Podcasts about peripheral arterial disease

Welcome to the Hot Topics podcast from NB Medical with Dr Neal Tucker. In this edition, we look at three new pieces of research.First, in the BMJ, a paper exploring whether a GP-led psychological intervention can help PTSD symptoms in our patients after ICU. Could this also be successful for other forms of trauma?Second, in the Lancet, research looking at whether semaglutide can improve walking distance in patients with diabetes and intermittent claudication.Finally, in the BJGP, can a practice-led physical activity intervention improve symptoms in survivors of cancer? Will anyone actually want to do it? The answer, and who, may surprise you.ReferencesPoor by Katriona O'SullivanBMJ PTSD paperLancet GLP1ra and PADBJGP Physical activity and cancer survivorsMoving Medicinewww.nbmedical.com/podcast

In this Healthed lecture, Dr Shannon Thomas provides a refresher on the presenting symptoms and signs of PAD, as well as its assessment and diagnosis. He will also outline the latest management options for this condition, including the advances in endovascular surgery that are reducing the risk of leg amputation in severely affected patients.See omnystudio.com/listener for privacy information.

Breaking Into Medical Sales: Gina Torres's Journey from Nurse to Industry Expert In this inspiring episode, Gina Torres, a seasoned peripheral vascular representative, shares her incredible transition from a peripheral vascular nurse to a top medical device sales expert at Shockwave. Discover how she leveraged her clinical background to drive innovation and improve patient outcomes, particularly in preventing amputations for those with peripheral arterial disease. Gina dives deep into the transformative power of intravascular lithotripsy technology and the critical role medical sales professionals play in advancing treatment solutions. She also sheds light on the evolving responsibilities of clinical specialists, balancing in-depth product knowledge with the art of sales. If you're considering a career in medical sales, Gina offers invaluable advice on how individuals from non-clinical backgrounds, such as marketing professionals, can successfully break into the industry. She also opens up about the challenges of balancing a demanding career with family life, sharing practical strategies for success. From launching Nurse Elevator to help nurses and techs transition into medical sales to her go-to book recommendation, Influence by Robert Cialdini, Gina's insights are packed with actionable takeaways. And, of course, we wrap up with a fun lightning round, including her must-try meal at Pecan Lodge in Dallas. Whether you're a healthcare professional, an aspiring medical sales rep, or simply curious about this dynamic field, this episode is packed with motivation, industry knowledge, and career-changing insights! Meet Gina: Gina is a former ICU and Interventional Radiology nurse who successfully transitioned into the medical device industry, where she is now an executive sales representative and a recognized expert in peripheral vascular interventions. Despite having no formal sales training, her deep clinical expertise and firsthand understanding of patient care have propelled her to excel in the field. She began her industry journey as a Clinical Support Specialist, where she quickly mastered the sales process with the guidance of exceptional mentors. Her ability to bridge the gap between clinical knowledge and sales strategy led her to secure a sales role, where she has since earned back-to-back President's Club awards. Passionate about helping other healthcare professionals leverage their skills beyond the bedside, Gina founded **Nurse Elevator**—a platform dedicated to guiding nurses, techs, and other clinicians into medical device sales and related non-hospital careers. She firmly believes clinicians bring unmatched value to the industry due to their deep understanding of patients and treatment algorithms. Through Nurse Elevator, Gina is on a mission to create a supportive and educational community that empowers healthcare professionals to confidently explore new opportunities. Connect with Gina: LinkedIn Connect with me: LinkedIn Love the show? Subscribe, rate, review, and share! Here's How » Want to connect with past guests and access exclusive Q&As? Join our EYS Skool Community today! The views and opinions Gina expressed are her own and not a reflection of Shockwave Medical or Johnson and Johnson MedTech.  

Read the article here: https://journals.sagepub.com/doi/full/10.1177/30494826241296674

The questions answered in this podcast are listed below.They were compiled by GPs and health professionals around Australia. Tell us exactly what we're talking about when we say peripheral artery? What about the incidence of peripheral arterial disease? Is it improving because less people are smoking or are you seeing no change in the incidents? How do these diseases present to general practitioners? How do mesenteric arteries and renal arteries present? If a patient developed small bowel infarction what is the mortality rate? What could help GPs lower the threshold and increase index of suspicion? How bad do your kidneys need to be before you start developing peripheral artery disease? What about the presence of some very significant proteinuria? Would you rate carotids as a peripheral arterial disease? How hard should GPs look for other vascular disease in a patient who either has peripheral arterial disease or coronary arterial disease or cerebral vascular disease? What are the red flags? Case: A patient with significant peripheral arterial disease who is being managed by a cardiologist and is stable enough for medical treatment, with no immediate need for surgical intervention. What lies ahead for these patients, apart from managing their cardiovascular risk factors? What are the chances that they recur? How many times can you redo small arteries? When discussing medical treatment, are you referring to the full range of polypharmacy, including medications for hypertension (antihypertensives), cholesterol management (statins), and blood clot prevention (antiplatelet drugs like aspirin)? And if so, are some medications more effective than others in these cases? Are there any special considerations for GPs when managing patients who are on both a DOAC and an antiplatelet agent, or those on triple therapy? Host: Dr David Lim | Total Time: 39 mins Expert: Dr Shannon Thomas, Vascular and Endovascular Surgeon Register for our fortnightly FREE WEBCASTSEvery second Tuesday | 7:00pm-9:00pm AEDT Click here to register for the next oneSee omnystudio.com/listener for privacy information.

Send us a textIn this episode, Dr. Maya Stein (General Internal Medicine fellow) interviews Dr. Beth Abramson (Cardiologist) on the 2022 CCS guidelines for peripheral arterial disease. Support the show

Guest Lola Coke, PhD, ACNS-BC, FAHA, FPCNA, FAAN, describes the impacts on smoking and peripheral aretry disease, as well as how to help patients with behavior change strategies for tobacco cessation. Resources:Stages of Change Theory: https://www.ncbi.nlm.nih.gov/books/NBK556005/ PCNA Behavior Change Mini-Certificate: https://pcna.net/online-course/behavior-change-mini-certificate/PCNA Heart Healthy Toolbox: https://pcna.net/clinical-resources/patient-handouts/heart-healthy-toolbox/ See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

PAD

This month our paediatric section includes a metabolic case and we talk about information sharing required by section 47 of the Children's Act and we update on how Martha's Law is being implemented in our trust.In the adult section we discuss safeguarding adults where self neglect may be an issue, Acute Limb Ischaemia and Silver Trauma.British Inherited Metabolic Diseases Group: https://www.bimdg.org.uk/site/index.aspMartha's Rule: https://www.england.nhs.uk/patient-safety/marthas-rule/Self Neglect- Section 14 Care Act 2014: https://www.scie.org.uk/self-neglect/at-a-glance/Peripheral Arterial Disease: https://cks.nice.org.uk/topics/peripheral-arterial-disease/RCEM Silver Trauma Safety Alert: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://rcem.ac.uk/wp-content/uploads/2021/10/Safety_Alert_Silver-Trauma_2019.pdf

Dr. Miles Sugar talks about peripheral arterial disease (PAD) symptoms and treatment options. PAD is primarily caused by the buildup of plaque in the arteries, especially in the legs, causing leg pain, discomfort, or cramping due to a decrease in blood flow to the legs and feet.

The prevalence of peripheral arterial disease (PAD) is surging due to cases related to diabetes. Benjamin Pearce, M.D., a vascular surgeon, discusses management of PAD by highlighting three non-operative advancements, including exercise therapy. Learn how PAD can be diagnosed using an ankle-brachial index. Dr. Pierce explains how a multi-disciplinary team manages this condition and how they intervene early to prevent chronic limb-threatening ischemia.

As part of a community health partnership with Valley Health, host Janet Michael welcomes Dr. Shashank Sharma, a vascular surgeon with Valley Health Vascular Surgeons at Winchester Medical Center. Their topic today focuses on peripheral arterial disease (PAD) in observance of September being PAD Awareness Month. The conversation covers what PAD is, its differences from coronary artery disease, common locations of blockages, and the demographics most at risk. Dr. Sharma explains that PAD involves plaque blockages outside the heart, which can occur in various parts of the body, including the limbs, abdomen, and neck. They also discuss the prevalence of PAD, highlighting that around 30 million Americans may suffer from it, although many remain asymptomatic due to the body's natural adaptive mechanisms. Dr. Sharma outlines the risk factors, including high blood pressure, poorly controlled diabetes, and smoking, and emphasizes the importance of early detection and awareness. The discussion also touches on the symptoms of PAD, which vary depending on the affected arteries, and the diagnostic tools used, such as ultrasound. Treatment options for PAD are explained, including endovascular approaches using wires, catheters, balloons, and stents, and the more traditional open surgeries akin to heart bypass surgeries. In addition to PAD, Dr. Sharma talks about other vascular conditions treated at Valley Health, such as aneurysms and blood clots, and their respective treatments. He stresses the importance of awareness and timely consultation with healthcare providers for effective management of these conditions. The episode wraps up with a call to action for listeners who might have PAD symptoms or a family history of the disease to consult their primary care physicians and consider referral to a vascular surgeon for specialized care. Dr. Sharma also highlights the long-term patient relationships that develop in the field of vascular surgery. To listen to more conversations in this series, visit: https://bit.ly/VHhealthpod 

The use of drug-coated balloons (DCBs) for peripheral arterial disease has been controversial in the past. However, new data and updated FDA guidance have helped these devices regain popularity. In this episode of the BackTable Podcast, Dr. Ally Baheti hosts a discussion with Dr. Sahil Parikh, an interventional cardiologist in New York City, and Dr. John Park, a vascular surgeon in Omaha. --- CHECK OUT OUR SPONSOR BD Lutonix https://www.bd.com/en-us/products-and-solutions/products/product-families/lutonix-drug-coated-balloon-pta-catheters --- SYNPOSIS They review the historical controversy surrounding the potential late-mortality risks associated with Paclitaxel-coated devices, discuss more recent literature on the safety and efficacy of DCBs, and examine the implications of the FDA's updated guidance in 2023. This update was made possible through collaborative efforts across specialties and regulatory bodies to establish best practices for vascular interventions. They also delve into patient selection criteria, lesion characteristics, and practical considerations for choosing between DCBs and other revascularization options. Each provider shares their treatment algorithm for DCB use in peripheral arterial disease. Dr. Park uses DCBs as a first-line treatment for patients with complete occlusions, CLTI symptoms, or lifestyle-limiting claudication, with adjunctive stenting sometimes required afterwards. In his experience, DCBs work best in lesions shorter than 100 mm and are preferable in locations where stenting is not feasible, such as across the knee joint. Dr. Parikh similarly prefers DCBs over plain balloon angioplasty and places stents in longer lesions. He notes that Hunter's canal is a challenging area to treat with DCBs alone and may require atherectomy or intravascular lithotripsy. He recommends considering drug-eluting stents as a proactive measure to prevent more costly interventions for future restenosis. --- TIMESTAMPS 00:00 - Introduction 02:14 - History of DCB and Controversy 07:46 - Updated Research and 2023 FDA Guidelines 16:44 - Importance of Collaboration and Patient Preference 26:34 - DCB Treatment Algorithms 33:31 - Drug-Eluting Stents 35:46 - Approach for Patients with Claudication 37:22 - DCB Sizing and Dose --- RESOURCES Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (2018): https://www.ahajournals.org/doi/10.1161/JAHA.118.011245 FDA- Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality–Letter to Health Care Providers (2018): www.fda.gov/medical-devices/letters-health-care-providers/update-treatment-peripheral-arterial-disease-paclitaxel-coated-balloons-and-paclitaxel-eluting FDA- Paclitaxel-Coated Devices to Treat Peripheral Arterial Disease Unlikely to Increase Risk of Mortality - Letter to Health Care Providers (2023): https://www.fda.gov/medical-devices/letters-health-care-providers/update-paclitaxel-coated-devices-treat-peripheral-arterial-disease-unlikely-increase-risk-mortality Mortality in randomised controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis (2023): https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02189-X/abstract

An estimated 8 million Americans are affected by peripheral arterial disease, also known as peripheral artery disease (PAD). This condition can cause leg discomfort when walking or more serious problems such as pain in the foot at rest, toe ulcers, toe infections and gangrene.   In this month's podcast, moderator Lillie Shockney is joined by vascular surgeon Dr. Rebecca Marmor, an assistant professor who specializes in the open and endovascular treatment of a wide range of vascular conditions.

More clinical pearls from ACP #IM2024, including emerging infectious diseases in the US (malaria, dengue, super gonorrhea, and a resurgence of syphilis), new C. diff treatments, coagulopathy and cirrhosis, fatty liver disease, HFpEF, peripheral arterial disease, Lp(a) and ApoB, CAR T-cells for autoimmune disease, SGLT2i for gout, and hematology updates. Paul and Watto are joined by Drs. Nora Taranto, Beth Garbitelli, and of course Chris “The Chiu Man” Chiu. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Tropical Diseases: Resurgence of Malaria and Dengue Fever 03:44 Infectious Diseases: Syphilis Rates and New Treatments for C. diff 08:28 Coagulopathy and Cirrhosis: Managing Hemostasis and Portal Vein Thrombosis 11:34 Fatty Liver Disease: Risk Stratification and Treatment 14:59 Cardiology Updates: Cardiovascular Kidney Metabolic Syndrome 31:03 New Medications for Hypertension 32:54 Renal Denervation and Hypertension 33:51 Lp(a) Drugs and Their Potential 36:01 Peripheral Arterial Disease and Claudication 38:10 SGLT2 Inhibitors and Gout 41:50 APO-B and LDL Cholesterol 42:45 Secondary Hypogonadism and Head and Neck Radiation 45:30 VEXAS: A Genetic Autoimmune Condition 49:08 Obesity-Induced Leukocytosis 52:49 CAR T-Cell Therapy in Rheumatologic Diseases Credits Producers/Writers/Show Notes: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD, Chris Chiu MD, Beth Garbitelli MD CME, Cover Art: Beth Garbitelli MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Nora Taranto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Sponsor: Litter Robot Go to stopscooping.com/CURB and enter promocode CURB to save an EXTRA $50 on any Litter-Robot bundle. Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Beginly Visit beginlyhealth.com/curbsiders for the job matching platform for every Physician and Advanced Practice Clinician, from training to practice

Special Guest: Kevin Thomas Morgan Website: https://inspirationalselfhelpbooks.com  

Dr. Miles Sugar is a vascular surgeon with Willis Knighton Vascular Surgery. He shares common symptoms, risk factors, prevention steps, and treatment options related to peripheral arterial disease.

More and more Americans rely on prostheses. They're custom-fitted, highly personal, and extremely expensive. Zachary Crockett investigates. SOURCES:Jordan Beckwith, YouTuber and advocate.Eric Neufeld, owner and medical director of Agile Orthopedics. RESOURCES:"Medicare Coverage of Durable Medical Equipment & Other Devices," by Medicare (2024)."Limb Loss in the U.S.," infographic by the Amputee Coalition (2022)."A Robot Hand Helps Amputees 'Feel' Again," by Jeffery Delviscio (Scientific American, 2019)."Differences in Myoelectric and Body-Powered Upper-Limb Prostheses: Systematic Literature Review," by Stephanie L. Carey, Derek J. Lura, and Jason Highsmith (Journal of Rehabilitation Research and Development, 2015)."Local Coverage Determination: Lower Limb Prostheses," from the Medicare Coverage Database (effective 2015)."Variation in the Care of Surgical Conditions: Diabetes and Peripheral Arterial Disease," by Philip P. Goodney, Nino Dzebisashvili, David C. Goodman, and Kristen K. Bronner (Dartmouth Atlas of Health Care Series, 2014)."Estimating the Prevalence of Limb Loss in the United States: 2005 to 2050," by Kathryn Ziegler-Graham, Ellen J. MacKenzie, Patti L. Ephraim, Thomas G. Travison, and Ron Brookmeyer (Archives of Physical Medicine and Rehabilitation, 2008).

This recording features audio versions of March 2024 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Transarterial Embolization of Simple Pulmonary Arteriovenous Malformations: Long-Term Outcomes of 0.018-Inch Coils versus Vascular Plugs ReadClinical Utility of Infrapopliteal Calcium Score for the Evaluation of Severity of Peripheral Artery Disease ReadPatient-Reported Outcomes and Return to Work after CT-Guided Percutaneous Lumbar Discectomy: A Prospective Study ReadMagnetic Compression Anastomosis of Benign Short-Segment Ureteral Obstruction ReadPulsed Electric Field Ablation versus Radiofrequency Thermal Ablation in Murine Breast Cancer Models: Anticancer Immune Stimulation, Tumor Response, and Abscopal Effects ReadSmartphone Augmented Reality Outperforms Conventional CT Guidance for Composite Ablation Margins in Phantom Models Read JVIR and SIR thank all those who helped record this episode:Host and audio editor:Manbir Singh Sandhu, University of California Riverside School of MedicineAbstract readers:Brian Ng, Saint Louis University School of Medicine, MissouriAndrew Brandser, Frank H. Netter MD School of Medicine at Quinnipiac UniversityEric Chang, MS, University of Illinois College of MedicineJustin Cook, University of Central Florida College of MedicineMillennie Chen, University of California Riverside School of MedicineVasan Jagadeesh, University of California San Diego School of Medicine ©  Society of Interventional RadiologySupport the show

On this episode of the PTA Elevation Podcast, host Briana Drapp, SPT, PTA, CSCS goes over the important things to know about Peripheral Arterial Disease when studying for the NPTE. At the end of this episode, Briana provides and reviews a sample question that helps students get a feel for how this subject will be asked on the NPTE - PTA. Tune in to learn more! REGISTRATION FOR MASTERCLASS: https://ptaelevation.com/masterclass Check out our FREE stuff!: https://ptaelevation.com/freebies Website: https://www.ptaelevation.com/ Join our FB group for FREE resources to help you study for the exam!  https://www.facebook.com/groups/382310196801103/ If you're interested in our prep course, check it out here:  https://ptaelevation.com/the-600-plus-system Follow us on our other platforms! https://www.ptaelevation.com/linktree

Peripheral Arterial Disease also known as PAD may be a little known disease but it affects approximately 12 million people in the United States according to the American College of Cardiology. PAD is a form of CVD, or cardiovascular disease. In combination with heart attacks, heart failure, strokes, aneurysms, and other types of CVD, PAD contributes to the nation's No. 1 cause of death. But there are many misconceptions about PAD. John Eidt, MD, RVT, RPVI, FACS, the Chief of Vascular Surgery for Baylor Scott & White Heart and Vascular Hospital – Dallas, helps explain what PAD is, risk factors for PAD and answer some of the most frequently asked questions about PAD.

Today, Dr. Ezra Schwartz and Dr. Nakia Sarad continue exploring how vascular surgeons and patients communicate. They discuss how we share stories and what may get lost in translation. Dr. Rita Charon is a general internist, professor of medicine, and professor and founding chair of medical humanities at Columbia University. Dr. Charon originated the field of narrative medicine and is the founder and executive director of the Program in Narrative Medicine at Columbia. A literary scholar, Dr. Charon completed a Ph.D. in English at Columbia, concentrating on narratology and the works of American-British author Henry James. She is the author of Narrative Medicine: Honoring the Stories of Illness, co-author of Principles and Practice of Narrative Medicine, and co-editor of Stories Matter: The Role of Narrative in Medical Ethics and Psychoanalysis and Narrative Medicine. Dr. Abraham Fuks is a clinical immunologist, a Professor in the Department of Medicine and Division of Experimental Medicine at McGill University, a Professor of Oncology at the Goodman Cancer Institute, and served as Dean of the McGill University Faculty of Medicine from 1995 to 2006.  Dr. Fuks' has published on the metaphors of medicine and ethics in clinical research. In 2021, Dr. Fuks published a book, The Language of Medicine, in which he explores the ability of language to heal or harm and the potent metaphors prevalent in clinical care, especially military metaphors. Dr. Anahita Dua is a vascular surgeon at the Massachusetts General Hospital, an associate professor of surgery at Harvard Medical School, and a frequent guest on Audible Bleeding.  Resources: Dr. Charon's related works: Narrative Medicine: Honoring the Stories of Illness The Principles and Practice of Narrative Medicine Stories Matter: The Role of Narrative in Medical Ethics and Psychoanalysis and Narrative Medicine TEDx Talk Dr. Fuks' related works: The Language of Medicine The Mindful Medical Learner Podcast featuring Dr. Fuks Arthur Frank, The Wounded Storyteller: Body, Illness, and Ethics  Dr. Dua's related works:  Epidemiology of Peripheral Arterial Disease and Critical Limb Ischemia Peripheral Artery Disease: Where We Are and Where We Are Going Validated QOL surveys and Patient Reported Outcome Measures: PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories): Overview of Design and Rationale of an International Prospective Peripheral Arterial Disease Study Patient-Reported Outcomes for Peripheral Vascular Interventions for the Vascular Quality Initiative Eric Cassell & Functionality Vasc QOL Questionnaire  PAD QOL Questionnaire Vasc QL-6 Questionnaire European QL 5D 5L Questionnaire X Handles (previously known as Twitter): Dr. Anahita Dua (@AnahitaDua) Dr. Rita Charon (@RitaCharon) Dr. Abraham Fuks (@Abe_McGill) Dr. Ezra Schwartz (@ezraschwartz10) Dr. Nakia Sarad (@NakSaradDO)

We welcome a new speaker, Frank Guerriero who is discussing Peripheral Arterial Disease. Frank is the Nurse Practitioner for the Vascular and Endovascular Surgery Department at Flinders Medical Centre situated in Adelaide, South Australia and he is currently undertaking a PhD project looking at the use of augmentative technology in the healing of limb-threatening diabetic foot ulcers.

Commentary by Dr Song-Young Park

“Challenges in Performing Research in Patients with Peripheral Vascular Disease” The Anne Klibanski Visiting Lecture Series was created to support and advance the careers of women. These lectures offer the opportunity for women faculty from outside institutions that have hosted Anne Klibanski Scholars to present on their expertise, either alone or in tandem with an Anne Klibanski Scholar. Presenter: Jennifer A. Rymer, MD, interventional cardiologist and John Bush Simpson Assistant Professor of Medicine at Duke University Learning Objectives Upon completion of this activity, participants were able to: Examine challenges in enrolling diverse patients with peripheral arterial disease (PAD) Examine recent clinical trials/registries in patients with PAD and the need for diverse patient enrollment Identify several potential solutions for enrolling underrepresented minorities and women into registries/clinical trials of patients with PAD Click here to watch webinar.  

In this episode, we will discuss all things peripheral arterial disease – definitions, staging, clinical presentation, risk factors, goals of therapy, and guideline-directed medication therapy recommendations including the newest evidence for the use of DOACs. Key Concepts Addressing modifiable risk factors (weight loss, smoking cessation, blood pressure and blood glucose control, dyslipidemia, structured exercise program, etc.) are recommended for the treatment of PAD. Single antiplatelet therapy with either aspirin 81 mg or clopidogrel 75 mg daily are recommended in patients to reduce stroke, MI and other vascular deaths in symptomatic (1A) and asymptomatic patients (IIa- C-EO). Rivaroxaban 2.5 mg BID, when added to aspirin 81 mg daily, is superior to aspirin alone in preventing composite outcome of stroke, MI, and CV death in PAD patients with recent revascularization surgery for PAD but increases the risk of major bleeding. In the absence of heart failure, cilostazol is effective in improving symptoms, quality of life, and increasing walking distance in patients with intermittent claudication.  References Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135:e686–e725. https://doi.org/10.1161/CIR.0000000000000470 Criqui MH, Matsushita K, Aboyans V, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2021;144:e171–e191. https://doi.org/10.1161/CIR.0000000000001005 Alonso-Coello P, Bellmunt S, McGorrian C, Anand SS, Guzman R, Criqui MH, Akl EA, Vandvik PO, Lansberg MG, Guyatt GH, Spencer FA. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e669S-e690S. doi: 10.1378/chest.11-2307. PMID: 22315275; PMCID: PMC3278062. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med. 2017; 377:1319-1330. https://www.nejm.org/doi/full/10.1056/nejmoa1709118 Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in peripheral arterial disease after revascularization. N Engl J Med. 2020; 382:1994-2004. https://www.nejm.org/doi/full/10.1056/nejmoa2000052

This week we are back with another pathology, Peripheral Arterial Disease, to continue our cardiovascular series.We'd highly recommend checking out the clinical handbook "Mind the Gap" which highlights how clinical signs and symptoms can appear differently on black and brown skin, essential reading for any clinician: https://www.blackandbrownskin.co.uk/mindthegap 

Hosts: Ocean Setia is a PGY-5 Vascular Surgery Integrated Resident. Keyuree Satam is a 4th year medical student at Yale.Survey: https://yalesurvey.ca1.qualtrics.com/jfe/form/SV_es8u2Dgef2a6i46Papers:Percutaneous radial artery access for peripheral vascular interventions is a safe alternative for upper extremity accessPercutaneous proximal axillary artery versus femoral artery access for endovascular interventionsNew imaging technology system reduces patient radiation dose during peripheral arterial endovascular interventionsRates of Intervention for Claudication versus Chronic Limb-Threatening Ischemia in Canada and United StatesGender Differences in Outpatient Peripheral Artery Disease Management in Germany: A Population Based Study 2009–2018Prediction of Technical Failure of Inframalleolar Angioplasty in Patients with Chronic Limb Threatening IschaemiaAlternative autologous and biologic conduits have worse outcomes than prosthetic grafts for infrainguinal bypass in patients with chronic limb-threatening ischemiaNon-reversed and Reversed Great Saphenous Vein Graft Configurations Offer Comparable Early Outcomes in Patients Undergoing Infrainguinal BypassEversion Endarterectomy – An Alternative Approach to Occlusive External Iliac Artery diseaseRates of Conversion from Dry to Wet Gangrene Following Lower Extremity RevascularizationComparison of Aortobifemoral Bypass to Aortoiliac Stenting with Bifurcation Reconstruction for TASC II D Aortoiliac Occlusive DiseaseFollow Us: Twitter @YaleVascular, Instagram @yalevascularEmail: ocean.setia@yale.edu, keyuree.satam@yale.edu

In a continuing series focused on vascular surgery, host Rick Greene, MD, FACS, talks to vascular surgeon Britt Tennessean, MD, FACS, about carotid occlusive disease and peripheral arterial disease. Britt H. Tonnessen, MD, FACS, is Associate Professor of Surgery, Division of Vascular Surgery & Endovascular Therapy; and Associate Program Director, Vascular Integrated Residency, Yale University School of Medicine. Learn more about Selected Readings in General Surgery, an American College of Surgeons publication that highlights highly relevant and practice-changing information from the world's most prominent medical journals.  #SurgicalReadings

In this episode of The Retrograde Approach, Sam and Yogi take an introductory look at peripheral arterial disease.

Peripheral Arterial Disease, or PAD, is a very common condition but this may be the first time you've ever heard of it. Dr. Mina Guerges discusses PAD, who is most likely to develop it, possible symptoms, and more.

Daily Cardiology Symposium 1401: Peripheral vascular diseases

In this episode we discuss a recent paper published in The Canadian Journal of Cardiology entitled Canadian Cardiovascular Society 2022 Guidelines for Peripheral Arterial Disease and co-authored by a national team of Canadian expertsWe are joined today by the two of the authors, Dr Sonia Anand and Dr. Eric KaplovitchDr. Sonia Anand is Professor of Medicine and Epidemiology, and a Vascular Medicine specialist at Hamilton Health Sciences. She holds the Canada Research Chair in Ethnic Diversity and Cardiovascular Disease (Tier 1) and is the Heart and Stroke Foundation of Ontario/Michael G DeGroote Chair in Population Health Research. Dr. Anand is a senior scientist at the Population Health Research Institute, and Director of the Chanchlani Research Centre, McMaster University. Her research focuses on the environmental and genetic determinants of vascular disease in populations of varying ancestral origin, women and cardiovascular disease, and peripheral artery disease. Dr. Anand graduated as a Doctor of Medicine from McMaster University in 1992. She completed internal medicine training at McMaster University and a Fellowship of the Royal College of Physicians and Surgeons of Canada, Ottawa, in 1996. Dr. Anand completed a thrombosis fellowship in 1997-98 under the supervision of Dr. Jeffrey Ginsberg at McMaster University, and Vascular Medicine Fellowship under the supervision of Dr. Mark Creager at the Brigham and Women's Hospital, Harvard University, Boston, USA in 2000-01. Dr. Anand received her Master's degree in clinical epidemiology in 1996 and PhD. in Health Research Methodology in 2002 under the supervision of Dr. Salim Yusuf, both at McMaster University. Dr. Anand was Principal Investigator of the WAVE trial in peripheral artery disease (PAD) patients, is the PAD Lead Investigator of the COMPASS trial, and is an executive committee member of the VOYAGER PAD trial. Dr. Anand's large-scale research programs include multi-centre prospective cohort studies and randomized trials. She has published more than 400 peer-reviewed, high-impact papers. In 2019 Dr. Anand was inducted as a Fellow to the Canadian Academy of Health Sciences. In 2021-22 Dr. Anand Co-chaired the Canadian Cardiovascular Society Peripheral Artery Disease Guidelines.ANDDr. Eric Kaplovitch completed his Internal Medicine training at the University of Toronto before completing additional Vascular Medicine and Thrombosis training at both McMaster University and the University of Toronto, as well as a subsequent fellowship at the HoPingKong Centre of Excellence with a focus on new models of care for patients with arterial and venous disease states. He currently practices Thrombosis and Vascular Medicine at the University Health Network and the Sinai Health System in Toronto and serves as the Quality and Safety Lead for the Blood Disorders program. Dr. Kaplovitch's current academic interests include optimizing the choice and intensity of vascular protective agents following severe vascular events, the organization of vascular care within local and regional health systems, as well as the teaching of vascular medicine and thrombosis to front-line clinicians. He served as co-lead for the antithrombotics section of the recent CCS guidelines on peripheral arterial disease. Follow us on Twitter: Thrombosis Canada: @thrombosiscanDr Sonia Anand: @DrSoniaAnand1Dr Eric Kaplovitch: @kaplovitchSupport the showhttps://thrombosiscanada.caTake a look at our healthcare professional and patient resources, videos and publications on thrombosis from the expert members of Thrombosis Canada

In this episode, we discuss the clinical manifestations, diagnosis and management of peripheral arterial disease. Our medicine minute focuses on emerging evidence for the use of Rivaroxaban following the release of the COMPASS trial in 2020. Written by: Dr. Palki Bhatt (Internal Medicine)Reviewed by:  Dr. Sonia Anand (Cardiology) and Dr. Kajenny Srivaratharajah (General Internal Medicine)Sound Editing by: Dr. Alison LaiThis episode was supported by Spatula Foods. Enjoy elevated cuisine every day with high-quality dishes you can cook yourself in just 10 minutes. Go to https://www.spatulafoods.com and use promo code INTERN for $40 off your first box- this will help support our podcast! Support the show

Welcome to the 15th episode of 5 Minute Medicine! We have a HUGE episode for you guys! In this episode, we will be exploring Peripheral Arterial Disease (PAD). We will discuss a clinical case, definitions and the pathophysiology behind this condition. We will then learn about the 3 cardinal symptoms and clinical features of this pathology, these being intermittent claudication, rest pain, and critical limb ischemia. We will then explore the clinical examination findings of PAD. Beurger test is an important test to perform on physical examination. This episode explores how to conduct the the test, and what a positive Beurger sign means. In terms of exploring diagnosis, we will delve into the Ankle-brachial pressure index, looking at how to conduct the test and interpretation of your findings. Imaging and treatment are also discussed! Don't forget to complete our exclusive exam-like quiz on PAD to solidify and apply your understanding of this pathology. Follow us on Spotify to be notified of our releases. We would really appreciate if you rate us 5 stars and give us a review on Apple Podcasts if you have the time too, as this really helps our discoverability follow our Ig @5.min.medicine for quizzes and notes on the topics!

In this episode, Mary Yost and Duane Mancini discuss why she founded the Sage Group, her background and why she got into this role, Peripheral arterial disease (PAD), the financial cost to the healthcare system, why it is undiagnosed and under-treated, who is most affected by this disease, current treatments and diagnostic tools, new devices and diagnostics on the horizon, what is next to spread awareness about this issue, and so much more. Mary Yost LinkedIn The Sage Group Website Project Medtech Website Duane Mancini LinkedIn Project Medtech LinkedIn

Episode #19  In this episode, we will discuss the etiologies and physical assessment findings in acute peripheral arterial disease.  Patient management strategies will also be discussed.Please check out my website at:  https://www.kayhoppepresents.comYou can also contact me via email at::kay@kayhoppepresents.comCome visit me on Facebook for daily [mock] CCRN Questions!  @kayhoppepresentsRemember the Online CCRN Review Course coming to you in January 2022!

https://www.satellitehealthcare.com/podcasts/building-trust-earning-trust “I really enjoy building relationships with my patients. I typically meet them when they have a serious problem. And I'm normally able to just fix it and take care of it. It's one of the most fulfilling things about my practice, to be able to follow up with these patients and see their progress.” Dr. Lindsey Pierce, MD Medical Director Tri-County Vascular Center

This episode covers leg ulcers.Written notes can be found at https://zerotofinals.com/surgery/vascular/legulcers/ or in the vascular surgery section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

This episode covers peripheral arterial disease.Written notes can be found at https://zerotofinals.com/surgery/vascular/pad/ or in the vascular surgery section of the Zero to Finals surgery book.The audio in the episode was expertly edited by Harry Watchman.

At the end of the episode, the learner will know the: Pathophysiology of PAD Clinical features of PAD Medical and surgical management of PAD

In today's episode, our guest Dr. Juan Carlos Correa, the managing physician at Modern Vascular Overland Park Clinic talks about the new tools and new techniques that they do in a very simple outpatient setting to help save people's legs. The company is doing complex vascular treatment and interventions despite the influence of the pandemic on their staff and in providing healthcare to their patients, they advocate for Peripheral Arterial Disease and mitigate the stigma underlying the disease in order to spread awareness and educate on proper treatment.

While I do understand that there may be this idea out there, that the OBL is some magical place, the truth is that I think the ideal scenario is what I have—which is practicing on both sides of the street, so to speak. Because they each pose their own challenges and they each have their own benefits. —Bret Wiechmann, MD, FSIRWarren Krackov, MD, FSIR, speaks with interventional radiologist Bret Wiechmann, MD, FSIR, about how he launched his office-based laboratory (OBL), how other IRs might do the same, and the prospects for trainees to enter this space. Note: This episode was recorded on  July 20, 2021.Contact us with your ideas and questions, or read more about about interventional radiology in IR Quarterly magazine or SIR's Patient Center.(c) Society of Interventional Radiology.Support the show (https://www.sirweb.org/corporate-gateway/advertising/)

Editor's Summary by Gregory Curfman, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the June 1, 2021 issue.

This podcast series will highlight the recommended approach to managing patients with peripheral arterial disease from screening to therapy selection. Appropriate risk factor modification and therapy is essential in PAD to optimize care by reducing cardiovascular morbidity and mortality. The information presented during the podcast reflects solely the opinions of the presenter.  The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

This podcast series will highlight the recommended approach to managing patients with peripheral arterial disease from screening to therapy selection. Appropriate risk factor modification and therapy is essential in PAD to optimize care by reducing cardiovascular morbidly and mortality. The information presented during the podcast reflects solely the opinions of the presenter.  The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

This podcast series will highlight the recommended approach to managing patients with peripheral arterial disease from screening to therapy selection. Appropriate risk factor modification and therapy is essential in PAD to optimize care by reducing cardiovascular morbidly and mortality. The information presented during the podcast reflects solely the opinions of the presenter.  The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

IU researchers are working to improve tick-borne disease prevention efforts, and a team of IU researchers are developing new treatments for the most severe form of peripheral arterial disease.

Dr. Kumar is is an Assistant Professor in the Department of Interventional Radiology at Rutgers New Jersey Medical School.  He completed his fellowship training in Vascular and Interventional Radiology  at the Mount Sinai system in NYC. He is an Assistant Professor in the Department of Interventional Radiology at Rutgers New Jersey Medical School. He mentors many residents and students interested in IRHis treats a wide spectrum of diseases using minimally invasive procedures include Peripheral Arterial Disease, venous disease, dialysis , women’s health/Uterine Fibroid Embolization, Liver cancer. He grew up in Houston, Texas and moved to New York City for residency after medical school. He has lived in NYC for 10 years. In his free time he enjoys trying new restaurants in the city, sports, traveling. 

The Filtrate:Swapnil HiremathSamira FaroukMatt SparksJoel TopfAnd two special guests:Vandana Dua Niyyar, Professor of Medicine at Emory University and the president elect of American Society of Diagnostic and Interventional Nephrology. Wears lead.Sophia Ambruso, assistant professor and nephrologist at the University of Colorado.Show Notes:Drug-Coated Balloons for Dysfunctional Dialysis Arteriovenous FistulasThe NephJC summaryThe article in the NEJMThe Haskal study, Stent Graft versus Balloon Angioplasty for Failing Dialysis-Access Grafts in the NEJM from 2010Accuracy of physical examination in the detection of arteriovenous fistula stenosisThe Big Three was a trio of Major League Baseball starting pitchers for the Atlanta Braves from 1993-2002 which consisted of Greg Maddux, Tom Glavine, and John Smoltz. The Big Three combined to win seven National League Cy Young Awards in the 1990s and helped lead the Atlanta Braves to a 1995 World Series win. Each member of the Big Three has had their jersey retired by the Atlanta Braves and has been inducted into the Baseball Hall of Fame. (From Wikipedia)The Trerotola study, Drug Coated Balloon Angioplasty in Failing AV FistulaeScathing anti-interventional nephrologist editorial by TrerotolaRebuttal though data by Beathard, Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologistsAnd then a walk back and update by Tretola…What is the current and future status of interventional nephrology?Paclitaxel mechanism of action video with awesome musicThe role of fungus in the paclitaxel story Twitter comment on the half life of balloon delivered paclitaxelThe meta analysis of peripheral revasculaization having a mortality signal with paclitaxel: Risk of Death Following Application of Paclitaxel-Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsFDA warning about paclitaxel balloons: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased MortalityThe NephJC primer on non-inferiority trials: Understanding the vortex of non-inferiority trialsASN Distinguished Clinical Service Award 2020 goes to Vandana Dua Niyyar! (and Derek Fine, who is also a great guy)ASN Kidney Week Sessions:Samira: Embracing Technology: Nephrology 2.0Swapnil: Hard-to-Control Hypertension: What to Do Next?Vandana: A Look Inside: Noninvasive Imaging of Kidney Diseases

Please visit the show notes for more information about peripheral arterial disease and possible treatments. BIO: Kent Hootman MD is an interventional radiologist who has been treating peripheral arterial disease for more than 20 years. He attended medical school at the University of Colorado, completed his residency at the University of Texas Medical Branch. Following […]

This episode features Dr. Maurice Walrond - Consultant in General Surgery. He provides some valuable insight on Peripheral Arterial Disease and how it can be prevented and managed. He notes the atherosclerosis in the lower limb and the greater importance of complete cardiovascular assessment in such patients. Follow us at https://www.facebook.com/cornerstonemedcc/ or instagram @cornerstonemed_246.

EJVES Editor's Choice

Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm Dr Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr Greg Hundley: I'm Greg Hundley, associate editor from the VCU Pauley Heart Center in Richmond, Virginia. Dr Carolyn Lam: Greg, amyloid cardiomyopathy is the rage. I cannot tell you the number of discussions I've had on the topic. Of course, it was tafamidis, the amazing results with that trial that really made us realize we need to pick this up. But have you ever thought about the cost effectiveness of tafamidis for amyloid cardiomyopathy? Well, guess what? We're going to have a whole feature discussion just about that. But first let's go to our summary, shall we? Dr Greg Hundley: You bet, Carolyn. Well, let me get started. I'm going to talk about regulation of cell cycle growth as well as division in regard to cardiac regeneration. My first paper comes from Dr Lior Zangi from the Mount Sinai School of Medicine. Well, Carolyn, have you ever wondered why the adult mammalian heart has limited regenerative capacity? Dr Carolyn Lam: All the time, Greg. Dr Greg Hundley: Well, of course you have. It's mostly due to postnatal cardiomyocyte cell cycle arrest. In this study the investigators evaluated the effect of pyruvate kinase muscle isozyme 2 and cardiomyocytes through models of loss, that is cardiomyocyte specific PKM2 deletion during cardiac development or gain using cardiomyocytes specific PKM to modified mRNA to evaluate PKM to function and regenerative effects post-acute or chronic MI in mice. Dr Carolyn Lam: Nicely described. What did they find, Greg? Dr Greg Hundley: What they found is that PKM2 is expressed in cardiomyocytes during development and immediately after birth, but not during adulthood. Using cardiomyocytes PKM to modified RNA, they found that cardiomyocyte targeted strategy following acute or chronic MI resulted in increased cardiomyocyte cell division, enhanced cardiac function, and improved long-term survival. They found that PKM2 regulates the cardiomyocyte cell cycle and reduces oxidative stress damage through anabolic pathways and beta-catenin. Dr Carolyn Lam: Cool, Greg. Man, this cardiac regeneration really, really is a hot area. Dr Greg Hundley: Carolyn, that is so insightful because these results really impact research toward unlocking pathways that could be involved in induction of myocyte cell division and regeneration in those sustaining MI or conditions like MI. Dr Carolyn Lam: Nice. Well, Greg, I'm going to change tones here and ask you, can we prevent atrial fibrillation with treatments for diabetes? Well, guess what? We have a paper next. It's from Dr Wiviott from the TIMI Study Group and his colleagues who really reason that since atrial fibrillation is associated with hypertension, obesity and heart failure in patients with diabetes and SGLT2 inhibitors have been shown to lower blood pressure, reduce weight, and reduce hospitalization for heart failure in these patients, perhaps SGLT2 inhibitors may also reduce the risk of atrial fibrillation. They explored the effect of Dapagliflozin on the first and total number of atrial fibrillation and atrial flutter events in patients from the DECLARE-TIMI 58. As a reminder, they had type two diabetes with either multiple risk factors for or known atherosclerotic cardiovascular disease. Now importantly, atrial fibrillation events were identified by a search of the safety database using these MedDAR preferred terms. Now what they found was Dapagliflozin reduced the risk of atrial fibrillation events during follow-up as well as the total number of atrial fibrillation events in patients with type two diabetes. These reductions were consistent across major subgroups including sex, presence of atherosclerotic cardiovascular disease, history of atrial fibrillation, history of heart failure, history of ischemic stroke, HBA1C groups, body mass index groups, blood pressure or EGFR. They looked at all these subgroups because these are all clinical factors, well established, with associations with the risk of atrial fibrillation. Dr Greg Hundley: Wow, Carolyn. Another sort of feather in the cap for the SGLT2 inhibitors. What does this mean for clinical practice? Dr Carolyn Lam: Ah. I'm not going to answer it here. I am going to say everybody has to read the excellent editorial by Dr Granger from Duke University and Dr Mahaffey from Stanford University School of Medicine. But what I will tell you is their concluding sentences. They said, "This report provides evidence that Dapagliflozin appears to reduce atrial fibrillation events in patients with diabetes and coronary disease and multiple risk factors. It also raises the issue of how to determine when effects on a secondary outcome, particularly one collected without the rigor of systematic collection using perspective definitions and case report forms, whether or not these are reliable." So must read. Dr Greg Hundley: Absolutely. Carolyn, my next study comes and evaluates arrhythmogenic right ventricular cardiomyopathy and is really investigating the concept of auto immunity, looking at associations of circulating anti heart and anti intercalated disc auto antibodies with disease severity and family history. The paper comes from Professor Alida Caforio from the University of Padova. Again, looking at the role of auto antibodies in patients with ARVC. An interesting topic. Dr Carolyn Lam: Yeah, that's really novel. What did they find? Dr Greg Hundley: They investigated ARVC pro bands, so those that sort of started with the disease process in a family and noted an increased frequency of serum organ specific anti heart autoantibodies and anti-intercalated disc autoantibodies in a sizeable arrhythmogenic RVC cohort as compared to controls. They found that positive AHA status. Dr Carolyn Lam: Anti-heart antibodies. Dr Greg Hundley: Yep. Was associated with lower left ventricular ejection fraction, a higher frequency of cardiac symptoms and implantable cardioverter defibrillator implantation. Positive AIDA was associated with lower ejection fractions in both the right and the left ventricle. Dr Carolyn Lam: AIDA being the anti-intercalated disc auto antibodies. Wow. That is interesting. But what are the clinical implications? Dr Greg Hundley: Well, the presence of both these organ specific AHA and AIDA antibodies provides evidence of autoimmunity in the majority, so 85% of familiar, and almost half, 45%, of sporadic ARVC. In programs and in effective relatives, these antibodies were associated with the disease severity features. So really a link with this auto immunity and ARVC. Dr Carolyn Lam: Yeah. I never thought of ARVC as an autoimmune disease. Very interesting. But let me also tell you what else is in this week's issue. There are letters to the editors, one from Dr Kaski regarding the mag STEMI randomized control trial questioning whether improving coronary vasal motion can be equated to restoring patient's cardiovascular health. Interestingly with a letter in response from Dr Sabatine. There's also a research letter by Dr Alahmad on the cardiovascular mortality and exposure to heat in an inherently hot region and where they were was Kuwait. They also drew some implications for climate change. Very interesting piece. There's also an ECG challenged by Dr Verma describing conduction abnormalities and ischemic cardiomyopathy in an 84-year-old man. Dr Greg Hundley: Very nice. Carolyn, in the mailbag, there's a nice research letter from Dr Nicholas Leeper from Stanford University School of Medicine. It's entitled “The 9p21 locus promotes calcific atherosclerosis.” Our own Josh Beckman has an on my mind piece regarding “The Big Mac Attack on Peripheral Arterial Disease.” Dr Carolyn Lam: I love that. I just love the titles Josh comes up with. Dr Greg Hundley: Then finally Bridget Kuehn has a very nice sort of correspondence on Cardiovascular News regarding cardiac imaging on the cusp of artificial intelligence. What a revolution we have ahead, Carolyn, and I know that's a topic that's true to your heart. Dr Carolyn Lam: It is. I loved her paper. Dr Greg Hundley: Okay. Carolyn, how about we get onto that feature article? I'm waiting to hear about the cost effectiveness of tafamidis. Dr Carolyn Lam: Me too. Dr Greg Hundley: Well listeners, we have got a great discussion for our feature publication today and we have Dr Dhruv Kazi from Beth Israel Deaconess in Boston and our own associate editor, Dr Justin Ezekowitz from University of Alberta. Well, as we get started, Kazi, can you tell us a little bit what was the hypothesis that you wanted to test with this study and maybe even before that a little bit of background with transthyretin amyloid and tafamidis? Dr Dhruv Kazi: Yeah. Transthyretin amyloidosis is a subgroup of patients who present with heart failure with preserved ejection fraction, which we know is a heterogeneous condition that has been pretty resilient to effective guideline directed therapies over the past decade. It's a subgroup of patients generally presenting in their 70s with slowly declining quality of life and a median survival of about three years. It hadn't had an effective therapy before and so when tafamidis, which is a stabilizer of transthyretin and prevents its deposition in the myocardium, was developed and tested in a randomized clinical trial that showed an improvement in survival, a reduction in heart failure hospitalizations and a slowing of decline and quality of life. It was viewed as a really big win for the heart failure community. What came as a surprise though is the pricing. It was launched in 2019 at $225,000 a year. We set out to ask, given that this is a severe disease without alternative treatments, is this price tag generating enough value? Is this a cost-effective therapy? The background here again is that oncologic therapies have had a long history of very high prices for rare diseases and severe diseases. But this is the first time we're seeing this in cardiology. Can we think more broadly about how we're going to tackle this issue? Not just for tafamidis but also for other drugs that come down the pipe. Dr Greg Hundley: Wow. $225,000 per year. Tell us what was your study design, and how did you go about evaluating this issue? Dr Dhruv Kazi: We started off with the one phase three trial of the drug that has been published and simulated in a mathematical model the population that would be eligible for this therapy, reproduced the events, heart failure hospitalizations, debts, quality of life that were seen in the trial for the first three years, and then extrapolated beyond the trial based on what we know about HFpEF and what we know about transthyretin amyloidosis. It's a mathematical model that first reproduces what was seen in the trial and then extrapolates beyond what we think is the best guess of what happens to these patients. We tested a variety of scenarios whether the drug continues to be effective, whether the effectiveness declines over time or the effectiveness ceases immediately after three years. Dr Greg Hundley: What did you find? Dr Dhruv Kazi: What we found was interesting and it surprised us a little bit, which is that in the base case, which is assuming that the drug stays effective beyond three years, the drug is actually very effective in the traditional sense. It added 1.3 quality adjusted life years. For context here, this is about twice the effect size you expect to see with Entresto, and the HFpEF patients. So here's a drug that we've accepted and HFpEF has part of guideline directed medical therapy. Tafamidis in that best-case scenario is about twice as effective, but it is not cost effective. Because you're paying $225,000 for every year that the patient is on the medication, its incremental cost effectiveness ratio compared with usual care was $880,000, so well above what we would consider value for money. That's the best-case scenario assuming that the drug is permanently effective, if the drug's effect wanes over time, which is very likely as these patients get older and sicker, then the drug gets even less economically attractive. Dr Greg Hundley: You've pointed out in your article, if you had 120,000 transthyretin patients in the United States, that would translate to how many dollars? Dr Dhruv Kazi: We estimate that if all of those 120,000 patients received tafamidis, the healthcare spending would go up by $32 billion a year and most of it is towards the drug. But the caveat is that we think 120,000 patients in the US is a very conservative number because the diagnostic technology for amyloid cardiomyopathy has improved substantially over the last five years so that we no longer need biopsies. We can use nuclear scans to diagnose the disease and we have pretty good to genetic testing to identify the genetic variant of the disease. We think that number is probably closer to 200,000 or even higher because the healthcare expenditure is almost entirely driven by drug costs. The more patients we diagnosed, the bigger the budget's impact on healthcare spending. Dr Greg Hundley: Oh my. Well Justin, for our listeners, Justin resides in Canada. Justin, what do we do with these results? I mean this is quite a sticker shock for probably an important therapy for this patient population. Dr Justin Ezekowitz: Greg, it's a great issue and Kazi, thank you very much for this terrific, easily understandable manuscript that I think everybody should read as it's very well written and easy to understand for us non-health economists. The sticker shock is a bit of a tricky one because we always want to do what's best for our patients. When we look at that budget impact analysis, the challenge is what do we think internationally? The US is critical in terms of understanding this, but then for the rest of the world, there's certainly almost no willingness to pay at this threshold and with an uncertain incidence of amyloidosis globally, but also within the US and Canada and the difficult in diagnosis already, I think we're going to have to realize what can we do for our patients and who benefits the most with this drug given its importance and its efficacy? Kazi, you mentioned another thing which I think is critical is what happens after 30 months if the effect wanes and where does that take us for the impact on cost and effectiveness over time but also the budget impact analysis? Because the second drug or third drug may very well come along that may fill that niche. Dr Dhruv Kazi: Justin, that's a really good question. I mean the study only goes to 30 months and that's the only one randomized trial for tafamidis that we're working off of. So there's substantial uncertainty about what happens to this drug beyond 30 months. It's reasonable to assume that some of the effect persists, that as patients get older, get sicker, that effectiveness will wane over time. Which ties very closely to the cost effectiveness. So if the patients continue to take the drug but it's not as effective as you can imagine, it becomes less cost effective. This also has implications for other drugs coming down the pike, which may or may not be more effective than tafamidis. They may or may not be tested head to head with tafamidis. Physicians are going to be left with the question, very clinically relevant question, of which drug to start with, how do you switch on them the next generation or more expensive drugs that come down the pike? We'll have to rely on both real-world evidence and to some extent mathematical modeling to use our best judgment on developing a treatment strategy for these patients. But rest assured that our current regulatory framework means that the drugs coming down in the future will be more expensive than tafamidis and hence, this is a good time to have the conversation about cost effectiveness and our willingness to pay for innovation. Dr Greg Hundley: What needs to happen next to help either lower cost or develop some sort of competition in the treatment of this disease to lower the cost? Dr Dhruv Kazi: I can take a stab at that. Greg, I think the findings of this particular drug in transthyretin amyloidosis is illustrative of the challenges that lie ahead. I think there are clinical research and policy implications. As clinicians, it's really important for us to know that this high cost of the drug is not a theoretical challenge. It's a practical challenge for our patients. The majority of these patients are going to be on Medicare part D. We estimate that the out of pocket costs is going to be in the range of $8,000 to $9,000 a year even with Medicare part D, which is a big amount of money for our fixed income seniors. I encourage our clinicians to have this conversation about out-of-pocket costs with patients, not just when you start the therapy but throughout the year. We know that the Medicare part D copays change over the course of the year based on where they are in the insurance plan. Having this conversation may help preclude costs related non-adherence. We might be able to identify patients early or at risk, put them into patient support programs or switch them to alternate therapies that may not be as effective but at least are likely to offer the patient some support. From a research perspective, we really need to figure out what subgroup of patients are more likely to benefit. Let's say we have 200,000 patients with transthyretin amyloidosis in the US. We need more research, and the company is not going to be vested in doing this research, it's going to have to be NIH funded research to identify subgroups of patients who benefit most from this drug, both in the short term and over the long term. From a policy perspective, what this drug pricing issue is telling us is that we provided incentives for companies to innovate in the rare disease orphan drug program. These incentives are working. More than half of the drugs that are coming out now or have in the past year are under this rare disease umbrella. But these drugs, once they're approved, are super expensive. We need to figure out a regulatory framework where we continue to incentivize innovation for rare diseases for orphan drugs, but at the same time tie those incentives to the final pricing to ensure that the patients get access to the drug and not just the wealthy patients who can afford the copays, but all patients who would benefit from the drug. One of the things that comes to mind as clinicians and researchers is that particularly in cardiology, we are obsessed with innovating, with regards to new molecules and new technology. I would like us as a community to focus not just on molecules but also on markets because the innovation is not meaningful if our patients cannot have access to them. This year being the presidential election year, we're going to hear a lot about drug pricing. What I hope that this example shines a light on is that drug pricing is complicated and trying to figure out the right framework to incentivize innovation while it's still ensuring access is going to take thoughtful interventions, regulatory interventions, and clinicians should very much be a part of that process. Dr Greg Hundley: Well listeners, we've heard a wonderful discussion here highlighting a new therapy for a disease process that's being increasingly diagnosed with our aging population and new technologies, magnetic resonance, echocardiography that identify this condition. But then how are we going to afford some of the therapies that are moving forward and design a system that emphasizes not only scientific discovery, but cost effectiveness? We want to thank Dr Dhruv Kazi from Beth Israel Deaconess and also Justin Ezekowitz from the University of Alberta. We hope you have a great week and look forward to speaking with you next week. This program is copyright the American Heart Association 2020.

In this episode, we present our first Audible Bleeding - JVS Editor's Choice collaboration as Adam Johnson discusses the JVS articles selected for the August 2019 edition of the Editor's Choice with JVS Senior Editor, Dr. Peter Lawrence.  JVS Editor’s Choice Video with Senior Editor Dr. Lawrence - YouTube Articles Featured in this month's discussion: Statin use Improves Limb Salvage after Intervention for Peripheral Arterial Disease http://bit.ly/2J6EwQ9 Technical Aspects and 30-day Outcomes of the Prospective Early Feasibility Study of the GORE® EXCLUDER® Thoracoabdominal Branched Endoprosthesis (TAMBE) to treat pararenal and Extent IV thoracoabdominal aortic aneurysms. http://bit.ly/2ZN1FwZ Episode 7 - Gustavo Oderich, MD - branched and fenestrated endovascular treatment of complex aortic aneurysms Validation of a Preoperative Prediction Model for Mortality within One Year after  Endovascular Aortic Aneurysm Repair of Intact Aneurysms.http://bit.ly/2Whz0xZ Information about QxMD App: https://qxmd.com/ The State of Complex Endovascular Abdominal Aortic Aneurysm Repairs in the Vascular Quality Initiative. http://bit.ly/2J30Yd4 The Vascular Quality Initiative https://www.vqi.org/ If you enjoy our content, please contribute to Support Audible Bleeding!  

Can heat therapy improve exercise tolerance in peripheral arterial disease patients? Associate Editor Nisha Charkoudian (U.S. Army Research Institute of Environmental Medicine) interviews lead author Ashley Akerman (University of Ottawa) and content expert Zachary Schlader (Indiana University) about the novel passive heat training study by Akerman and co-authors. While exercise is the gold standard for conservative management of peripheral arterial disease (PAD), patients often struggle to comply with exercise treatment guidelines due to painful atherosclerotic plaque build-up in their arteries. Aimed at breaking the vicious cycle of needing to exercise but failing to do so because of pain, Akerman and collaborators designed a 12-week intervention study to compare exercise to heat therapy in older PAD patients. While functional walking improved for both groups, systolic blood pressure was markedly reduced in the heat therapy group. Surprisingly, other measures such as blood volume and flow mediated dilation were largely unchanged in both groups. Could these results have a wider impact on other patient populations, such as younger individuals recovering from an injury or diabetes patients?   Ashley P. Akerman, Kate N. Thomas, Andre M. van Rij, E. Dianne Body, Mesfer Alfadhel, James D. Cotter Heat therapy vs. supervised exercise therapy for peripheral arterial disease: a 12-wk randomized, controlled trial Am J Physiol Heart Circ Physiol, published June 5, 2019. DOI: doi.org/10.1152/ajpheart.00151.2019

Kim Hodgson, MD is the David Sumner endowed Chair of vascular and endovascular surgery at Southern Illinois University School of Medicine in Springfield, Ill. and is the current president of the Society for Vascular Surgery.  He received his medical degree at the University of Pennsylvania, did his general surgery residency at Albany medical college and vascular surgery fellowship at the Southern Illinois University. He has over 100 peer-reviewed publications, 40 book chapters and has been the PI on numerous clinical trials.  He was the inaugural editor of VESAP and co-editor in chief of the second and third editions of VESAP. Dr. Hodgson served on the Vascular Surgery Board and recently presented as the SVS representative at the multidisciplinary panel for the Circulatory system devices and medical devices advisory committee as part of the FDA oversight into paclitaxel devices in PAD. These are the opinions of Dr. Hodgson and do not necessarily represent a formal stance by the SVS.  Updates from The FDA Circulatory System Devices Panel Meeting, June 19-20th, 2019: US FDA Panel Reviews Paclitaxel Device Data: No Recommendations Issued as More Work is Needed. VascularNews.com. June 20, 2019. FDA Letter to Health Care Providers, UPDATE: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality. FDA.gov. June 20, 2019. FDA Executive Summary, Circulatory System Devices Panel Meeting, Paclitaxel-Coated Balloon and Paclitaxel-Eluting Stent Late Mortality Panel, June 19-20, 2019 Next steps: Society for Vascular Surgery’s VQI Adds New Analysis to Paclitaxel Device Discussion. VascularNews.com. June 14, 2019. The problems with Target Lesion Revascularization (TLR) as an endpoint. Vascular Specialist. January 25, 2015. Support Audible Bleeding!

Dr. Darren Schneider and Dr. Joseph Mills recently participated in the Vascular Leaders Forum: Drug Elution in Peripheral Artery Disease (PAD): A Critical Analysis from a Multispecialty Consortium on March 1-2, 2019 and take time tell us what they heard and how it has impacted their practice. Darren Schneider, MD (@VascularMD) is Chief of Vascular and Endovascular Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.  He completed his training and was on faculty at the University of California, San Francisco and has extensive experience in minimally invasive vascular procedures and research interests in the design and development of endovascular devices for the treatment of aortic aneurysm and peripheral arterial diseases. Disclosures: None. Joseph Mills, MD (@jmills1955) is Professor and Chief of the Division of Vascular Surgery & Endovascular Therapy at the Baylor College of Medicine.  He has held numerous leadership positions in vascular surgery, is co-editor for Rutherford’s Vascular Surgery and is most well known for his work in developing the WIfI wound criteria for critical limb ischemia. Disclosures: None (04:15) Risk of Death Following Application of Paclitaxel‐Coated Balloons and Stents in the Femoropopliteal Artery of the Leg: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials (11:30) FDA UPDATE: Treatment of Peripheral Arterial Disease with Paclitaxel-Coated Balloons and Paclitaxel-Eluting Stents Potentially Associated with Increased Mortality - Letter to Health Care Providers (12:30) Coronary stents - SPIRIT trial

Today on MedNet21, we're going to discuss Peripheral Arterial Disease.

Chronic Limb Threatening Ischemia (formerly Critical Limb Ischemia) is a natural progression of untreated or unrecognized Peripheral Arterial Disease. It is important for providers to recognize symptomatic patients for prompt referral. Graeme McFarland, MD, discusses how the earlier a diagnosis can be made, the earlier treatment can be started with less serious consequence.

Experiencing leg pain that doesn't go away? Or perhaps wounds in your legs and feet that heal very slowly? It may have to do with your heart. Consistent leg pain may be due to Peripheral Arterial Disease (PAD), which goes hand-in-hand with heart disease. With September being PAD Awareness Month, we brought interventional cardiologist Ian Cawich, MD into the studio to talk about how you can lower your risk for PAD, and how a history of smoking can increase that risk.

Awareness of peripheral arterial disease (PAD) is very low in both patients and in primary care practice despite an increase in incidence. Referral to vascular medicine can aid in both diagnosis and risk factor modification and can lead to better outcomes. Benjamin Pearce, MD, discusses the presentation of PAD to primary care and some easy questions/non-invasive tests to help improve appropriate and timely referral.

Dr. Campia Speaks at Brigham and Womens' Hospital

Dr. Andrew Klein and Dr. C. Michael Gibson Discuss

Dr. Brian Kolski and Dr. C. Michael Gibson Discuss

Peripheral Arterial Disease Management & Interventions. The role of Interventional Radiology in PAD. Hosts: Adam Swersky & Benjamin Roush Music: Balloons Rising by A. A. Aalto Find the link on our website CC BY NC

Peripheral artery disease (P.A.D.) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood. P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach.Listen in as Elizabeth A Blazick, MD, a vascular surgeon at Maine Medical Center, discusses P.A.D and although P.A.D. is serious, it's treatable.

Peripheral artery disease (P.A.D.) is a disease in which plaque builds up in the arteries that carry blood to your head, organs, and limbs. Plaque is made up of fat, cholesterol, calcium, fibrous tissue, and other substances in the blood. P.A.D. usually affects the arteries in the legs, but it also can affect the arteries that carry blood from your heart to your head, arms, kidneys, and stomach.Listen in as Elizabeth A Blazick, MD, a vascular surgeon at Maine Medical Center, discusses P.A.D and although P.A.D. is serious, it's treatable.

Host: Jennifer Caudle, DO Guest: Timothy W.I. Clark, MD Host Dr. Jennifer Caudle welcomes Dr. Timothy Clark, Associate Professor of Clinical Radiology and the Director of Interventional Radiology at Penn Presbyterian Medical Center. Dr. Clark will review the prevalence of peripheral arterial disease (PAD) in the U.S., the central risk factors, and how PAD is properly diagnosed and managed. He will also review advanced endovascular procedures for PAD and other therapies that make a difference in patient care and outcomes.

Host: Jennifer Caudle, DO Guest: Timothy W.I. Clark, MD Host Dr. Jennifer Caudle welcomes Dr. Timothy Clark, Associate Professor of Clinical Radiology and the Director of Interventional Radiology at Penn Presbyterian Medical Center. Dr. Clark will review the prevalence of peripheral arterial disease (PAD) in the U.S., the central risk factors, and how PAD is properly diagnosed and managed. He will also review advanced endovascular procedures for PAD and other therapies that make a difference in patient care and outcomes.

Peripheral arterial disease (PAD) usually occurs when arteries outside the heart and brain become narrowed or blocked. PAD most often occurs in the arteries of the pelvis and legs. Narrowing or blockages are usually caused by the buildup of plaque in the arteries, creating a condition known as hardening of the arteries (atherosclerosis). Left untreated, serious cases of PAD can lead to loss of circulation in the legs, gangrene and amputation of the affected limb. Learn more from Dr. William Robinson, a UVA specialist in vascular surgery, about treatments for this condition and ways to reduce your risk from a UVA specialist in vascular surgery. Tagged under: Heart Health

This week, Amol, general internal medicine resident at the University of Toronto, and Fahad, general internist at St. Michael's hospital in Toronto, discuss two recent papers: Fahad and colleagues recently published a study in JAMA that looks at severe adult undernutrition in low and middle income countries. Using 20-year health survey data collected by USAID, ...The post Fahad's Work and Fahad Gets Worked Up: Prevalence of severely underweight women and peripheral arterial disease appeared first on Healthy Debate.

This week, Amol, general internal medicine resident at the University of Toronto, and Fahad, general internist at St. Michael's hospital in Toronto, discuss two recent papers: Fahad and colleagues recently published a study in JAMA that looks at severe adult undernutrition in low and middle income countries. Using 20-year health survey data collected by USAID, ... The post Fahad’s Work and Fahad Gets Worked Up: Prevalence of severely underweight women and peripheral arterial disease appeared first on Healthy Debate.

JAMAevidence Podcast

JAMAevidence Podcast

Dr. Ed Livingston discusses Peripheral Arterial Disease with Dr Nadia A. Khan.

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 […] The post Peripheral Arterial Disease – Top Docs Radio appeared first on Business RadioX ®.

The latest cardiology education and news - focused on training, research, and career planning. Through fellow conducted interviews of leading cardiologists, the Fellows' corner provides a forum to share experience and knowledge while facilitating exchange and promoting optimal practice. Interviews are conducted by fellows from the leading US-based academic institutions and are produced on a monthly basis.

Guest: Niren Angle, MD Host: Steven Edelman, MD People with diabetes are at increasingly higher risk for developing peripheral arterial disease. However, the disease may have no symptoms and often goes undiagnosed. What is the link between PAD and diabetes? Our guest, Dr. Niren Angle, chief of vascular and endovascular surgery at the University of California, San Diego, outlines the symptoms, diagnosis and treatment for peripheral artery disease. Join host Dr. Steven Edelman to learn more.

Peripheral Arterial Disease (PAD) treatment topics covered are Medications, Angioplasty, Bypass Surgery, and Thrombolytic Therapy. (January 2009)

Why are we missing peripheral arterial disease (PAD)? How is it diagnosed using the Ankle-Brachial Index (ABI)? What treatments improve symptoms and reduce cardiovascular risks? When should revascularization be considered?** Register for 2025 Digital Education & Artificial Intelligence Conference !! **It will be an inspiring day filled with hands-on workshops and expert panels designed to empower educators with practical digital media and AI tools.Transcript and Show notesTimestamps:(02:23) | PEARL 1: When to suspect PAD? Risk factors?(07:34) | PEARL 2: How to work up PAD?(16:26) | PEARL 3: Improving symptoms and quality of life (25:38) | PEARL 4: Approach to therapy: Preventing CV mortality (33:53) | PEARL 5: Deeper Dive into Antithrombotic Therapy and Anticoagulation (39:09) | PEARL 6: Who needs revascularization? Tags: CoreIM, PAD, Peripheral Arterial Disease, ABI, claudication, vascular medicine, revascularization, internal medicine, smoking cessation, lipid management, primary care, physician assistant, nurse practitioner, cilostazol. supervised exercise therapyFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy