What is Peripheral Arterial Disease (P.A.D.)

P.A.D affect 8 to 12 million people in the United States, especially those over age 50. It does not always cause symptoms, so many people may have PAD and not know it. People who do experience symptoms, such as pain, or cramping in the legs, often do not report them, believing they are a natural part of aging or due to another cause.

Risk Factors:
Some conditions and habits raise your chance of developing P.A.D. Your risk increases if you:

• Are over the age of 50
• Smoke or used to smoke
• Have diabetes
• Have high blood pressure
• Have a personal history of vascular disease, heart attack, or stroke
• Are African American

Diagnosis:
Physical Exam – during the physical exam your pulse in both legs and feet will be examined to determine if there is enough blood flowing to these areas as well as the color, temperature, and appearance of your legs and feet and for signs of poor wound healing on the legs and feet. A review of your medical and family history including: your current diet and medications; any symptoms you may be experiencing in your legs while sitting, standing, walking, climbing, or participating in other physical activities; your status as a current or former smoker; presence of diabetes, high blood pressure, high cholesterol and other important factors are all crucial to an accurate diagnosis.

Non-Invasive Vascular Testing:
Ankle-brachial index (ABI) – ABI compares the blood pressure in your ankle with the blood pressure in your arm by using a regular B/P cuff and a special ultrasound device to evaluate blood pressure and flow.

Duplex doppler – this test uses standard ultrasound methods to produce a picture of a blood vessel and surrounding organs. Also, a computer converts the doppler sounds into a graph that gives information about the speed and direction of blood flow through the blood vessel being examined.

Magnetic Resonance Angiogram (MRA) – it is a type of MRI scan that uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body. It can see the blood flow as well as the condition of the blood vessel walls.

CT Angiogram – is an imaging test for various types of heart disease. It relies on a powerful X-ray machine to produce images of your heart and heart vessels. This is used primarily to check for narrowed arteries in your heart that can put you at risk for a heart attack.

Vascular Testing -The “Gold Standard”
Angiography with Contrast
By injecting a dye (contrast material) into your blood vessels, this test allows your doctor to view blood flow through your
arteries as it happens. Your doctor is able to trace the flow of the dye using imaging techniques such as X-ray imaging or MRA or CT angiography.

Treatment:
Timely detection and treatment can help reduce your symptoms, improve the quality of your life; help you keep your independence and mobility; and can reduce your risk of heart attack, stroke, leg amputation and even death. There are three main approaches to treating P.A.D.

1. Making lifestyle changes
2. Taking medication
3. In some cases, having a special procedure or surgery

Lifestyle changes:

• Quit smoking – Don’t smoke, and if you do quit!!
• Lower your numbers – Work with your health care provider to correct any high blood pressure, cholesterol and blood glucose levels.
• Follow a health eating plan – Choose foods that are low in saturated fat, transfat, and cholesterol. Be sure to include whole grains, vegetables, and fruits.
• Get moving – Make a commitment to be more physically active, Aim for 30 minutes of moderate-intensity activity on most, preferably all, days of the week.
• Aim for a healthy weight – If you are overweight or obese, work with your health care provider to develop a supervised weight loss plan.

Medication:
In addition to lifestyle changes, your health care provider may prescribe one or more medications. The medications are used to:

• Lower high blood pressure and cholesterol levels and treat diabetes.
• Prevent the formation of blood clots that could cause a heart attack or stroke.
• Help reduce leg pain while walking or climbing stairs.

Special Procedures and Surgeries
If the blood flow in one of your limbs is completely or almost completely blocked, you may benefit from having a procedure of surgery in addition to medications and lifestyle changes. Procedures such as angioplasty and bypass graft surgery will not cure P.A.D., but they can improve the blood circulation to your legs and your ability to walk.

Questions to ask your health care provider:

• Will P.A.D. increase my risk for other conditions?
• Which screening tests or exams are right for me?
• What are my cholesterol numbers? (LDL, HDL, and triglycerides.)
• What is my blood pressure?
• What is my blood sugar level?
• What can I do to quit smoking?

The IAC is comprised of five divisions including Vascular Laboratories, which is dedicated to promoting noninvasive vascular diagnostic testing in the delivery of health care by providing a peer review process of laboratory accreditation. Accreditation is a voluntary process. For more information on accreditation visit: www.icavl.org.

Committed to balancing the changing needs of both the vascular community and the general public, the ICAVL was created in 1990 by uniting physicians, technologists and sonographers from the sponsoring organizations. Collaborating together, those physicians, technologists and sonographers composed the body of work known asThe Standards, an extensive document defining the minimal requirements for vascular laboratories to provide high quality care. Laboratories use The Standards as both a guideline and the foundation to create and achieve realistic quality care goals.

ICAVL Accreditation is offered in the following testing areas:

• Extracranial Cerebrovascular
• Intracranial Cerebrovascular
• Peripheral Arterial
• Peripheral Venous
• Visceral Vascular
• Screening

Dr. Kassouf is accreditated in Extracranial Cerebrovascular, Peripheral Arterial and Peripheral Venous.

For a limited time, those suffering from spider veins can come into Soho Vein & Vascular and receive a free initial consultation. To make an appointment call 1.888-ZIP-VEIN today.

Now is the perfect time to treat those unsightly spider veins before the summer is over!

Most insurances are accepted.

Vitamin A
Vitamin A plays a role in several functions throughout the body including vision, immune function, embryonic development and reproduction, bone metabolism, and most important in regards to varicose veins, skin health and antioxidant activity.

Found in orange and dark green fruits/vegetables like carrots, pumpkin, sweet potatoes, winter squashes, cantaloupe, pink grapefruit, apricots, broccoli, spinach, and most dark green, leafy vegetables Vitamin A is actually best absorbed from animal sources like beef, calf, and chicken liver; fish liver oils; whole milk dairy products such as yogurt and cottage cheese; eggs.

A vitamin A intake of 25,000 IU is recommended for skin integrity and in the case of existing varicose veins, can promote the healing of ulcers.

Vitamin C & Flavonoids
Vitamin C and flavonoids has been found to aid circulation, promote healing of sores, and assist in the strengthening of fragile vein walls.

Particularly high levels of vitamin C can be found in broccoli, bell peppers, kale, cauliflower, strawberries, lemons, mustard and turnip greens, brussels sprouts, papaya, chard, cabbage, spinach, kiwifruit, snow peas, cantaloupe, oranges, grapefruit, limes, tomatoes, zucchini, raspberries, asparagus, celery, pineapples, lettuce, watermelon, fennel, peppermint and parsley.

The recommended daily intake is 1,000 mg vitamin C and 500 mg flavonoids 3 times a day. Reduce vitamin C dose if diarrhea develops.

Vitamin E
Vitamin E promotes improved circulation, connective tissue growth and is believed to help relieve calf pain due to narrowing of the arteries (though studies are inconclusive).

Excellent sources of vitamin E can be found in asparagus, avocado, eggs, milk, nuts (such as almonds or hazelnuts), seeds, spinach and other green leafy vegetables, unheated vegetable oils, wheat germ, wholegrain foods such as fortified cereals.

Check with your doctor if taking anticoagulant medications. Dosage recommendations take 300 to 800 IU.

B Vitamins
Vitamin B-complex can help maintain strong blood vessels and has been found to support and increase the rate of metabolism, help maintain healthy skin and muscle tone, enhance immune and nervous system function, and promote cell growth and division—including that of the red blood cells that help prevent anemia.

B vitamins are found in all whole, unprocessed foods such as brown rice, wheat and barley. B vitamins are particularly concentrated in meat and meat products such as liver, turkey, and tuna. Other excellent B vitamin sources include: potatoes, bananas, lentils, chile peppers, tempeh, beans, nutritional yeast, brewer’s yeast, and molasses.

The following steps are not only beneficial for those already suffering from varicose veins but also decrease the likelihood of developing varicose veins in the future.

1. Elevate your feet at least once a day for 15 minutes. When seated at work or home simply put your feet on a elevated surface

2. Avoid tight fitting clothes, non-stretchable fabrics, and clothing that cuts at the waistline as they can restrict blood flow.

Tip: Make sure when wearing suits that pants or skirts do not feel too tight when sitting. Most people try on clothes and make judgments on the fit when they are standing up. Before buying clothes, sit down in them to see how they feel.

3. Avoid standing or sitting for long periods of time. If you have to work on your feet or sit for long periods of time, keep moving, this will help to keep blood flowing throughout the day. Do NOT cross your legs while seated.

4. When sitting, flex your muscles and wiggle your toes to increase blood flow. When standing shift your weight between both legs and stand on your toes occasionally.

5. Avoid the lifting of heavy objects as this can create unnecessary strain.

6. Eat plenty of blackberries and cherries. They are rich in compounds that help prevent varicose veins and can lessen the discomfort attributed to them over time.

7. Apply Castor oil over the varicose veins after bathing. Used for hundreds of years, castor oil helps to relieve pain, increase lymphatic circulation and reduce inflammation.

8. Avoid scratching the itchy skin above varicose veins. Scratching can irritate the thin skin creating ulcerations and bleeding.

9. Wear special elastic compression stockings also referred to as compression hose or compression socks. Compression stocking are a simple, inexpensive way to treat varicose veins. It’s best to consult with a physician on the proper compression level for your condition. These specially fitted hose are designed to reduce the pooling that occurs but won’t eliminate varicose veins.

Doing a few simple exercises along with the tips below may help to decrease the risk of DVT.

• Ankle Circles: Raise your feet off the floor and rotae them in a circular motion. Make five circles in clockwise and counterclockwise directions with each foot.
• Knee-to Chest Stretch: While seated, lean slightly forward and clasp your hands around one knee. Slowly pull your knee toward your chest and hold for 15 seconds. Release and switch to the other leg. Repeat twice.
• Foot Pumps: With your heels on the floor, raise your toes as far as possible. Hold for a few seconds and lower them to the floor. Then raise your heels while keeping our toes on the floor and hold for several seconds. Repeat five times.
• Neck Roll: Relax your shoulders. Stretch your neck toward your left shoulder; hold for a few seconds, slowly roll your head toward your chest, and then stretch toward the right shoulder. Hold for several seconds and then reverse, rolling your head from right to left. Repeat three times.

Long-distance travel, exciting as it may be, can also be tiring following these tips can reduce the stress and fatigue that may occur with long-distance travel and can combat the jet lag that may result from crossing time zones;

• Wear comfortable clothing and shoes.
• Get a good night’s sleep before your trip and rest as much as possible during the flight.
• While away, get as many hours of sleep every day as you would normally at home. Taking short naps of 30 to 40 minutes will help to refresh you as you adjust to the new time zone.
• Drink plenty of water and/or juice before and during the flight to stay hydrated.
• Eat light meals during your flight. Also, avoid caffeinated and alcoholic beverages.
• Don’t remain in one position too long; peform the simple stretches above and walk when possible.

Specializing in the treatment of varicose and spider veins, Soho Vein & Vascular also offers cosmetic and skin care services designed to rejuvenate and recreate a more youthful you. Watch and learn more.

In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months. However, new veins may appear over time and may require repeat visitations.

When choosing a physician, it is important to make an informed decision. This involves knowing the qualifications, training, and experience of your physician. With over 25 years of experience, Dr. Michael Kassouf, a board certified surgeon, has been helping those who suffer from varicose and spider veins improve their appearance and regain vitality of their legs.

Although sclerotherapy is a common procedure used in the removal of spider veins, laser treatments are often the most effective way to treat facial spider veins or those spider veins very close to the surface of the skin. The use of a laser allows the selective targeting of the spider vein without damaging the surrounding tissue. The procedure is relatively quick, and no anesthesia is needed. After treatment, the skin can be noticeably more uniform and natural in appearance.

The amount of time varies from fifteen minutes to one hour, depending on the size of the area being treated, as well as the severity of the problem. Usually, more than one treatment may be needed to achieve the desired results.

More information on Laser Treatments for Vein Removal