Q&A — Carotid Artery Disease

Q&A — Carotid Artery Disease


My name is Bara Zuhaili. I am a Johns Hopkins vascular surgeon at Howard
County General Hospital. Peripheral arterial disease is when the arteries
that takes blood from your heart up to your brain, to your hand and to your leg start
getting kind of aging, so they start putting some plaque, some calcifications and over
time they start narrowing the lumen that takes blood to the tissue. So as a result, you can have multiple different
symptoms related to lack of blood to that specific tissue or that specific organ. Symptoms with peripheral vascular disease
can vary significantly. You could have significant peripheral artery disease
with absolutely zero symptoms and those are usually the silent most dangerous ones because
you don’t know about them unless it is almost too late. Other people can get some pain in their leg
either when walking or they could have pain just sitting down doing nothing. Other people could have significant tissue
loss meaning ulcers or sores, either in their toes, their heels or any end organ such as
the fingers. Risk factors for peripheral arterial disease
are mostly related to the lifestyle that the patient is leading. The most significant one is smoking. Smoking has been shown time over and over
that it causes significant peripheral arterial disease. Other related factors are related to eating
habit, obesity, also significant family history, meaning having bad genes in your family could
by itself expose you to peripheral artery disease. Also, if you have significant blockage in
your heart arteries that could indicate that you have a blockage somewhere else in your
body. Treatments for peripheral arterial disease
vary depending on the presenting symptoms. Usually, most of the time, and that’s the
cornerstone of what we do, we try to prevent peripheral arterial disease from progressing,
from getting worse. So we spend significant time with the patient
talking about their lifestyle, about their habit, about their smoking, if they do smoke,
so that’s the most important part. There are a few medications that help slow down
the progress, but it doesn’t necessarily reverse the whole blockage that happened. At some point, when we reach a level where
the blockage and the artery is causing significant symptoms whether it is significant pain, tissue
loss, ulcers, sores, then we talk about more aggressive treatment and that would usually
include getting an angiogram. Angiogram usually can give us an idea of where
exactly the blockage is and about 80 percent of the time we are able to fix the blockage
just with the angiogram, without any surgery, without any incision. Twenty percent of the time, the angiogram
that has been done to show us the blockage would not been enough to fix the issue and
that’s when we sit down, we talk with the patient about doing surgical option such as
bypass, endarterectomy or anything to get the blood from point A to point B. Patients who are having surgery for peripheral
arterial disease will vary in terms of their recovery. Most of the time that will involve 2-3 days
stay in the hospital depending on their symptoms, and depends on the extent of the surgery, they
can either go home or they can go to rehab to regain their strength. After that, most patient who undergo peripheral
arterial disease surgery will notice significant improvement almost immediately. So for people who are having pain when they
walk they are expected to have complete resolution of that pain. On the other hand, people who have ulcers,
or sores or tissue loss will take more time for them to notice that result of the surgery,
but eventually they will notice that the ulcer that has been present for month or years before
that will be completely gone. So diabetes and peripheral arterial disease
are linked together at multiple levels. Unfortunately, diabetes makes peripheral arterial
disease progression much faster. As a result, most of the time when we are
dealing with a diabetic patient, we talk with them about very strict control of
their diabetes to prevent the progression of peripheral arterial disease. This usually involves multiple discussions,
refer to an endocrinologist to help us with that. Usually, people with diabetes have more aggressive
disease when it comes to peripheral arterial disease and those patients tend to have a
specific disease pattern in specific locations of their body. So expect them to have specific types of ulcers,
specific types of symptoms that don’t certainly exist with other people.