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Peripheral Arterial Disease

Peripheral Arterial Disease

As many as 12 million Americans are dealing with peripheral arterial disease (PAD), a progressive blockage of the blood vessels that carry blood to the lower extremities.  For many of these patients, amputation is the outcome, leaving them without a foot, or in others, half or more of their leg.  Medical literature has shown that in these patients, their risk of death within 1 to 5 years of their amputation they have a 40% likelihood of amputation of the remaining leg and a significant risk of death.  It’s clearly a serious problem.

But we can reduce the rate of amputation among these patients and we can also reduce the severity of intervention required to address the problem if we catch it early.  Dr. Joseph Ricotta, vascular surgeon and director of the Northside Hearth & Vascular program, stopped by the studio to talk about what can be done to improve patient outcomes for those with PAD.  We talked about the troublesome statistics around peripheral arterial disease, including the fact that among diabetics with PAD who develop a non-healing wound resulting in amputation, as many as 50% of them never receive a non-invasive study that could prevent the loss of their leg.

That means we need our partners in primary care and foot/ankle surgery to take an aggressive stance when presented with patients who are at risk for PAD or who have a poorly-healing wound on their leg or foot.  There are numerous non-invasive studies that take only minutes in the vascular surgeon’s office that can readily identify patients who have blockage affecting blood flow to their feet.  In these cases, if caught early, surgeons like Dr. Ricotta have more options and greater probability they can reestablish adequate blood flow that helps a wound to heal, preventing or mitigating extent of amputation.

We talked about the fact that Northside offers access to 2 of the country’s 10 robotic devices that significantly improves the effectiveness of minimally-invasive procedures by allowing the vascular surgeons to access and treat previously-inaccessible locations.  Additionally, with the assistance of the robot, the surgeons are able to reduce damage that can occur on the inside of the vessel being treated, which reduces the likelihood that scarring after the procedure will block the vessel off again (a leading cause of reocclusion in PAD lesions).

I also spoke with foot and ankle surgeon, Dr. Michael Bednarz of Ankle & Foot Centers of Georgia, whose office is located in Woodstock, just north of Marietta.  He talked about treating PAD patients with wounds from the perspective of the specialist who is tasked with managing the wound and ultimately, treating it surgically as necessary (including amputation when efforts to heal the wound fail and serious infection is a risk).

We talked about the fact that amputation should be viewed as a last-ditch option.  And Mike shared that no patient should face amputation without having had a vascular study to determine if poor flow is contributing to the wound not healing.  He talked about the fact that when he’s presented with a poorly-healing wound, particularly in a patient with PAD risk factors such as diabetes, one of the first things he does is request a vascular study to assess blood flow.  He also utilizes Transcutaneous Oximetry, a non-invasive test that shows how well the tissue at the surface where a wound is located is getting oxygen.

With the results of those studies, he is able to address poor blow flow by referral to a vascular surgeon and/or to hyperbaric medicine (readily available in Atlanta and surrounding suburbs) to address poor oxygen levels in the skin.  He also evaluates other risk factors such as glucose levels and presence of infection, often resulting in consults with infectious disease and/or endocrine specialists to help heal the limb-threatening wound.  We talked about the fact that a multi-specialty approach insures that more patients can avoid amputation and the resultant high mortality rates that come with them.

Early involvement with an experienced wound specialist, vascular diagnostics/intervention, infection control, and endocrinology are all vital in helping patients avoid an amputation that might also cost them their life.

Special Guests:

Joseph Ricotta, MD, Medical Director, Heart & Vascular Institute, Northside Hospital  linkedin_small1  twitter_logo_small  facebook_logo_small3  youtube logo

Northside Vascular

  • Doctor of Medicine, Thomas Jefferson University School of Medicine
  • Surgical Residency, Johns Hopkins University School of Medicine
  • Fellowship, Vascular Surgery, Mayo Clinic
  • Fellowship, Advanced Endovascular Surgery, Cleveland Clinic Foundation
  • Associate Professor of Surgery, Georgia Regents University, University of Georgia School of Medicine

Michael Bednarz, DPM, Ankle & Foot Centers of Georgia  linkedin_small1  facebook_logo_small3  twitter_logo_small  youtube logo

Ankle & Foot Centers of Georgia

  • Doctor of Podiatric Medicine, Kent State University School of Podiatric Medicine
  • Residency, Department of Veteran Affairs Medical Center, Miami
  • Board Certified, American Board of Foot/Ankle Surgery
  • Recognized as a “Top Doc” in the WellStar Health System

Dr. Jon Minter of Northside Total Joint Specialists

Northside Total Joint Specialists

Dr. Jon Minter of Northside Total Joint Specialists

This week I sat down with Dr. Jon Minter of Northside Total Joint Specialists.  In our ongoing monthly series with Northside Hospital we learned about the various conditions that could lead to a total joint replacement.  Dr. Minter shared some great information about some of the techniques he uses now to perform the surgery, including using robotic assistance with portions of the procedure.  Having robotic assistance helps the surgeon minimize surgical trauma to the tissue in the surgical field, making the recovery process proceed more quickly and with less pain.

Dr. Minter talked about the fact that he is able to perform joint replacement for a wide variety of joints from knees, to hips, shoulders, wrists, ankles and even digits.  He is able to repair joint damage from disease processes such as arthritis as well as traumatic injuries.  I was surprised to learn that patients undergoing total hip replacement and total knee replacement can often go home to recover the same day as their surgery rather than staying for several days in the hospital.

Dr. Minter discussed how he takes a conservative approach to joint replacement, exploring non-surgical options where feasible to attempt to give the patient relief of pain while avoiding surgery if possible.  If you or a loved one is experiencing a decrease in activity in an effort to avoid pain you should seek a consultation with this specialist.  You will be pleased to experience his pleasant, personable demeanor.  We talked about the fact that when patients begin to avoid activity in an effort to prevent experiencing pain, they can see their heart health decrease over time, potentially shortening their lives.  Dr. Jon Minton of Northside Total Joint Specialists can help you or your loved ones get your life back through his expert, conservative approach to joint replacement.

Special Guest:

Dr. Jon Minter, DO, of Northside Total Joint Specialists  linkedin_small1 

Northside Total Joint Specialists

  • Doctor of Osteopathy, Kirksville Osteopathic Medicine
  • Residency, Orthopedic Surgery, Parkview Hospital
  • Adult Reconstructive and Arthritis Fellowship, Florida Orthopaedic Institute/Tampa General Hospital
  • Published Study Author and Frequent Lecturer on the subject of Joint Replacement