In this episode of Cardiovascular Matters, Dr. Craig Walker discusses the post-procedure care and follow up for patients who have undergone treatments for venous disease. He covers different types of procedures like stenting of the iliac veins, removal of deep vein clots, and closure of superficial and perforator veins.

Dr. Walker explains the recovery process for each type of procedure. For iliac vein stenting, patients may experience some back pain that typically lasts less than a week. They are also prescribed antiplatelet drugs for at least 3 months. For deep vein clot removal, patients need to take anticoagulants like Xarelto for at least 6 months to a year to prevent clots from returning. Superficial and perforator vein closures have a very short recovery with just pressure applied after the procedure.

He stresses the importance of follow up care, especially for patients who underwent treatment for venous ulcers. Their wounds are checked the following week to ensure proper healing. Various wound dressings and skin substitutes can be used to help large ulcers close. All patients are advised to continue walking and focus on weight loss to prevent recurrence of venous disease.

Dr. Walker and Terry Roberts emphasize that venous disease is more prevalent than other conditions but often ignored. Post-procedure lifestyle changes and medication can help patients finally get relief from debilitating symptoms they may have suffered with for decades.

Key points:

- Recovery timelines for different venous procedures
- Medications prescribed after stenting, clot removal etc
- Importance of follow up checks for ulcer patients
- Ongoing lifestyle measures like compression stockings, exercise
- Impact of venous disease and relief it provides patients

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This episode of Cardiovascular Matters explores perforator veins and their role in non-healing leg ulcers with Dr. Craig Walker. Dr. Walker discusses how perforator veins connect deep and superficial leg veins, and how they can cause high pressure that prevents ulcer healing.

• Perforator veins are connections between deep and superficial leg veins
• They are important not to cause issues like deep vein thrombosis during treatments
• Large perforator veins can apply high pressure to skin and cause ulcer formation

Dr. Walker explains that even with compression stockings, leg elevation and other measures, ulcers may not heal if perforator veins are applying pressure. Historically, perforator veins were difficult to treat due to their small size, but new minimally invasive techniques like laser ablation have revolutionized treatment.

• Perforator veins can cause ulcers to persist even with compression and elevation
• Early treatments were challenging due to size of perforator veins
• Laser ablation uses a thin fiber that can accurately treat perforator veins

Dr. Walker demonstrates how laser ablation of perforator veins is performed using ultrasound guidance, numbing and a laser fiber thinner than a hair. Multiple burns along the vein permanently close it off. This often provides immediate relief and allows ulcers to finally heal.

• Laser ablation is performed with ultrasound guidance for accuracy
• Numbing is given to prevent pain from laser heat treatment
• Multiple burns along the vein length close it off to reduce pressure

If you or a loved one suffers from non-healing leg ulcers, especially if other treatments have failed, perforator vein evaluation and treatment may help. Contact Dr. Walker at Cardiovascular Institute of the South for a consultation.

• Non-healing leg ulcers could be from underlying perforator vein issues
• Evaluation and treatment with Dr. Walker may help ulcers finally heal
• Contact Cardiovascular Institute of the South for a consultation

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Welcome to Cardiovascular Matters, a podcast dedicated to discussing all aspects of cardiovascular health and disease. Today we're joined by Dr. Craig Walker, a leading cardiologist and expert in peripheral artery disease. Dr. Walker will help us understand what PAD is, who is affected, and why early detection and treatment is so important for overall health and longevity. For many, PAD presents no symptoms but it serves as an important indicator of systemic atherosclerosis. Let's listen in as Dr. Walker addresses these topics and more.

Keypoints:

• PAD affects over 28 million Americans
• Major risk factors are smoking, diabetes, family history, high cholesterol, high blood pressure
• Even asymptomatic PAD is a marker for increased cardiovascular risk and death
• Sick legs are rarely attached to totally healthy people
• PAD patients have higher risk of heart attack than those who already had one

Dr. Craig Walker begins the discussion by explaining that peripheral artery disease (PAD) is more common than many realize, affecting over 28 million Americans. The major risk factors for PAD are smoking, diabetes, family history of cardiovascular disease, high cholesterol, and high blood pressure. PAD develops as a result of atherosclerosis, or hardening of the arteries due to plaque buildup. This restricts blood flow to the limbs, usually the legs.

While PAD often causes no symptoms, even asymptomatic PAD is an important marker for increased cardiovascular risk. Dr. Walker discusses studies that showed individuals with PAD are at higher risk of heart attack, stroke, and early death. This is because the same atherosclerotic process affecting the legs is also occurring in other arteries of the body. He emphasizes that screening for PAD is important, as a simple pulse check or ankle-brachial index test can identify patients who may be at risk.

Treatment involves lifestyle changes like quitting smoking, improving diet, increasing physical activity, and managing underlying conditions like diabetes and high blood pressure. Medications are also important such as statins to lower cholesterol, aspirin or Plavix for anticoagulation, and cilostazol to improve leg blood flow. For those with critical limb ischemia, procedures may be needed to restore blood flow through angioplasty or surgery. Dr. Walker stresses the need for a multidisciplinary approach involving primary care, cardiology, and vascular surgery.

In closing, Dr. Walker has emphasized that PAD is a widespread yet often overlooked condition that signifies increased risk for other cardiovascular problems. Simple screening can identify those with PAD, even if asymptomatic, so they can make lifestyle changes and receive the medical care and monitoring warranted by their higher risk profile. A multidisciplinary approach is key to properly managing PAD patients and preventing limb loss or other complications down the road. Thank you for joining us today on Cardiovascular Matters. Be sure to subscribe so you don't miss our next episode, where we will delve deeper into PAD treatment options.

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