Vascular Insights Issue #1

SEPTEMBER 2010

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ISSUE 0001

VASCULAR INSIGHTS A QUARTERLY NEWSLETTER OF VASCULAR ASSOCIATES, LLC

We Are Committed To Making A Difference

Dr. Bud Shuler and Clark Stream, PA-C focuses exclusively on vascular surgery. They thoroughly understand diseases affecting the arteries and veins, as well as the most effective and appropriate treatment for each patient. Their reputation as the premier vascular surgery practice in Northwest Florida is based on fellowship training and board-certification in vascular surgery, vascular medicine, and venous disease.

Your next step to great legs starts here.

Physicians from throughout the region refer patients to Vascular Associates with confidence, whether the need is emergency consultation, major vascular surgery, noninvasive diagnostic services or advanced treatment for varicose veins. They know that Dr. Bud Shuler and Clark Stream, PA-C along with their warm and knowledgeable staff, will ensure that you receive a smooth, uncomplicated visit and prompt attention to your every vascular need.

At Vascular Associates, you know you are in great hands, because we are committed to making a difference.

IN THIS ISSUE Facts about PAD..................... pg.2 All in a Day’s Work................. pg.3 Better Your Quality of Life..... pg.4 Do You Have PAD?.................. pg.5

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Facts About Peripheral Arterial Disease (P.A.D.) •

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One in every 20 Americans over the age of 50 has P.A.D., a condition that raises the risk for heart attack and stroke.

Peripheral Arterial Disease develops when your arteries become clogged with plaque-fatty deposits that limit blood flow to your legs.

At least half of the people who have P.A.D. don’t have any signs or symptoms of it. Some people who have P.A.D. may have symptoms when walking or climbing stairs. These may include pain, numbness, aching, or heaviness in the leg muscles. Symptoms also may include cramping in the legs, buttocks, thighs, calves, and feet.

Take Steps to learn about

P.A.D.

Peripheral arterial disease, or PAD, affects 8 to 12 million people in the United States, especially those over age 50. Yet, few people know they have PAD until it reaches advanced stages because often there are no warning signs.

What is P.A.D.?

Peripheral vascular disease refers to diseases of blood vessels (both arteries and veins) outside the heart and brain.

PAD reduces blood flow to the arms and legs to such a degree that the person has symptoms. It is most commonly caused by atherosclerosis, or hardening of the arteries.

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Narrowed artery

to amputation. People with P.A.D. may become disabled and not be able to go to work. As time goes on, they may have a very poor quality of life.

What are the causes and risks of the disease?

Peripheral arterial disease is generally caused by atherosclerosis. Atherosclerosis is caused by an injury to the inside layer of the artery. It usually occurs where the artery bends or branches. Damage to the walls of the artery may be caused by a number of factors, including:

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._Is P.A.D. serious?

Lower-extremity P.A.D. is a serious disease that affects about 8 million Americans.

The hardened arteries found in people with P.A.D. are a sign that they are likely to have hardened and narrowed arteries to the heart and the brain. That is why people with P.A.D. are at high risk for having a heart attack or a stroke.

When the blood flow to the legs is greatly (or severely) reduced, people with P.A.D. may have pain when walking. P.A.D. may cause other problems that can lead 2

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high blood pressure high cholesterol diabetes smoking infection

Atherosclerosis is more common in men than in women. A person’s risk of atherosclerosis goes up as he or she ages.

People who are sedentary are also at higher risk. PAD may also be caused by a blood clot that lodges in an artery of the arm or leg. Less commonly, PAD may be caused by a blood clot that lodges in an artery of the arm or leg.

The good news is that like other diseases related to the arteries, P.A.D. can be treated by making lifestyle changes, by taking medicines, or by having endovascular or surgical procedures, if needed.

Reference: http://www.activeforever.com

About our Doctor

All in a Day’s Work: Saving a Leg to Save a Life

Peripheral arterial disease (PAD), often called “hardening of the arteries”, begins as early as the teenage years as a fatty, cholesterol smudge on the walls of the arteries carrying blood to the muscles and skin of the legs. Over time, this builds up to more significant blockages (plaque) that slow or stop the ability of oxygen and nutrients to make it to your legs. It is made worse by smoking, diabetes, high blood pressure, obesity, sedentary lifestyle, and unfortunately, age. These symptoms include cramping pain, heaviness, and fatigue in the calves or thighs with activity but are almost immediately relieved by rest. Walking up a hill or stairs usually brings symptoms on faster. Ulcers and gangrene are signs of more significant disease and warnings of limb loss. Although treated differently, PAD is also a marker for heart disease and stroke because of the similar build up of plaque in these arteries.

Article by Bud Shuler, MD, FACS

What is great about knowing that you have PAD is that it can be controlled most often without a procedure. Changing your diet; controlling your blood sugar, cholesterol, and blood pressure; exercising regularly; and kicking the smoking habits each lower your risk significantly. In addition, a trial of medications may improve your pain-free walking distance and should usually be tried before any procedure is performed. Your primary care provider is an expert at guiding you through this process. These measures often improve your quality of life, and allow you more time to affect the lives of others in a positive way, especially the lives of your grand and great-grandkids! If conservative measures fail to improve your quality of life, one should seek consultation with a vascular expert, someone committed to making a difference in your life.

www.ArteryandVeins.com

Dr. Bud Shuler is NW Florida’s only fellowship trained vascular specialist, board certified in both Vascular Surgery and Vascular Medicine. His central focus is on PAD and venous disease of the legs and on making a positive difference in the lives of others. He is the medical director of the panhandle’s first nationallyaccredited, comprehensive vascular lab for diagnosing the many aspects of vascular disease.

For more information, please visit www.ArteryAndVeins.com.

Bud Shuler, MD, FACS

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We Help Better Your Quality of Life Article by Candice Dunlap, RVT

Peripheral arterial disease (PAD) is a narrowing of the peripheral arteries. The most common symptoms of PAD in the lower extremities are cramping, pain or tiredness in the leg or hip muscles; usually while walking or climbing stairs. Typically, this pain goes away with rest and returns when you walk again. There is a higher risk of PAD if the patient smokes, has diabetes, high blood pressure or high cholesterol.

Ultrasound is the most common noninvasive vascular test. We use duplex scanners and plethysmography (ABIs/LEADs/segmental pressures) to evaluate the peripheral arterial system. PAD is often evaluated with this type of testing. Since it is noninvasive; the test are done right here in our office by a registered vascular technologist.

The duplex scan is performed with a probe in contact with the skin, utilizing a gel medium, to create an image of the artery. It gives a real time, 2D evaluation of the arterial system. We scan to evaluate plaque characteristics, known as morphology and take certain velocity measurements with Spectral Doppler. Doppler provides a waveform on a scale, along with the velocity of the blood moving through the vessel. Images are taken in gray scale, color Doppler and with Spectral Doppler.

By combining the sources of information drawn from these images, a diagnostic assessment can be made. The main sign of arterial stenosis or occlusion are hemodynamically significant lesions within the vessel that are registered by Doppler, grayscale imaging or visually, by the sonographer’s naked eye.

Plethysmography (aka segmental pressures, abis, leads) uses infrared light to respond to changes in the bloods oxygen content, along with a series of blood pressure cuffs placed in segments along the lower or upper extremities, to include fingers or toes. The cuffs are then inflated and allowed to deflate, first to produce the arterial tracing/waveform, and then inflated again to calculate the blood pressure volume for that segment. The segments are then compared against the brachial pressures to determine normal arterial outflow. The normal pulse waveform has a quick upstroke, a sharp peak, and a down stroke towards the baseline. Prolonged upstroke, pressure drop or differences in segments, rounded peak, and down 4

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stroke bowed away from the baseline all suggest arterial obstruction.

PAD can be treated with lifestyle changes, medications and/or surgery.

There are several surgical options available. Angioplasty, arterial stenting or bypass surgeries are all options for patients with severe disease. About 8 million Americans have PAD and are often undiagnosed. If left untreated PAD can lead to gangrene and amputation.

If you have any questions or need an arterial evaluation, please contact our office.

References: Americanheart.Org MayoClinic.Com Ridgway, Donald P. Introduction to Vascular Scanning, Davies Publishing, Inc. 2004.

Varicose Veins... Should You worry?

Article by: Clark Stream, PA-C

Clark Stream, PA-C

It is estimated that there are more than 80 million Americans who suffer from some form of venous disorder, making this a common problem. The following questionnaire will help you determine when to seek an evaluation to help avoid the longterm problems associated with untreated varicose veins.

1. Have you or anyone in your family been diagnosed with varicose veins or venous reflux disease?

2. Do you have varicose veins which exhibit any of the following characteristics?

• Large, bulging veins on your legs • Swollen, red or warm to the touch • Skin discoloration or texture changes

3. Are you experiencing any of the following symptoms in

About our Physician’s Assistant Clark Stream PA-C is a highly specialized vascular physician assistant with unique training from nationally and internationally renowned experts in cardiac, thoracic, and vascular surgery. He is a sought after expert in the development and implementation of advanced sclerotherapy techniques.

your legs, ankles or feet?

• Pain (aching, cramping feeling) • Heaviness/Tiredness • Burning or tingling sensations • Swelling • Tender areas around the veins • Restless legs

4. Have you previously had skin ulcers or wounds on the leg that were slow to heal?

5. Have you previously attempted conservative treatments

without success (e.g. exercise, weight loss, elevating legs, avoiding long periods of standing/sitting, compression stockings)?

Each YES answer increases your risk. Listen to your legs… they are telling you something…

It’s time to seek an evaluation and treatment at the Vein Center at Vascular Associates. This step is easy because no referral is necessary; just call 872-8510 to set up an appointment. Your worries end here because you will be under the expert care of our treatment team, Dr Bud Shuler and Clark Stream PA-C, “Committed to making a difference”.

For more information on our surgery procedure, please call (850) 872-8510, or visit www.ArteryandVeins.com.

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Ways to Prevent Future Risks Associated with P.A.D. Treatment for PAD focuses on reducing symptoms and preventing further progression of the disease. In most cases, lifestyle changes, exercise and claudication medications are enough to slow the progression or even reverse the symptoms of PAD.

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Physical Activity

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Diet

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Smoking

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Procedures

Regular Physical Activity is the most effective treatment for PAD. Take time to go for a walk or ask your healthcare provider to design a plan that is best suited for your situation.

A diet low in saturated fat, trans fat and cholesterol can help lower blood cholesterol levels.

Stop smoking! Smokers have FOUR TIMES the risk of developing PAD than non-smokers.

For a minority of patients the above recommendations and treatments aren’t enough, and minimally invasive treatment or surgery may be needed. source: http://www.heart.org

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