[music] my name is thomas reifsnyder, and i'm avascular surgeon at johns hopkins. my job as a vascular surgeon basically isone of education. every patient that we see we try toeducate not only about their disease but about whatthe treatment options are.
and i try to guide them to what would be the best treatment modality fortheir disease. one of the things that absolutely amazes me is that people will undergo anamputation
of their lower extremity and not get a second opinion before their leg isremoved. peripheral arterial disease requires a lotof expertise and a lot of experience to be able to treat in thebest fashion. i frequently get phone calls fromphysicians and family members of patients. telling me that their loved one is goingto require an amputation. and when i see those patients as a secondopinion. frequently the repair or the re, or thenecessary surgery to save that limb is known as, it, is easily done and
something that can absolutely change thepatient's life. its much better than to do a fairlysignificant operation and save a limb than it is to undergo anamputation. many surgeons and many physicians outthere believe that an amputation solves theproblem. you can get an, a prosthesis and you'll beable to walk again. and you don't have to undergo multipleprocedures to try to save that limb. most patients can actually undergo one ortwo sophisticated operations and save a limb, which will absolutelychange their life.
peripheral arterial disease which, whichused to be called peripheral vascular disease basically is blockage of thearteries going to an extremity. technically, it could involve blockage ofarteries going to the arm or hand. but that's uncommon. the most common is blockage to the lowerextremities. millions of americans have peripheralarterial disease. the most common presentation is nosymptoms whatsoever. in other words, they go to their doctor,and the doctor cannot feel their pulses. there are millions of people in america
who have decreased circulation in theirlower extremities, but because they're getting older, they'renot as mobile, they don't have any symptomswhatsoever. those patients we don't typically see as avascular surgeon. the more common presentation for a patientwith peripheral arterial disease, is someone who develops pain in theircalves or legs when walking. that is called lower extremityclaudication. in the past, we didn't treat that veryaggressively because it's not a threat to the patient's life orlimb.
however in this day and age where we havea variety of minimally invasive techniques particularly in the youngerpatients who have this problem we may aggressively treat it withangioplasty and stenting. the, the risk factors for peripheral arterial disease include smoking,diabetes, high cholesterol, and one that we don't reallythink about, but just aging. as people get older their blood vesselstend to wear out. peripheral arterial disease is manifestedmost commonly as. no symptoms what so ever.
the. the patients gets a routine physicalexamination and the doctor. can't feel pulses. unfortunately a lot of americans don'texercise enough. and if you don't exercise. or don't walk very much. then, there's not a large requirement forblood flow to the legs. and so you could have peripheral arterialdisease and not know it. the most common symptom for peripheralarterial
disease is what we call lower extremityclaudication. and the term claudication actually meansto limp. patients don't actually limp with this. but what they do get is they get pain in their calves or thighs after a certaindistance of, of walking. the nice thing about peripheral arterialdisease is that it's very easy to diagnose. people with lower extremity claudicationhave that symptom every day whenever they walk thatdistance.
it's not like one day they can walk a block, and the next day they can walk amile. it's at one block their calves starthurting or a calf starts hurting consis,consistently every day. the patients that are the toughestpatients to treat are those who present with poor circulation to their lower extremities and severe peripheralarterial disease. these patients can present with a lot ofpain in the foot clearly they won't be able towalk too far.
and sometimes they'll actually presentwith ulceration or gangrene of the foot. these people clearly are clearly need tobe treated and or otherwise, they could end up losing thefunction or, or actually losing their leg depending upon the location of thedisease. whether it's in the arteries near the aorta versus the arteries in lowerextremity. these patients can be treated withangioplasty and stinting, or they can be treated with lowerextremity bypass procedures. a totally different group of patients arethe diabetic patients.
diabetes tends to not only effect thelower extremity arteries, but also extra it also affects the lowerextremity nerves. and the root cause of almost all diabeticfoot problems is the fact that diabetics don't have normalsensation to their foot. this doesn't this, this doesn't allowfeedback from their foot so that if they develop a blister they continue totraumatize that blister until it turns into a ulcer. and in the worst cases, that ulcer then gets infected and can threaten the wholefoot.
diabetics sometimes will have normalcirculation to their foot and sometimes they will have poorcirculation to the foot. so treatment of a diabetic ulcer of thefoot really depends upon whether or not it's infected. and then whether or not the patient haspoor circulation. the treatment of the diabetic foot problemcan involve just local wound care, it can involvepartial reconstruction of the foot, or partial amputation oftoes, toe, or toes of the foot. and or it might involve restoring normalcirculation depending upon the situation.
in the last couple of decades thetreatment of peripheral arterial disease is reallyundergone a revolution. there have been a large number of minimally invasive techniques that havethey've really become quite common, and are quitewidely available across the united states. and what i'm talking about is angioplastyand stinting. angioplasty is inserting a balloon into ablood vessel and opening up the balloon and thereforeopening up the blood vessel. years ago, you might do angioplasty on ablood vessel
that is narrowed but only narrowed over ashort distance. and nowadays, the techniques are availablewhere we can actually take totally blocked up blood vessels and beable to reopen them. generally, this, this also involvesputting in a stent, which is sort of a metal scaffolding thatsorta looks like a chinese finger trap, and thathelps keep open the artery over a longer periodof time. in the worse cases the patient would needa lower extremity operation or a lower extremity bypass operation to beable to restore the blood flow.
the concept is really very straightforward and very simple, they have a blockage and you need to bypassfrom above the blockage where the circulation is stillnormal to below the blockage where the circulation ha been reduced, sothe idea is very straightforward. the actual surgical part can be a littletricky at times and most of the time what we do is, is we create a new bloodvessel out of the patient's own vein. so you are taking a vein which normallycarries blood to the heart. and making it into an artery which nowwill be supplying blood to the extremity. as with most procedures in americanmedicine nowadays.
we've gone to more minimally invasivetechniques. and in vascular surgery, minimallyinvasive techniques involve angioplasty and stinting, or reopeningblood vessels with a balloon or a, a little metal stint orscaffolding to keep the blood vessel open. the real advantage to these procedures arethat they're minimally invasive and therefore are lowimpact on the patient. most of these procedures are done asoutpatients they can be done under local anaesthesia with just atiny bit of sedation. and generally take one to two hours to
perform, and the patients then are, arerecovered for only an hour or two, sometimes three orfour hours and then can go home that same day. most patients really feel nothing otherthan maybe a little soreness at the site where theprocedure is done. which will go away in a couple of days andbasically can re, resume normal or more activity thanpreviously within a day or two. [music]. johns hopkins has a wealth of experiencein
treating lower extremity arterial disease,or peripheral arterial disease. over the last decade johns hopkins hasadded two new endo suites. which are operating rooms that, where you can not only perform angioplasty andstenting. but also operating rooms where you can doopen operations. or you can combine those two techniques. the new johns hopkins hospital will, willbe opening. which has even more sophisticatedfacilities for the treatment of peripheral arterialdisease.
i think the most important aspect of thetreatment of peripheral arterial disease is having an experiencedsurgeon taking care of you.
Diabetic Foot Icd 10,it's not only the techniques involved, butit's the decision making that is most, mostimportant. aggressive treatment of lower extremityarterial disease will result in limb salvage and maintain the amb,mbulatory status of the patient.
Now you know how to deal with your condition, you are much better able to have the appropriate options and alterations in your daily life. Take into account that these tips are only pertinent if you utilize as the majority of them as you possibly can, and for that reason you ought to begin today to see prompt results.
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