Rhode Island Medical Imaging

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(PAD) Peripheral Arterial Disease and Claudication

"Claudication" is a medical term that refers to leg pain while walking that is relieved by rest within a few minutes. It usually occurs in the calf, but can also occur in the thigh or buttocks. It is usually caused by atherosclerotic plaques in the arteries that supply blood flow to the legs. The build up of plaques narrows the arteries and restricts blood flow. This is most noticeable when demand for blood flow is increased during walking.

There are over 2 million Americans who suffer from claudication, including as many as 10% of those over the age of 70 years. Claudication is a chronic, life-style limiting disease--fewer than 20% will progress over 5 years to require interventions to unblock arteries to avoid tissue loss or gangrene. However, claudication is very restrictive of activities usually associated with a satisfying life, and the quality-of life impact of claudication is severe. In fact psychometric studies have shown that claudication decreases patient-reported quality of life similar to other well-know medical conditions such as heart attack and heart failure.

Diagnosis

Claudication is a condition that can usually be readily diagnosed based on the symptoms and simple physical examination findings. Pain in the leg muscles brought on by walking or stair climbing that is reproducible, and relieved within a few minutes of rest, is highly suggestive of the diagnosis. Absence or reduction in pulses in the involved leg is usually confirmatory. A simple noninvasive test, called an "ankle-brachial index" (ABI), can be done to quantify the reduction in blood flow to the leg. This is similar to a blood pressure measurement, but is done on the ankles.

Ankle-brachial indexes and other noninvasive tests can be done in the office of vascular specialists, or increasingly, in the primary care office. There are new generations of ABI machines that are semi-automated and don't require specialized training to obtain accurate ABI measurements. These are increasingly available in primary care offices. For equivocal cases, other tests such as exercise treadmill testing or magnetic resonance may be helpful.

Treatment

Prior to the availability of minimally invasive treatments to open up blocked arteries, most patients with claudication were managed conservatively. That is, they did not undergo surgery to open or bypass arterial blockages--the risk was too great. Recently, new drugs have been developed that are useful for many people, and those with mild disability are often best managed with reassurance, claudication medications, exercise, and global atherosclerotic disease risk reduction.

For those whose activities are hampered by their claudication, interventional procedures like angioplasty and stenting are often done, and can be performed with a small (1/8") incision, often on an outpatient or "short stay" hospitalization (less than one day). The risk of interventional treatments is reduced 90% compared with surgery, and many patients with claudication can have their symptoms relieved with these low risk procedures.

Research

The Interventional Radiology department at Rhode Island Medical Imaging is actively enrolling in the National Institutes of Health CLEVER Study (Claudication: Exercise Vs. Endoluminal Revascularization). This pivotal study of claudication patients will examine and compare the principal treatments for this disease: medications, supervised exercise, and interventional treatments.

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East Providence I-195 West On-ramp Closures
Posted: 04.02.18

As RIDOT replaces the Parkway Ramp Bridge in East Providence (see below for more information), they will need to close the I-195 West on-ramps from Veterans Memorial Parkway and Warren Avenue in East Providence beginning Wednesday, April 4. Get detour information here.

Traffic heading north on the Parkway will follow a detour using Lyon Avenue to Warren Avenue to Broadway. Local traffic on the Parkway north of Lyon Avenue can use Mauran Avenue (the last street before the Parkway on-ramp) to Burgess Avenue to reach Warren Avenue and the detour route to Broadway.

Those heading to destinations on the East Side of Providence may wish to follow Valley Street to North Brow Street to Massasoit Avenue to use the Henderson Bridge as an alternate detour. Motorists also may wish to use Pawtucket Avenue or the Wampanoag Trail to the East Shore Expressway for I-195 West access.

The bridge replacement will be completed in late fall, however work on the nearby Washington Bridge will extend its reopening until the end of 2019.

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Posted: 11.28.17

Despite lung cancer causing the most fatalities of any cancer in the United States, funding for lung cancer research has not drastically improved for many years. The American Lung Association drove home this message and other insights during the Lung Force Expo at the Crowne Plaza Hotel on November 8, 2017.