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What is Peripheral Artery Disease

The primary function of arteries is to bring oxygen-rich blood from your heart to the rest of your body. Peripheral Artery Disease (PAD) is the narrowing of arteries to the point where the blood is not properly circulated most commonly to your legs. This narrowing results from obstructed arteries due to assembly of fatty deposits overtime restricting oxygen supply. This may result in cramping or leg pain while walking commonly referred to as claudication.


Approximately 8.5 million in the U.S. have PAD equally affecting both men and women.

Diabetics and smokers over the age of 60 are the highest at risk of developing PAD. There are multiple treatment options to manage PAD including lifestyle changes, medications, and minimally invasive procedures.


Causes of Peripheral Artery Disease 

PAD can be caused by multiple factors. The most common factors are listed below. 

  • Most commonly PAD is caused by a build up of plaque in the wall of arteries called atherosclerosis which reduces blood flow.
  • Inflammation of blood vessels
  • Blood clots in the arteries
  • Injury to the limbs


Signs and Symptoms of Peripheral Artery Disease

We at Long Island Heart & Vascular Specialists suggest that you schedule a consultation if you have any of the following symptoms. These symptoms may worsen overtime if left untreated:

  • Cramping in your thigh, hip, or calf muscles as a result of walking or climbing stairs
  • Leg pain at rest
  • Coldness in the feet
  • Swelling in the leg or feet muscles
  • Loss of hair on the legs and feet
  • Aching in the feet or toes
  • Changes in the color of skin (bluish or reddish)
  • Impotence (Men erectile dysfunction)
  • Non-healing wounds


Diagnosis and Risk Factors of Peripheral Artery Disease

Risk Factors of PAD

People having the following risk factors are subject to higher risk of PAD:

  • 60 years or older
  • Smoking
  • Obesity
  • Diabetes
  • High Cholesterol level
  • High blood pressure
  • Lack of physical activity or no exercise lifestyle
  • Family history of PAD or heart disease


There are several ways PAD can be diagnosed. First your doctor will go over your symptoms, signs, medical and family history. If PAD is suspected, certain tests can be performed on your legs: 

Ultrasound Scan

Ultrasound uses high frequency sound waves to look at organs inside the body. This scan helps identify blockages or narrowing of arteries.


Ankle-Brachial Index (ABI)

ABI is the ratio of blood pressure at the ankle to the blood pressure in the brachium (Upper arm). Compared to the arm, lower blood pressure in the ankle suggests congestion of arteries possibly due to peripheral artery disease (PAD).



Angiography is a medical imaging technique where dye that can be seen by X-Ray are injected into the leg arteries. Examined using X-Rays, these images can directly identify any narrowing or blockages inside your arteries.


Treadmill Test

Treadmill test also referred to as Exercise Stress Test is used to find out how well your heart can handle exercise. During this test your heart is monitored with an electrocardiogram. The test can reveal whether the blood supply is reduced in the arteries that supply the heart.


Treatment Options for Peripheral Artery Disease


Treatment for peripheral artery disease (PAD) focuses on managing symptoms and preventing further progression of disease. Patients may accomplish these goals by committing to lifestyle changes and regular exercise. Your doctor may prescribe medications to stop the progression of atherosclerosis and advise the following

Physical Activity

An effective treatment for PAD symptoms is regular exercise. This helps prevents progression of symptoms and may range from simple walking activity to a treadmill exercise program and so on.



Many PAD patients have shown higher cholesterol levels. A diet lower in trans and saturated fats can help control blood cholesterol levels.


Quitting Smoking 

Smoking is a major risk factor for PAD and for heart attack and stroke. Quitting smoking would help slow the progression of PAD and other heart related diseases



This may include medications to help control high blood pressure lower cholesterol blood sugar, and medications to prevent blood clots.


Managing Diabetes/Sugar

Diet changes and regular exercises may work wonders in managing diabetes and as a result may help reduce limb related complications.


Symptom-Relief Medications

This may include medications to help control high blood pressure, lower cholesterol, blood sugar, and medications to prevent blood clots.


Minimally Invasive Options

  • Balloon Angioplasty – Widening of narrowed blood vessel by means of a balloon catheter. A catheter is a thin tube through which a special dye is injected into the bloodstream. A special balloon is inserted through a device in your arm or leg. The balloon is then inflated in the artery to flatten the plaque against the artery wall to allow blood flow. Once the doctor has viewed your arteries on X-ray screen, the balloon is deflated to remove from your body.

  • Stent therapy – A stent is a small, extendable, mesh-like device that is placed inside the narrowed artery through a catheter. The stent helps in expanding the artery across its walls to improve blood flow.

  • Atherectomy- plaque excision – Atherectomy is a way of removing plaque directly from the artery wall. It’s the recommended treatment when PAD is severe. During this process, the doctor shaves plaque off of the artery walls and removes it from the body.


What is Chronic Venous Insufficiency

Our legs are made up of a complex vein anatomy containing valves that when healthy open and close to aid the return of the blood to the heart. If these valves stop working properly and allow blood to flow backward, venous insufficiency or venous reflux occurs and can progress to Chronic Venous Insufficiency. If the blood is not being pushed back to the heart properly it can cause blood in the legs to pool and if left untreated it can progress to varicose veins, pain, swelling, and leg ulcers.


Approximately 30% of the U.S. population has venous disease.

Venous disease is one of the most common health conditions affecting both men and women of all ages. Those at risk of developing venous insufficiency are those with a family history, previous pregnancies and sedentary lifestyle.The disease is progressive in nature which means it can worsen over time if left untreated.


Whether you are experiencing early symptoms or at a chronic stage, you should schedule a consultation with Dr. Gujja who has a proven track record of treating thousands of venous disease patients with minimally invasive treatments out of his outpatient facilities.


Causes of Venous Insufficiency

Venous disease is caused by incompetent venous valves that allow blood to leak backward causing blood to pool in the legs. Venous disease is a progressive disease that may worsen overtime. Below are the factors that cause venous disease.

  • Hereditary – Most common cause

  • Pregnancy or multiple pregnancies

  • Age (40+)

  • Gender

  • Obesity

  • Heavy Lifting

  • Prolonged standing

  • Lack of exercise

Signs and Symptoms of Venous Insufficiency

The experts at Long Island Heart & Vascular Specialists suggest that you schedule a consultation if you have any of the following symptoms that may be disabling or causing pain. The following symptoms can worsen overtime if left untreate

  • Varicose veins

  • Leg or ankle swelling

  • Leg heaviness and fatigue

  • Leg pain, aching, or cramping

  • Burning or itching of the skin

  • Restless legs

  • Skin changes or rashes

  • Ulcers or open wounds

  • Spider Veins or Reticular Veins


Varicose Veins

When the blood pools in the legs due to valve incompetence, it forms a visible bulge and protrusion medically known as varicose veins. Varicose veins can cause physical pain and leave an unappealing raised appearance. If left untreated it can lead to worse symptoms.


Edema (Swelling)

While the earlier stages of venous diseases is not always painful, as it progresses it is common to experience discomfort. The patient can experience fatigue, itchy skin, leg cramps, restless leg syndrome, and edema or swelling


Eczema (Skin Changes)

Eczema, pigmentation and other skin changes can occur during various stages of venous disease. Eczema is where the skin becomes red or scaly while lipodermosclerosis is where the skin gets thick. Brown discoloration of the skin occurs when there is blood leakage from the vessel to the tissue which is a sign of advanced stage of venous disease and may lead to an ulcers.

STAGE 1                                     STAGE 2


STAGE 3                    STAGE 4

Venous Ulcers

A venous ulcer is a sore that takes a long time to heal because of the weak blood circulation in the limb. These ulcers may last for weeks, months or even years. If not treated properly, they can lead to serious problems.


Who Gets Them?

About 1% of Americans experience venous ulcers. Older people and women are more likely to get them. Other causes include:

  • Having previous leg injuries
  • Having varicose veins
  • Smokers
  • Obese
  • Previous circulation problems such as blood clots



A venous ulcer is more like a bump near the ankle that is itchy and causes burning sensation. Other symptoms are:

  • A rash or dry skin
  • Brownish discoloration
  • A foul-smelling fluid in the affected area
  • Worsening pain
  • Fever


Diagnosis and Risk Factors of Venous Insufficiency

Risk Factors

Venous insufficiency is a common disorder characterized by poor blood flow in the veins. Some important risk factors for venous insufficiency may include the following : 

  • Family history
  • Sedentary lifestyle
  • Trauma
  • Prolonged standing
  • Obesity or excess weight
  • Current or previous pregnancies
  • Smoking



Upon consultation, our staff will go over the patient’s complete medical history and conduct a physical exam. One of our team of technicians will then perform a Venous Ultrasound exam which is a non-invasive test where high-frequency sound waves are sent to test the reflection from red blood cells. The test detects blood clots, faulty valves and the problems in connection between the superficial and deep veins.


Treatment Options for Venous Insufficiency


In the past, venous diseases was treated with invasive surgical methods that required long recovery periods for the patient. However, with the advancements in medical technology, there are now multiple non-invasive and minimally invasive options available to treat venous disease. These procedures are performed at our outpatient facility in a matter of no time. At Long Island Heart & Vascular Specialists, we have the latest cutting edge procedures to offer all patients performed by vascular specialists and a dedicated staff ready to help you the moment you give us a call


Compression Stockings

Compression stockings are a preventive tool in the treatment of venous disease. They improve circulation, help prevent blood clots, and can reduce symptoms of venous disease.The process involves squeezing the legs to compress the veins so that the blood flows in the right direction. The squeeze is tight at the ankle and gradually reduces further up the leg. There are a variety of stockings available depending upon the strength ranging from lowest to highest compression. Our staff can provide you with a pair of stockings upon your first consultation. Feel free to contact us today or visit our office to learn more about compression stockings and how they can be useful for your treatment.


Closurefast Procedure

The ClosureFast procedure uses radiofrequency energy to treat patients suffering from venous disease. This procedure is performed in the office under local anesthesia 

  • Minimally invasive
  • Provides improved Patient Comfort
  • Uses heat to close the vein
  • 10-15 minute procedure
  • Next day recovery

Thus far, 900,000 patients in 100 countries have been treated with Closure Fast and is covered by most health insurance plans. 


Venaseal Procedure 

VenaSeal is the only non-thermal non-tumescent procedure performed to treat venous disease that delivers a medical adhesive to close the vein. As a result of not using heat, it eliminates the risk of nerve injury. Clinical research suggests that this procedure is both safe and effective. It is a painless procedure that eliminates the need for tumescent anesthesia which involves multiple needle sticks and compression stockings after the procedure. 

  • Minimally Invasive
  • Painless Procedure
  • No Tumescent Needle Sticks
  • No Risk of Nerve Injury
  • No Need for Post Compession Stockings
  • Same Day Recovery


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