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

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

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

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

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

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

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

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

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

Keypoints:

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

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

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

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

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

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In this informative episode of the Cardiovascular Matters podcast, host Dr. Craig Walker sits down with his colleague Terry Roberts to discuss pulmonary embolisms (PEs) in comprehensive detail. PEs, which occur when blood clots travel to the lungs, are a serious cardiovascular condition that can quickly become life-threatening if not properly diagnosed and treated.

Dr. Walker begins by explaining what a PE is on a physiological level, noting how clots blocking blood flow in the lungs can strain the heart and prevent oxygenation of blood throughout the body. He discusses how PEs originate as clots elsewhere in the body, most commonly the legs, that break off and travel to the lungs. Depending on their size, PEs can range from causing minor breathing issues to sudden cardiac arrest.

The discussion then delves into risk factors for developing PEs. Genetic hypercoagulable conditions that cause easier clotting are highlighted, as are external risk factors like smoking, prolonged immobility, recent surgery or trauma, and certain cancers. Dr. Walker stresses the importance of prophylactic measures for at-risk patients, such as compression stockings and blood thinners.

Some key points:

• PEs are the second leading cause of death from cardiovascular disease and can be fatal if large clots block oxygen from circulating in the blood.
• Risk factors for PEs include hypercoagulability, injury, prolonged immobility, surgery, cancer and smoking.
• Symptoms include shortness of breath, arrhythmias, and potentially sudden death from large clots.
• Diagnosis involves imaging tests like CT scans to detect clots in the lungs.
• Traditional treatments include blood thinners like heparin to prevent further clotting.
• Newer options like thrombolytic drugs and thrombectomy devices can dissolve or remove clots quickly in severe cases.
• Emergency support like ECMO can oxygenate the blood while clots are addressed.

Turning to diagnosis, imaging tests like CT scans that can detect clots in the pulmonary arteries are outlined. Dr. Walker also notes newer diagnostic guidelines that help physicians determine the likelihood a patient is experiencing a PE. Traditional first-line treatments involving blood thinners are explained, along with their limitations in dissolving large clots.

The bulk of the conversation focuses on recent advances in PE treatment. Dr. Walker enthusiastically discusses thrombolytic drugs that break down clots, endovascular thrombectomy devices that physically remove clots, and emergency circulatory support like ECMO. He shares inspiring case studies of how these interventions have saved critically ill patients within minutes of their arrival. The risks of these procedures are also addressed.

Overall, this podcast episode is an invaluable resource for anyone seeking to learn more about pulmonary embolisms, from causes and symptoms to state-of-the-art diagnosis and life-saving therapies. Dr. Walker's expertise and passion for the topic shine through, making complex cardiovascular science easy to understand.

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