Peripheral Arterial Disease (PAD) affects roughly 18 million Americans. Due to a lack of knowledge in the United States, many Americans do not even know they have PAD, as they do not present any symptoms. In fact, the Cardiovascular Coalition (CVC) estimates that somewhere between 25-50% of the population are unaware they have the condition! Thankfully, there are some great resources and organizations available today to fight the spread of PAD. In this article, we’re going to examine the risk factors and causes of PAD, PAD symptoms, methods of diagnosis, and most importantly, some minimally-invasive treatment options. We’ll also share a special patient success story and a few important resources at the end.

Risk Factors & Causes of PAD

There are a range of risk factors that can contribute to your chances of developing PAD. Some cannot be avoided, such as family history, but others can be mitigated by adopting healthy living practices. However, it’s important to note that patients who smoke or who have diabetes have markedly reduced blood flow, which puts them at the highest risk for developing the disease. The main risk factors for PAD are the following:

• Smoking
• Diabetes
• Increased Age
• Physical Inactivity & Obesity
• High Cholesterol
• High Blood Pressure
• Family History of PAD, Heart Disease or Stroke

PAD is caused by a narrowing of the arteries, which reduces blood flow to the limbs, often in the lower extremities. Frequently, this circulatory issue is caused by atherosclerosis, or what happens when fatty deposits build up on the artery walls. This fatty buildup can greatly reduce blood circulation in patients — affecting not only blood flow to the heart, but also blood flow to the arms or legs.

A prolonged lack of blood supply and oxygen can create ischemia in the legs or feet, which is referred to as Critical Limb Ischemia (CLI), and is the most severe form of PAD. When undiagnosed, patients with prolonged CLI may be at risk of losing their limbs. If caught in time by an experienced interventional radiologist, the limbs can be saved. Additionally, PAD increases a patient’s risk for coronary artery disease, stroke or a heart attack. Like many illnesses, early diagnosis and treatment of PAD is key to preventing more serious issues down the line.

PAD Symptoms & Diagnosis

Many patients who have PAD do not present anything outright, but the typical PAD symptoms include pain, tightness, or fatigue in the legs, calves, or buttocks during physical activity. Once the patient has stopped exercising, the pain typically goes away. This cramping pain is called intermittent claudication. The following are some practices that can help prevent claudication:

• Quit smoking
• If diabetic, maintain even blood sugar levels
• Eat foods low in saturated fat
• Exercise Frequently
• Maintain a healthy weight
• Lower your Cholesterol levels
• Lower your Blood Pressure levels

At VIP, we use a simple test called the Ankle-Brachial Index, or ABI, to determine if a patient has PAD. This noninvasive test measures blood pressure in the ankles and compares it with blood pressure in the arms at rest and after exercising to see if there are significant differences in pressure. Abnormal results can indicate PAD as the cause of pain.

Minimally-Invasive Treatment Options for PAD

If a patient has CLI, they will need to have their vascular anatomy evaluated. Vascular imaging, including CT (computed tomographic) angiography, MR (magnetic resonance) angiography, or Ultrasound is then utilized to study blood circulation. If obstructions are severe, an angiogram, or arteriogram, may be necessary.

Angiograms are minimally-invasive procedures conducted by interventional radiologists that enable the physicians to see where there is blockage in the arteries. During the procedure, the interventional radiologist uses X-rays and contrast dye to identify narrowed or blocked sections. The physician can then place balloon catheters in the blocked arteries to open them up. Lastly, the physician will place stents in the arteries to keep them open after the angiogram.

PAD Patient Success Story

Here at VIP, our team has successfully treated many patients with PAD. One of our biggest success stories is patient Dr. Gloria Hutchinson. Not only did we save Gloria’s right leg from amputation, but we subsequently saved her left leg from being amputated only a few years later! Gloria’s story is sadly not uncommon. When she went to the hospital after suffering complications from a non-healing wound, she was told by the physician on call that amputation was the only option for her, due to her infection spreading to the bone. To Gloria, this did not seem like a true option at all, and she struggled with knowing what to do. She finally decided that she did not want to have her leg amputated.

Shortly thereafter, her daughter found VIP, and interventional radiologist Dr. Bret N. Wiechmann was able to see her mother. After fully evaluating her PAD symptoms and her vascular anatomy, Dr. Wiechmann determined Gloria was a viable candidate for an angiogram. The procedure was successful, and Gloria’s leg was saved! A few years later, Gloria had history repeat itself; this time, with her left leg. Thankfully, she knew to head straight to VIP for a consultation. Today, she is a proud grandmother to her first grandson. Without the proper diagnosis and treatment, Gloria would be a double amputee — or worse. Statistics for patients living with amputated limbs are not promising; mortality rates are close to 50% one year post amputation, and almost 71% three years post amputation.

PAD Resources

If you think you might have PAD,  your first step is to visit your primary care provider. If your provider finds that your current symptoms may be related to PAD, they can refer you to an outpatient treatment center like Vascular and Interventional Physicians in Gainesville, Florida. Of course, be sure to support organizations like the CVC that are working hard to spread awareness and to make sure patients get the best treatment possible for the disease. To take further action, call your Member of Congress today to stress the importance of PAD Awareness Education — both in physicians, and in patients!

This year, we have had multiple patient success stories at Vascular and Interventional Physicians after treating women who were suffering from Pelvic Venous Insufficiency, or PVI. It is estimated that at least 10% of women in the US develop issues post-childbirth that can eventually lead to Pelvic Venous Insufficiency. The symptoms of PVI can be similar to Chronic Pelvic Pain, or CPP, and are often under recognized. Because of this, it can be possible that a patient diagnosed with CPP actually has PVI. Because the pelvic region involves multiple systems in the body, it is easy to receive multiple diagnoses for what are truly PVI symptoms. One of our patients, C.T., said: “I had been to every doctor known to man… from urologists, to gynecologists, to gastroenterologists… Little by little, I was losing hope as I continued to have excruciating pain without finding a solution.”

Together, we’ll examine common symptoms for Pelvic Venous Insufficiency, as well as the picture of a typical patient, the methods of diagnosis, and available treatment options.

Your Pelvic Pain and Discomfort may actually be Symptoms of Pelvic Venous Insufficiency (PVI)

Common symptoms of Pelvic Venous Insufficiency include: a feeling of chronic pelvic heaviness, continual pelvic pain and discomfort, difficulty sitting or standing for long periods of time, frequent urination, and pain during or after intercourse. One of our patients, Rachel, went from having occasional pain to consistent pain that would show up without notice: “I would get sharp pains that would stop me in my tracks, and I would be bent over [from the pain].” After suffering for years and years without resolution, she continued to seek out new doctors to get additional opinions.

Another patient, C.T., said that the heaviness and pain in her pelvis felt like a “concrete block wrapped in sandpaper,” and that it hurt to do all types of normal activity, including eating. Furthermore, she said: “it started to affect my mental state. Despite being an active person, I didn’t feel like doing things due to the pain and began feeling depressed.”

Don’t Settle for Pain Medications or Hormones to Treat your PVI 

Unfortunately, Pelvic Venous Insufficiency is sometimes under recognized as the root cause of Chronic Pelvic Pain by primary care physicians and gynecologists. Rachel shared that she went to doctor, after doctor, after doctor. “They all performed the same tests, and they all gave me the same answers: they could give me pain medication or hormone therapy. I finally couldn’t take it anymore and really lost my confidence in physicians at that point. I was feeling very frustrated and discouraged.”

What is occurring with PVI is instead of the ovarian veins bringing blood up and out of the pelvis, the veins are faulty and leak, causing blood to be pulled by gravity in the wrong direction. This causes dilation and swelling in the pelvic veins, creating varicose veins and causing pain and discomfort in the pelvic region. For C.T., she felt grateful to finally find a doctor who truly listened to her and who could identify the core problem, saying, “For the first time in my life, I was positive that someone might be able to help me. It was the first time I had felt any relief or hope with my condition.” Thankfully, our interventional radiologists at Vascular and Interventional Physicians (VIP) in Gainesville, Florida are trained in the diagnosis and treatment of PVI.

Characteristics of Patients Suffering from Pelvic Venous Insufficiency

Who is most likely to develop PVI? Patients who typically develop the disorder are women between 25 and 45 years’ old who have had 2 or more pregnancies and who have not yet gone through menopause; however, this is not always the case. Our patient Rachel had experienced two normal pregnancies and had already gone through menopause. Thankfully, at Vascular and Interventional Physicians, we offer minimally-invasive solutions for female patients that are suffering from this disorder that require no hospitalization and little down time.

Talk with Your Primary Care Physician or OB-GYN About Your Possible PVI

So, how do you go about diagnosing and treating PVI? If you’re experiencing the symptoms we have previously described and fall within the demographics of a typical PVI patient, it is possible that you may have the disorder. For next steps, talk with your primary care provider or gynecologist, and he/she can work with you to determine if you might have PVI. If it looks likely, he/she can refer you to an interventional radiologist at our VIP office in Gainesville, Florida.

Work with an Interventional Radiologist at Vascular and Interventional Physicians to Diagnose your PVI

At your appointment at Vascular and Interventional Physicians (VIP), you’ll meet with one of our interventional radiologists to determine if you do have PVI. To do this, your doctor may utilize diagnostic imaging to identify the root cause of your symptoms, including the use of an MRI or CT. If not already performed, transabdominal and transvaginal ultrasound may be used to measure ovarian vein sizes and reflux. Once he reviews your results, he will be able to give you a comprehensive diagnosis with possible treatment options.

Exploring Minimally-Invasive Treatment Options for Pelvic Venous Insufficiency at VIP

After your interventional radiologist has developed your unique treatment plan for addressing PVI, you may be a candidate for a pelvic vein/ovarian vein embolization (PVE/OVE), which is a minimally invasive solution for treating PVI. The embolization is a procedure that uses a catheter to block the blood supply to the faulty veins, causing them to shrink. Rachel worked with Dr. Bret Wiechmann at VIP in Gainesville who, “was very inviting and patient. He took his time to thoroughly explain what was going to happen [with my procedure].”

Most procedures only require moderate sedation and local anesthesia. To place the catheter, the interventional radiologist inserts a thin tube through the vein at the top of the thigh and uses X-Ray (fluoroscopy) to guide it to the vein. X-Ray dye is injected into the veins to identify the catheter position. Once confirmed, tiny coils and/or medications are injected into the blood vessels, which blocks blood flow to the leaky veins and causes them to shrink. C.T. also had a Pelvic Vein Embolization, and she couldn’t believe how quickly she felt relief. “I felt great after the procedure… like I had nothing wrong with me! My relief was instant, and I felt lighter right away. I’m hoping that others suffering from this disorder can read this and seek the treatment that they need.”

Schedule an Appointment at Vascular and Interventional Physicians Today!

Patients that undergo a Pelvic Vein Embolization can see results as quickly as 1-3 days, with minimal downtime. The procedure allows you to recover quickly and to return to a normal work routine within a week. If you think that you might have Pelvic Venous Insufficiency, reach out to your primary care doctor to begin the path towards relief today. Our interventional radiologists at Vascular and Interventional Physicians in Gainesville will be happy to assist you with your diagnosis, treatment and recovery! As C.T. says, “There’s nothing to lose by pursuing this avenue. This disorder is not publicized and is difficult to diagnose. I hope that other women can read my story and find a solution that will work for them. It could really save their life!”