Transcription:

Melanie Cole, MS (Host): If you're like me and you get a pain in your calf and you're never quite sure what it is, and you sort of worry that is could be a peripheral vascular situation. Today we’re gonna learn what those symptoms exactly are for peripheral arterial disease. My guest is Dr. Jenna Kazil. She’s a vascular and general surgeon and a member of the medical staff at Manatee Memorial Hospital. Dr. Kazil, I'm so glad to have you with us today. Explain a little bit about peripheral arterial disease and peripheral vascular disease. Are they the same thing? Really, what is it?

Jenna Kazil MD (Guest): Absolutely. So peripheral arterial disease is a blockage or occlusion of the arteries, which is the blood vessels that bring the blood from your heart to the rest of your body. Some people use peripheral arterial disease interchangeably with peripheral vascular disease. However, some people also use this to refer to peripheral venous disease, which is a very different issue in and of itself. That deals with the vessels that bring the blood from your periphery to your heart.

Host:   So who’s at risk for that? I'm a 55 year old woman. I exercise a lot, but I certainly have seen a lot of it in my years. So tell us who’s at the greatest risk?

Dr. Kazil:  The people at the greatest risk are those patients who are smokers, those patients who are diabetics, and those patients who are on dialysis. All of those patients have an increased risk. There's also an increased risk of arterial disease with patients who have heart problems as well.

Host:   So how would we know? You know you’ve just given us the risk factors and so thereby the cause. How would we know? I mentioned that pain in the calf. Are there other things that would let us know that we are somebody who maybe has a buildup in our arterial system?

Dr. Kazil:   So the majority of patients who have arterial disease actually are asymptomatic and they have no idea. However if you have pain, usually in your calves when you walk a particular distance. Patients will say every time I walk around the mall more than once, my calves hurt. Every time I walk down my driveway, my thighs hurt. That’s something you need to address with your physician.

Host:   So how do you detect it? What tests should they ask their doctor about?

Dr. Kazil:   The very first test that can be done in most primary doctor’s offices would be an ABI, or something called an ankle brachial index. What this is is a measurement of the blood pressure in your feet compared to the blood pressure in your arm. By taking this measurement, that gives us a pretty good idea of how risky it is and what your overall risk is. Now that being said, once you have that measurement, the next step is usually an ultrasound, which is painless.

Host:   Does that show if there are some buildup and blockages if you're having an ultrasound?

Dr. Kazil:   Arterial disease is very easily seen for the most part by arterial ultrasound. That will show quite a bit of the disease. It does not always show the entire extent.

Host:   Cool. So if somebody is diagnosed, what is the first line of defense? Do you look right away to medication or do you talk about lifestyle first?

Dr. Kazil:   The very first step when I see someone is often lifestyle modification, but usually in that same visit I'm also giving them medication. The medications are often things like aspirin and cholesterol medications even if somebody has a normal cholesterol level.

Host:   So then what does that do for them?

Dr. Kazil:   The cholesterol medication is going to help prevent progression of the plaque and the blockages. The aspirin or other anti-platelet medication is going to help prevent the platelets from sticking together. In addition with a structured walking regimen this is actually going to decrease pain and encourage your body to grow new blood vessels.

Host:   So what lifestyle modifications? Because exercise is obviously recommended, Dr. Kazil, but for people with that claudication—that pain—sometimes it’s hard to exercise. So what do they do?

Dr. Kazil:   So the first lifestyle modification that’s absolutely necessary is to stop smoking and all tobacco products. As soon as anybody has even one puff of a cigarette, you are destroying all the very teeny tiny blood vessels that make it very difficult for your body to function. So that’s step one. The second step when it comes to exercise is you need a structured exercise regimen. This can be done at home or it can be done with a physical therapist. That pain that people feel once it’s been diagnosed by a physician is your body begging for more blood flow. By continuing to walk despite having this pain, you're going to encourage new blood vessels to form. But, again, before you start something like this you need to see your physician first.

Host:   Can it be reversed, Dr. Kazil? Once we've done all of these things—If the person has quit smoking, maybe they're on cholesterol medication or aspirin. They’ve started a supervised exercise program. They're doing all the right things. Is it reversible or does it just not get any worse?

Dr. Kazil:   That is a very interesting question. I think that the jury is still out. However, that being said, I've seen many patients reverse their symptoms completely. So they will go from having symptoms to having zero or almost no symptoms whatsoever, but it still takes time and effort.

Host:   Are there any surgical interventions that ever become part of this discussion?

Dr. Kazil:   There are absolutely multiple different kinds of surgical interventions that are part of treating peripheral arterial disease. As a vascular surgeon, I do both endovascular—so that would be minimally invasive technique—as well as open surgeries like bypasses and aortic surgery.

Host:   As there are so many treatment options, but we would rather prevent it in the first place. Give us your best advice for peripheral arterial disease and hopefully preventing it.

Dr. Kazil:   The best thing you can do is see your primary physician regularly and stop smoking. If you can do those two things, the majority of peripheral arterial disease is preventable. If you do suspect you have that, you should see a vascular surgeon as soon as possible.

Host:   That’s great advice and so well put. Thank you so much Dr. Kazil for joining us today and sharing your expertise. That wraps up this episode of Manatee Talk Radio with Manatee Memorial Hospital. For more information head on over to our website at manateememorial.com for more information and to get connected with one of our providers. If you found this podcast as informative as I did, please share with your friends and family. Share with social media. Don’t forget to check out all the other important podcasts in our library. Physicians are independent practitioners who are not employees or agents of Manatee Memorial Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks for listening.