Peripheral Arterial Disease Case Report – Mr. A.L.

Authored by Adam Goldfarb, M.A., D.C., D.E.S.S.

Mr. A.L. is a 71-year-old semi-retired realtor. He currently lives with his wife of 44 years and his two dogs. Mr. A.L. is a former smoker who had been diagnosed with hypercholesterolemia and borderline hypertension but was otherwise healthy and active. Mr. A.L. had become concerned by a progressively worsening sensation of pain in both legs, right worse than left, during extended periods of walking. Mr. A.L. had found that he was unable to golf without the aid of a cart due to his symptoms. The pain will increase to the point where he must cease walking entirely. His pain subsides during periods of rest but gradually returns as soon as activity levels resume. He had always envisioned golfing at a greater frequency as his working hours reduced and had therefore found these events to be quite disconcerting. He had undergone treatment sessions with a massage therapist in an attempt to alleviate his symptoms. However, there were no sustained benefits for his leg pain.

Mr. A.L. visited his family physician. Provided his medical history, it was suspected that Mr. A.L. was suffering from Peripheral Arterial Disease (PAD). The physician examined the blood flow in his legs and checked the strength of peripheral pulses. She then calculated the Ankle Brachial Index by comparing the blood pressure between his arm and his leg. As a score of less than 1.0 was obtained (0.7), the diagnosis was confirmed.

PAD is a common condition that affects approximately 12 to 20% of the ageing population. It develops as a result of atherosclerosis in the arteries of the lower extremities. Smoking, advanced age, and concomitant medical conditions such as diabetes, hypertension and coronary artery disease have been shown to increase the risk of PAD. The pain that Mr. A.L. experiences during prolonged periods of walking is termed intermittent claudication. The distance a given patient has ambulated when the onset of pain is first experienced is termed the Initial Claudication Distance (ICD). The distance at which the patient must stop walking as a result of the severity of symptoms is termed the Absolute Claudication Distance (ACD). As a result of the plaque build-up in the arteries of the lower extremities, there is impaired blood flow to the muscles during periods of activity when demand for arterial blood is increased. Conventional treatment for this condition involves lifestyle changes, pharmacotherapy, and surgical interventions.

Mr. A.L. was fairly active and had ceased smoking several years ago. His physician reviewed the treatment options for PAD with him and recommended a pharmaceutical agent that enhances blood flow. After many weeks, Mr. A.L. found that his walking tolerance remained significantly reduced despite taking the medication daily. During a subsequent visit to his physician, invasive interventions such as surgical revascularization and percutaneous transluminal angioplasty were discussed. Mr. A.L. was naturally reluctant to undergo surgery at his age but he accepted the referral to the specialist to review his options.

Mr. A.L. met with a vascular specialist the following week. It was determined that the plaques affecting his leg arteries were fairly diffuse and much of it existed in the infrapopliteal region. In this specialist’s clinical experience, patients with these types of lesions do not respond well to surgery. Alternatively, the specialist recommended an Intermittent Pneumatic Compression (IPC) device to manage his condition. It was explained that an IPC is attached to the lower leg and compresses the calf at regular intervals to increase blood flow. Researchers have demonstrated that utilization of IPC devices in PAD patients for a couple hours per day over a period of several months resulted in significant clinical outcomes. Specifically, it had been shown repeatedly that these devices increase the Ankle Brachial Index as well as both ICD and ACD. Most IPC devices are large and externally powered and therefore require the patient to be stationary. Additionally, there can be an unpleasant sensation or discomfort during the rapid inflation of the chambers. However, Mr. A.L. was informed that there are currently a number of portable battery powered units called Mobile Compression Devices. Of particular interest to Mr. A.L. was the Venowave. In contrast to other devices, the Venowave was a self-contained single unit that allowed him to remain fully mobile during treatment periods. Furthermore, the Venowave was reported to be well-tolerated by patients due to its unique waveform motion.

Mr. A.L. obtained two Venowave devices for each of his legs and wore them for one hour in the morning and two hours in the evening. He noticed a significant increase in walking distances after a period of two months. At that time, Mr. A.L. was able to play a round a golf while walking the shorter holes and using a cart for the longer holes. He was also able to take his dogs on walks with increasing distances before requiring a brief rest. After a period of six months, Mr. A.L. noticed further increases in his walking tolerance with continued commitment to the Venowave device.

During follow-up visits with his family physician, it was found that the Ankle Brachial Index had steadily climbed during this period. His last measurement was 1.1, well above the abnormal range. More importantly, Mr. A.L. continues to experience lifestyle benefits as a result of the Venowave. With pacing, he is able to walk a full round of 18 holes without the aid of a cart. He is also able to walk his dogs without interruption or concern of experiencing pain after short distances.

As demonstrated in this case study as well as in the biomedical research literature, Mobile Compression Devices such as the Venowave effectively increase arterial blood flow in the lower extremities for those suffering from the debilitating symptoms and functional limitations associated with Peripheral Arterial Disease. Compression therapy may serve as a promising treatment option for PAD patients who are not candidates for surgical interventions. For those seeking a device that features both comfort and portability, the Venowave may be ideally suited for this population.

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