By Julian J. Javier, MD, FSCAI, FACC, FACP and Leandro Perez, MD, FACC, FSCAI, RPVI
One of the most common conditions for people over 55 years old is vascular problems of the legs, known to many as circulatory problems. Many risk factors like overweight, type of work that required long periods of standing or sitting, family history, hypertension, high cholesterol, smoking, age, amount of pregnancies in women, and others can lead to arterial or venous disorder of the legs that can cause significant disruption of our daily activities and quality of life.
It is estimated that one out of two people over 55 years old will suffer from circulatory conditions of their lower extremity in the United States.
Symptoms can start very subtle, and many blame age and weight as the causes of it. Simple symptoms like heavy legs, cramps at night, dark spots, restless legs, burning sensation, ankle swelling can be signs from venous or arterial disease. Vascular problems can progress quickly and lead to serious problems like chronic ulcers, debilitating legs, and sometimes leads to leg amputations.
Although we refer to circulation problems as a whole, arterial and venous diseases present differently. For instance, for vein problems, the initial symptoms will be the appearance of small varicose veins call spider and reticular veins, then will develop heavy and burning sensations of the legs, dry skin, achy legs, night cramps, and ankle swelling. Not all symptoms are present at the same time. As venous disease progresses, the appearances of bulging varicosities will show, followed by hardening and darkening of the skin called lipodermatosclerosis. Venous disease, unlike arterial disease, is a slower, more insidious onset, unless you develop clots in the large veins of the legs, known as deep vein thrombosis or DVT which, if left untreated, can lead to pulmonary embolism and death, most venous problems of the legs will develop over several years. Bulging varicosities is one of the most common presentations of venous disorders and easy to detect; although bulging varicosities are very common in women with a 3:1 proportion to men, men can develop painful varicose veins. Varicosities are not only esthetically unpleasant; they can also cause pain, discomfort, and affect people’s daily life. Arterial disease is a more acute problem and, if not treated on time, can lead to painful ulcers and, on occasions to limb amputation.
Arterial disease of the legs is most commonly seen in current or former smokers, diabetics, hypertensive, and those with high cholesterol. The most common symptoms are pain with exertion, most of the time, the pain is in the calf, but it can be anywhere in the extremity and sometimes in the buttocks. Pain can present as cramps or sharp and usually relieved by resting—most people complain of cold or numb feet or loss of hair, and some experience weak legs.
Diagnosis is confirmed by performing a detailed physical examination of the legs, checking for pulses, and corroborated using ultrasound and Doppler; with arterial disease; we also add an Ankle-Brachial Index or ABI, which measures the blood flow in your extremities. These tests are simple to perform and done in an office setting.
Once diagnosis is confirmed, then there are multiple treatment options and can be conservative or invasive; it all depends on the severity of the condition.
For more advanced conditions, invasive treatment is needed. Until recently, invasive treatments were mostly surgical, very traumatic with days of recovery in hospital post-surgery; however, in the last decade, the introduction of percutaneous non-surgical techniques procedures has shifted the treatments from surgery to catheter-based interventions that do not require blades or general anesthesia. The same techniques used to open arteries of the heart without surgeries using catheter-based therapy are now the method of choice for the treatment of venous or arterial disease of the legs. The introduction of catheter-based techniques has now caused a shift from a surgical technique to a percutaneous technique that can be done in the comfort of an office without the need of hospitalization, all done under local anesthesia as an outpatient procedure.
Julian Javier, MD and Leandro Perez, MD
Dr. Julian J. Javier and Dr. Leandro Perez are Cardiac and Vascular specialists with a special emphasis on limb preservation and venous disorder. Dr Javier and Dr Perez are board certified in cardiovascular disease and are well known nationally and internationally, authors of multiple articles in prestige peer review journals and book chapters on venous and arterial disease. They are affiliated with Physicians Regional Medical Center and Collier Regional and are accepting new patients.
To Schedule your appointment with Dr. Javier, please call (239) 300-0586.
Naples Heart & Vein
1168 Goodlette-Frank Rd N Naples, FL 34102