation, and treatment of any underlying conditions. These coated stents are called drug-eluting stents, in contact to noncoated versions, which are called “bare-metal” stents. When the acute inflammation is no longer present, the CRP rapidly dissipates from the body. Thus this test is used to assess risk of cardiovascular problems in conjunction with other testing, such as measuring cholesterol levels. Angiomas are benign vascular growths that commonly occur in adults as red macules and papules on the trunk and proximal extremities. Treatment involves compression, leg elevation, and often débridement, sometimes followed by skin grafting. The CRP typically rises within 6 hours of the start of inflammation, allowing the inflammation to be confirmed much sooner than through the use of the erythrocyte sedimentation rate (ESR), which usually increases about a week after inflammation begins.
Similar to seborrheic keratoses, therapy for angiomas is usually not necessary unless they are pruritic, irritated, or inflamed. Aspirin or pentoxifylline is a helpful adjunctive treatment to improve peripheral blood flow, allowing ulcers to heal more rapidly. Selection depends on the state of the ulcer (infected, soupy, or clean), the amount of exudate, ulcer depth, and patient compliance. Malignant potential is extremely low, but left untreated, approximately 5% to 20% of actinic keratoses deteriorate to invasive squamous cell carcinoma within 10 to 25 years.3 Actinic keratoses deserve treatment to forestall progression into squamous cell carcinoma. Options include local destruction with either cryotherapy (liquid nitrogen) or curettage and the topical application of 5-fluorouracil (Efudex, Fluoroplex, Carac), imiquimod (Aldara), or diclofenac (Solaraze) for more extensive disease. Obviously, sun avoidance and the use of sunscreens help to minimize photo damage, solar lentigines, and actinic keratoses.



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