Prof. Dr. Niazi Khusrow

Prof. Dr. Khusrow Niazi
Member, American College of Cardiology Competency Management Committee
Professor of Medicine, Emory University, Atlanta, Georgia

What tests to do to identify vascular cause of lower extremity wounds

K. Niazi
Peripheral Vascular Intervention, Emory University, Atlanta, Georgia, USA

Ulcers on the foot or around the ankle area are frequently encountered in clinical practice and carry the ominous danger of limb amputations if prompt diagnosis and treatment is not instituted. Clinically vascular causes may be divided into arterial, venous and others. The most common cause is chronic venous insufficiency (CVI) followed by atherosclerotic arterial occlusive disease also called peripheral arterial disease (PAD). Most of the patients will give a history which will guide the diagnostic testing to confirm the underlying pathology for the ulcer. Physical examination will add to the history in directing what type of vascular testing is performed.
Simple diagnostic testing in the office may help including an ankle-brachial index (ABI) and a Doppler examination of the venous system of the lower extremity. If an abnormal ABI is identified then MRA or CTA of the lower extremities will define the arterial obstructive disease. Majority of these obstructions may be addressed endovascularly without exposing the patient to more invasive vascular procedures. Once the blood flow is improved then with local wound care, healing is expedited. Similarly, once venous insufficiency is demonstrated in the great or small saphenous vein, treating these will expedite wound healing. The treatment is office based thus avoiding any major surgeries.
Venous doppler is an extremely useful test in assessing for chronic venous insufficiency in the lower extremities. The test should be done when the patient is well hydrated and has walked around for 20-30 mins. It should be done with the pt standing as reflux may not be demonstrated with pt lying down.

Endovascular procedures for the treatment of lower extremity wounds

K. Niazi
Peripheral Vascular Intervention, Emory University, Atlanta, Georgia, USA

Once the arterial obstructive disease is confirmed, patient may be referred for revascularization. This may be accomplished endovascularly (percutaneous) or by open surgery using autologous vein or artificial bypass grafts. With advancement of technology, most of the arterial obstruction can be treated endovascularly and it will be dependent on the local expertise. The major advantages of endovascular being that it is less invasive, can be performed as outpatient with very limited morbidity. High risk patients for open surgery can undergo endovascular procedures with less risk.
These days for endovascular treatment there is a plethora of devices at the disposal of the physician treating the patient. The most important factor in deciding how to treat obstruction in the lower extremity arterial disease is for the physician to know their comfort zone with the method they decide to use. The devises available range from simple balloon angioplasty, specialty balloon, atherectomy, LASER, stents and drug coated balloons. Many times, a combination of these devices are employed to treat the obstructive disease. The goal of the therapy is to establish patency and to reduce the risk of re-occlusion.

Scurt CV

Dr. Niazi is board certified in Internal Medicine and Interventional Cardiology by the American Board of Internal Medicine. In addition, he is certified in Vascular Medicine Board and in Endovascular Board by the American Board of Vascular Medicine and is a Fellow of the American College of Cardiology and the Society of Vascular Medicine. He has had extensive experience working in some of the leading institutions of the world including USA. He was one of the first physician who conducted a prospective trial of small vessel stenting and demonstrated that stenting was superior to balloon angioplasty in small caliber coronary arteries as diabetes was very common. He joined Emory University in 2003. He has trained many cardiologists and has done mini-seminars in how to do and read non-invasive Doppler techniques for the diagnosis of vascular diseases and complex interventional procedures. He has written two book chapters in Interventional Cardiology 2nd edition on PAD and chronic venous disease. Dr. Niazi is a prolific teacher and besides teaching medical students, residents and cardiology fellows, he has been invited to give lectures, grand rounds locally, nationally and internationally. He has done live demonstration cases demonstrating various endovascular techniques in different countries.