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Featuring Mahmoud Malas, M.D., Assistant Professor of Sugery, Director of Endovascular Surgery at Johns Hopkins Bayview Medical Center
My name is Mahmoud Malas, I’m the director of the Endovascular Surgery at Johns Hopkins Bayview Medical Center. I’m also the director of the Vascular and Endovascular Clinical Research Center at Johns Hopkins Bayview Medical Center.
PAD, or peripheral arterial occlusive disease, is a very common disorder that affects 10% of the general population and up to 20% of the elderly in the United States. It involves blockages, or narrowing, of the blood vessels that circulate the blood to the lower extremities.
Peripheral arterial occlusive disease manifests by difficulty walking or intermittent claudication. The patients have difficulty walking at a certain distance that prevents them from doing their daily activities. As the disease progresses further, the patients will start having pain, even at rest, and often the pain will wake them up from sleep. The pain at this point will be due mainly to not enough blood to the lower extremities and to gravity. A lot of patients get better just by dangling their foot off the bed, or by getting up in the middle of the night and walking around their house.
As the disease progresses further, it affects several vessels circulating the blood to the leg, the patients start having more severe manifestations, such as tissue loss, or ulceration, where any simple trauma can cause a non-healing wound in the foot. And ultimately, the disease can cause gangrene or death to the tissue in the lower extremities.
Peripheral arterial occlusive disease is diagnosed by the doctor listening to their patient and getting a good history. A good physical exam also is very important because the doctor is able to examine the pulses in the patient’s foot. Absence of pulses is a good sign of decreased circulation to the lower extremities. More important is what the patient is feeling and correlating the symptoms to the physical exam. There are several non-invasive testing that the vascular surgeon can order and obtain on their patient. These simple tests can be done with no pain to the patient and will allow the doctor to confirm objectively that the patient has poor circulation to the lower extremities.
The risk factors for developing peripheral arterial occlusive disease are age, smoking, dyslipidemia, or high cholesterol, diabetes mellitus, obesity and family history. Most of our patients are heavy smokers and have been smoking for many years. PAD is a disease of the elderly, so while up to 10% of the general population has it, as we age, the risk of the disease is dramatically increased and it can be as high as 20% of patients over the age of 70. Diabetes is another major risk factor and up to 50% of people with PAD will have diabetes, as well as coronary artery disease.