Peripheral Arterial Disease - Rajiv Maraj, MD

Ask A Doctor
Rajiv Maraj, MD
Peripheral Arterial Disease

Q: What is peripheral arterial disease (PAD)?
A: PAD is a common circulatory problem in which narrowing of the arteries causes reduced blood flow to the limbs. When one develops PAD, one’s extremities, usually the legs, don't receive enough blood flow to keep up with demand. This causes leg pain during walking. Up to 12 million Americans have PAD and 50-75% of them are undiagnosed. Three out of four adults are not even familiar with PAD. It may be one of the deadliest diseases you've never heard of.

Q: What are the dangers of living with PAD?
A: PAD is likely to be a sign of a more widespread accumulation of fatty deposits in the arteries (atherosclerosis). This condition may result in reduced blood flow to the heart and brain that increases the risk of a heart attack or stroke. If left untreated, severe PAD can lead to gangrene affecting the legs and could result in amputation.

Q: What is the difference between PAD and venous disease in the legs?
A: PAD is due to a problem with the blood going to the legs. Venous disease is usually due to a problem with the blood returning from the legs. Venous disease in the legs (varicose veins) is usually due to a malfunction of the valves in the veins.

Q: Are there cosmetic symptoms of PAD, like varicose veins?
A: Cosmetic symptoms due to PAD include discoloration of the toes and leg sores that do not heal . In more severe cases one may develop gangrene which is the death of skin/soft tissue due to insufficient blood supply.

Q: What are the symptoms of PAD? How do I know if I am at risk?
A: Patients with PAD usually present with buttock and hip, thigh, calf, or foot pain. They may experience pain or cramping in their leg muscles that develops with activity, is relieved with rest, and recurs upon resuming activity (intermittent claudication). Men may present with erectile dysfunction. Some patients notice a discoloration of their toes or may develop leg ulcers that do not heal in more advanced cases.

Q: How do you diagnose PAD?
A: PAD is diagnosed by a healthcare provider after carefully reviewing one’s symptoms and “risk factors” and performing simple tests. Risk factors include age ≥ 70 years, a history of smoking or diabetes, high blood pressure, obesity, high cholesterol, known blockages at other sites (eg, heart, neck vessels, or kidneys). Family history of blockages also plays a role. Decreased foot pulses may be detected on physical exam. This is usually followed by a test called an ABI. This is a simple and non-invasive outpatient test that evaluates blood flow to the legs. Ultrasound may also be used.

Q: What treatments are available for PAD?
A: PAD is managed by reducing the “risk factors.” This includes quitting smoking, treating high blood pressure, diabetes and high cholesterol. Certain medications may help decrease the leg discomfort. Regular exercise is recommended. In patients who have ongoing symptoms despite these measures or severe disease that is threatening the loss of a leg, a percutaneous intervention (without incisions) is generally attempted before surgery since it is less invasive and has fewer cardiovascular risks. This may include angioplasty, stenting or atherectomy which is a minimally invasive method of removing the blockage. Some patients may require surgical bypass which often involves sewing in a graft to go around the blockage.

Q: What is the difference between coronary artery disease and peripheral artery disease? If I have been diagnosed with one of these conditions, how likely is it that I have the other?
A: Coronary artery disease (CAD) refers to blockages in the blood vessels that supply blood to the heart. PAD usually refers to blockages in the blood vessels that supply blood to the legs. The two conditions often occur together. Patients with PAD face up to a 6-7 times higher risk of heart attack, blood clot and stroke.


Q: Is it possible to prevent PAD?
A: One may reduce one’s chances of developing PAD by not smoking, controlling diabetes, high blood pressure, and managing high cholesterol. Regular exercise and a heart-healthy diet are very important. Also practise good foot and skin care. Consider seeing a podiatrist.

Bio:
Rajiv Maraj, MD, is a Cardiologist with Sierra Cardiology and has been practicing in Sonora for close to five years.

Dr. Maraj grew up in South Africa and was inspired by his father, also a physician, to pursue a career in medicine. He attended medical school at the University of Cape Town, South Africa. He trained at Groote Schuur hospital, which is the hospital where the first successful human heart transplant was performed and also where Dr. Maraj found his interest in Cardiology.

Dr. Maraj then underwent further medical training in the United Kingdom, followed by a fellowship in Cardiology Research and a residency in Internal Medicine at Albert Einstein Medical Center, Philadelphia. His fellowship in Cardiology and Interventional Cardiology were completed at the University of California-Irvine. He has been with Sierra Cardiology for close to 5 years.

Along with his wife and 4 year old son, Dr. Maraj enjoys the outdoor activities available in the foothills.