Diabetes & Vascular Disease
Bloomfield Vein & Vascular
Diabetes and PAD
Diabetes is a condition that affects the body’s ability to properly deal with sugar, which is a source of energy for our bodies. High levels of glucose damages the inner lining or walls of our arteries, leading to the formation of plaque, a process known as atherosclerosis. Plaque inside of our arteries limits the flow of oxygen-rich blood to the muscles in our lower legs. This is known as Peripheral Artery Disease (PAD) or Peripheral Vascular Disease (PVD).
Dangers of Diabetes
Unlike patients who do not have diabetes, PAD in diabetics is often a silent process, which makes it a very dangerous condition. Often the first sign or symptom that a patient has diabetes is when they develop a foot wound or a foot infection. PAD is silent in diabetics because diabetes tends to damage the nerves in the legs, and this blunts the normal response to pain or discomfort that would be present when there is lack of blood flow.
The combination of reduced blood flow and damaged nerve leads to a silent, dangerous condition
Diabetics tend to have blocked arteries in the lower leg, between the knee and the ankle, known as the tibial arteries. Because of this, blood flow to the foot and toes is markedly restricted. Diabetics also tend to have changes to the skin that causes the skin to dehydrate more readily and there are changes to the small muscles and tendons on the feet that cause changes to the shape of the foot. The changes to the foot cause diabetics to walk differently (without realizing it) and as a result of these changes in how diabetics walk, there tends to be pressure in areas of the foot that are not meant to have pressure. The combination of skin that dehydrates more readily, which can lead to small skin tears, different, abnormal pressure points on the foot and toes, and restrictions to blood flow in the arteries, lead to the development of wounds on the foot or the toes. Diabetics also tend to have impaired healing.
This is an angiogram (picture of the arteries) showing blood flow below the knee, including a completely occluded AT artery and a disease peroneal artery. A 3rd artery, the Posterior Tibial (PT) is also occluded and not seen
Because of these factors, diabetics are at risk of developing wounds on their feet or toes that do not heal. Because the nerves are not working properly, these wounds sometimes are not associated with pain. Although prevention is key, once you develop a wound, you need to be properly evaluated and an effective treatment plan must be established to minimize the potential for limb loss.
This image shows the typical location of wounds that develop in diabetics.
What We Offer
At Bloomfield Vein & Vascular, we have the expertise to help manage your diabetes and PAD. We will examine you, perform a specialized ultrasound test and if it is necessary, recommend a minimally invasive approach to deal with the arteries that are blocked and are not providing appropriate flow to your foot and/or toes. It is important that you understand that the management of this condition is complex and as a vascular surgeon with close to two decades of experience, I can help you in this regard.
Our office has a state-of-the-art angiography suite that allows us to treat your PAD safely and without hospitalization. We have access to the latest technology to minimize complications, using advances such as IntraVascular Ultrasound (IVUS) to see the inside of your arteries and using CO2 instead of IV contrast to decrease the risk of kidney damage. We work closely in collaboration with your primary care doctor, podiatrist and/or endocrinologist to ensure the best results and minimize the risk of an amputation.
The following angiograms shows before and after treatment of tibial disease in a diabetic patient, whose image was seen at the top of this page (3rd image).
The image on the LEFT captures the narrowing of the AT artery as a result of plaque. After minimally invasive treatment (atherectomy and angioplasty), restoring flow in the diseased peroneal and AT arteries.