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Hello - I Had A Doppler Of Legs And Iliac

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Posted on Sun, 16 Dec 2018
Question: Hello - I had a Doppler of legs and Iliac arteries yesterday at the Montreal Heart Institute. I have moderate to severe plaque of the Iliac arteries and my PAD in my legs is moderate also.
The doctor who saw my results suggested a catheter procedure to open up the Iliac arteries. I understand this procedure is quite safe. I am meeting the head cardiologist at the Montreal Heart Institute on December 18th to go over results (Doppler PLUS additional heart echo to be taken this coming Monday). My LDL is 1.45, all other tests are good. Is this the right procedure? I believe it is. Some days, it is painful even just walking around my apartment, other days - like today - I did my walking and the pain was much less (3 out of 10). I am anxious and need some reassurance about the PTA procedure. Thank you!
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Follow up: Dr. Ilir Sharka (0 minute later)
Hello - I had a Doppler of legs and Iliac arteries yesterday at the Montreal Heart Institute. I have moderate to severe plaque of the Iliac arteries and my PAD in my legs is moderate also.
The doctor who saw my results suggested a catheter procedure to open up the Iliac arteries. I understand this procedure is quite safe. I am meeting the head cardiologist at the Montreal Heart Institute on December 18th to go over results (Doppler PLUS additional heart echo to be taken this coming Monday). My LDL is 1.45, all other tests are good. Is this the right procedure? I believe it is. Some days, it is painful even just walking around my apartment, other days - like today - I did my walking and the pain was much less (3 out of 10). I am anxious and need some reassurance about the PTA procedure. Thank you!
doctor
Answered by Dr. Ilir Sharka (3 hours later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on -Ask a Doctor- service!

I passed carefully through your concern and would like to explain as follows:

When discussing about lower limbs arteries disease, especially its therapeutic strategies, it is important to consider two main issues: the severity of clinical symptomatology (does the limb pain especially on exertion limits the daily life activity?) and the extension of the vessel lesions (whether the location is only distal such as the crural regions or is spread also in the aorto-iliac and femoro-popliteal segments.

if you have severe symptoms and the arteries lesions are widely spread, from the (aorto)-iliac region to the more distal areas, then a revascularization procedure is necessary.

Coming to this point percutaneous angioplasty (PTCA) would be a rational option especially if the lesion requiring direct intervention is not extended (no more than 25 cm in the superficial femoral artery, or the common femoral artery is patent). In such case endovascular therapy with stent implantation appears a comfortable strategy offering an arterial patency rate of more than 90% after 5 years.

But, if the artery disease is more severe and especially widely spread, a hybrid strategy including angioplasty with endarterectomy or bypass surgery, could be more appropriate and with a higher patency rate.

Coming to this point, it is necessary to carefully investigate the exact severity and extension of the arterial lesions. Besides the Doppler ultrasound, it is necessary to perform other imagine studies like angio CT or MR angiography.

Meanwhile, it is very important to continue a supervise exercise training program, follow a healthy life-style (avoid smoking contacts, properly treat potential hypertension, maintain a controlled blood lipid profile also with the help of antilipemic therapy, etc.)

You should discuss with your doctor on the above mentioned issues.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr, Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
I would explain as follows:

Detailed Answer:
Hello!

Welcome back on -Ask a Doctor- service!

I passed carefully through your concern and would like to explain as follows:

When discussing about lower limbs arteries disease, especially its therapeutic strategies, it is important to consider two main issues: the severity of clinical symptomatology (does the limb pain especially on exertion limits the daily life activity?) and the extension of the vessel lesions (whether the location is only distal such as the crural regions or is spread also in the aorto-iliac and femoro-popliteal segments.

if you have severe symptoms and the arteries lesions are widely spread, from the (aorto)-iliac region to the more distal areas, then a revascularization procedure is necessary.

Coming to this point percutaneous angioplasty (PTCA) would be a rational option especially if the lesion requiring direct intervention is not extended (no more than 25 cm in the superficial femoral artery, or the common femoral artery is patent). In such case endovascular therapy with stent implantation appears a comfortable strategy offering an arterial patency rate of more than 90% after 5 years.

But, if the artery disease is more severe and especially widely spread, a hybrid strategy including angioplasty with endarterectomy or bypass surgery, could be more appropriate and with a higher patency rate.

Coming to this point, it is necessary to carefully investigate the exact severity and extension of the arterial lesions. Besides the Doppler ultrasound, it is necessary to perform other imagine studies like angio CT or MR angiography.

Meanwhile, it is very important to continue a supervise exercise training program, follow a healthy life-style (avoid smoking contacts, properly treat potential hypertension, maintain a controlled blood lipid profile also with the help of antilipemic therapy, etc.)

You should discuss with your doctor on the above mentioned issues.

Hope to have been helpful to you!

In case of any further questions, feel free to ask me again.

Kind regards,

Dr, Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ilir Sharka (2 hours later)
The cardiologist I saw, who is one of the best in Canada, does not believe at this point that an Angiogram is necessary. I am seeing him again on December 18th after the Echo on Monday and after a Mapa is done, and to discuss the Doppler tests. My BP at rest is 125/56.

The doctor I saw yesterday suggested the endovascular procedure after viewing my Doppler of my legs and Iliac arteries. If he suggested this, it is because he saw how extensive the plaque is/was and how long it was. He said the Iliac arterial plaque was moderate to severe. The legs were moderate +.

Can a surgeon not do the PTA on the Iliac arteries, then at another time, on the femoral artery? Reply to this questions please... With the improved blood flow in the Iliac arteries, the leg arteries should improve. The collateral circulation in legs is excellent!!!!

As I have said many, many times, I exercise almost every day now = 40 mins each time, I take Crestor 10 mg. LDL is 53 mgL, I take Amplodipine and Olmetec plus aspirin. What more can I do? They are not lesions doctor = plaque stenosis.

I find you are very knowledgeable but perhaps a bit overkill. You are SCARING me now AND I SUFFER FROM PTSD. Please...

Is there anything over the short-term I have to be frightened about??? Please reply. As I said, I am seeing him on the 18th of December to come to a decision. In the meantime, I have consulted a vascular surgeon to see what can be done when the time comes. I do not wish to undergo by-pass surgery if it can be avoided.

The cardiologist does not believe I have CAD since I am asymptomatic. And he took an ECG two weeks ago that was normal.

Today, when I walked there was almost NO pain. Yesterday, there was a lot of pain. Normally, after a good night's sleep, there is little pain but when I do not sleep well, pain the next day when walking. When there is pain, I am a bit out of breath due to the effort walking. Today= NONE. All was very good.

Please comment and try to be reassuring and NOT too technical OK?
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Follow up: Dr. Ilir Sharka (0 minute later)
The cardiologist I saw, who is one of the best in Canada, does not believe at this point that an Angiogram is necessary. I am seeing him again on December 18th after the Echo on Monday and after a Mapa is done, and to discuss the Doppler tests. My BP at rest is 125/56.

The doctor I saw yesterday suggested the endovascular procedure after viewing my Doppler of my legs and Iliac arteries. If he suggested this, it is because he saw how extensive the plaque is/was and how long it was. He said the Iliac arterial plaque was moderate to severe. The legs were moderate +.

Can a surgeon not do the PTA on the Iliac arteries, then at another time, on the femoral artery? Reply to this questions please... With the improved blood flow in the Iliac arteries, the leg arteries should improve. The collateral circulation in legs is excellent!!!!

As I have said many, many times, I exercise almost every day now = 40 mins each time, I take Crestor 10 mg. LDL is 53 mgL, I take Amplodipine and Olmetec plus aspirin. What more can I do? They are not lesions doctor = plaque stenosis.

I find you are very knowledgeable but perhaps a bit overkill. You are SCARING me now AND I SUFFER FROM PTSD. Please...

Is there anything over the short-term I have to be frightened about??? Please reply. As I said, I am seeing him on the 18th of December to come to a decision. In the meantime, I have consulted a vascular surgeon to see what can be done when the time comes. I do not wish to undergo by-pass surgery if it can be avoided.

The cardiologist does not believe I have CAD since I am asymptomatic. And he took an ECG two weeks ago that was normal.

Today, when I walked there was almost NO pain. Yesterday, there was a lot of pain. Normally, after a good night's sleep, there is little pain but when I do not sleep well, pain the next day when walking. When there is pain, I am a bit out of breath due to the effort walking. Today= NONE. All was very good.

Please comment and try to be reassuring and NOT too technical OK?
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Follow up: Dr. Ilir Sharka (1 hour later)
The blockages are in the Iliac arteries and femoral area of the knees...
default
Follow up: Dr. Ilir Sharka (0 minute later)
The blockages are in the Iliac arteries and femoral area of the knees...
doctor
Answered by Dr. Ilir Sharka (6 hours later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I am really sorry to have triggered your anxiety, although this was not in my intentions.

I was just trying to be as more informative as possible about the possible treatment modalities and their possible combination.

You are right to say that maybe I was talking more in a technical language than needed. But this is a common mistake for us as doctors when talking to our patients.

Anyway, I agree with you on the fact that PTA can be done for both the Iliac and femoral arteries. It is also true that with a good collateral blood circulation the blood supply to the legs is going to improve after restoring the blood flow in the Iliad arteries.

So there is no reason to panic!

You should know that there are many patients like you with a very good outcome from PTA, as this procedure is quite safe and XXXXXXX invasive.

I would just recommend discussing with your doctor on the possibility of performing an angio CT scan, which has a higher accuracy compared to the Doppler ultrasound ( if there are no contraindications to the procedure) in order to examine better the vessels diameter and blood flow in them.

I remain at your disposal for any further questions whenever you need!

Wishing all the best,

Dr.Iliri




Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Ilir Sharka (0 minute later)
Brief Answer:
My opinion as follows:

Detailed Answer:
Hello again!

I am really sorry to have triggered your anxiety, although this was not in my intentions.

I was just trying to be as more informative as possible about the possible treatment modalities and their possible combination.

You are right to say that maybe I was talking more in a technical language than needed. But this is a common mistake for us as doctors when talking to our patients.

Anyway, I agree with you on the fact that PTA can be done for both the Iliac and femoral arteries. It is also true that with a good collateral blood circulation the blood supply to the legs is going to improve after restoring the blood flow in the Iliad arteries.

So there is no reason to panic!

You should know that there are many patients like you with a very good outcome from PTA, as this procedure is quite safe and XXXXXXX invasive.

I would just recommend discussing with your doctor on the possibility of performing an angio CT scan, which has a higher accuracy compared to the Doppler ultrasound ( if there are no contraindications to the procedure) in order to examine better the vessels diameter and blood flow in them.

I remain at your disposal for any further questions whenever you need!

Wishing all the best,

Dr.Iliri



Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Kampana
doctor
Answered by
Dr.
Dr. Ilir Sharka

Cardiologist

Practicing since :2001

Answered : 9538 Questions

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Hello - I Had A Doppler Of Legs And Iliac

Hello - I had a Doppler of legs and Iliac arteries yesterday at the Montreal Heart Institute. I have moderate to severe plaque of the Iliac arteries and my PAD in my legs is moderate also. The doctor who saw my results suggested a catheter procedure to open up the Iliac arteries. I understand this procedure is quite safe. I am meeting the head cardiologist at the Montreal Heart Institute on December 18th to go over results (Doppler PLUS additional heart echo to be taken this coming Monday). My LDL is 1.45, all other tests are good. Is this the right procedure? I believe it is. Some days, it is painful even just walking around my apartment, other days - like today - I did my walking and the pain was much less (3 out of 10). I am anxious and need some reassurance about the PTA procedure. Thank you!