While there are seemingly countless spinal surgical approaches and techniques, all spinal surgeries fall into one of two categories: decompression or stabilization. Decompression involves taking pressure off neurologic structures including the spinal cord and, more commonly, nerve roots to improve function and relieve pain. Stabilization involves restoring structure to one or more spinal segments, i.e. two adjacent vertebra and the intervening disc, by creating an environment for bone to grow from one vertebra to the next. This may be performed to treat gross instability from a traumatic fracture or chronic instability from a degenerative spondylolisthesis.
Peripheral arterial disease, or PAD, is a disease process in which plaque buildup causes the arteries to narrow, resulting in reduced blood flow to the limbs. This can lead to a variety of medical emergencies: Claudication, stroke, uncontrolled hypertension, and possibly amputation.
Over 10 million people in the Unites States and over 200 million worldwide have peripheral arterial disease (PAD).1 Critical limb ischemia (CLI), defined as ischemic rest pain or tissue loss resulting from arterial insufficiency, affects approximately 1% of the adult population, or 10% of patients with PAD.2 Further increasing the impact of CLI is the poor prognosis it carries. Major amputation occurs in 33-67% of patients with ischemic tissue loss at 4 years.3,4 Mortality at 2 years in CLI patients is as high as 40%, and appears to be even higher in those with tissue loss. The vast majority of these deaths are due to cardiac events, cardiovascular disease, and cancer, rather than PAD.4,5
More than 10 million people in the United States are affected by Peripheral Artery Disease (PAD). About one in every twenty Americans over the age of 50 has PAD. Smokers are four times more likely to develop the condition. Peripheral Artery Disease is a strong indicator for potential heart attack and stroke. Most people are aware of coronary artery disease but few know the symptoms of vascular disease. The most common symptom of PAD in the lower extremities is a painful muscle cramping in the hips, thighs and calves when walking or exercising. Other symptoms to be aware of are leg numbness, skin discoloration of the legs or toes & loss of hair on the lower legs.
Lipedema (Lip- fat, edema- swelling) is a disease of abnormal and disproportionate adipose tissue deposition almost exclusively occurring in women1. While the disorder was originally described in 19402, lipedema remains under-recognized and underdiagnosed in the United States3. This article aims to elucidate the salient features of lipedema toward the goal of raising awareness among the medical community.
Peripheral artery disease is a widespread and vastly underdiagnosed disease, affecting nearly 12 million Americans, mostly those over the age of 50, though the incidence increases with age. The most common symptom of peripheral arterial disease is claudication, which is pain, fatigue or aching in the legs when someone attempts to walk. This is due to the poor blood flow to the muscles in the legs. Beyond simply the discomfort in the legs, we know that having peripheral vascular disease makes one much more likely to have poor cardiovascular outcomes. Among patients with symptomatic peripheral arterial disease, more than 10% will have a stroke, heart attack, or die from a cardiovascular cause within two years. And when we look longer term, the statistics are even more sobering. For patients with symptomatic peripheral arterial disease, their mortality rate is 25% at 5 years and 50% at 10 years. When looking at patients with critical limb ischemia (those who have pain at rest or wounds on their feet), the numbers are even worse: they have a mortality rate of 50% at 5 years and 90% at 10 years.
Approximately 12 million Americans suffer from peripheral artery disease (PAD), yet general awareness of the disease is at 25%. Patients over the age of 50 with a history of smoking, high cholesterol, diabetes, hypertension, and heart disease are at the greatest risk. A staggering 50% of PAD patients have unrecognized symptoms that may progress directly to severe disease.
Most people are aware that atherosclerosis can cause blockages in the coronary arteries, resulting in chest pain or heart attack, or in the carotid arteries, precipitating a stroke. But atherosclerosis can lead to another serious but often under-diagnosed condition: peripheral arterial disease (PAD). Defined as atherosclerotic obstruction of the arteries to the lower extremities, PAD causes leg pain and is associated with other cardiovascular disease. Although lower extremity PAD affects an estimated 12 to 20 million people in the United States, only four to five million of them are experiencing symptoms.
Early detection of coronary artery disease is a signiﬁcant problem. One third of deaths after 35 are secondary to cardiovascular disease. One half of middle aged men and one third of middle aged women will develop coronary artery disease. Currently our ability to detect early disease is limited. By the time symptoms occur there is usually 70% obstruction of the coronary artery. Data from autopsies on Korean War casualties indicate initial signs of development of coronary plaque in the early 20’s of age. Theoretically it would seem appropriate to begin prevention therapy as soon as possible but who should get it? Obviously, the patients with known vascular disease and equivalents such as diabetes would need this therapy. Those without established disease need an estimate of their risk.
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