South Charlotte General and Vascular Surgery

02/21/2026

Peripheral Artery Disease: The Silent Progression We Cannot Ignore

As we enter another year confronting peripheral artery disease (PAD) in the United States and across the world, we must pause and confront the magnitude of what stands before us.

Peripheral artery disease is not rare. It is not benign. And it is not slowing down.

The Numbers We Must Face
• In the United States, an estimated 8.5 to 12 million Americans are living with PAD.
• Globally, more than 230 million people are affected.
• PAD prevalence increases sharply with age — affecting over 20% of individuals older than 80.
• Patients with PAD have a 2–3× higher risk of cardiovascular death compared with those without the disease.

But what concerns me most is progression.

Among patients classified as Rutherford Category 3 (severe claudication):
• Approximately 5–10% will progress to critical limb-threatening ischemia (CLTI, Rutherford 4–6) within 1–2 years, particularly in the presence of diabetes, smoking, renal insufficiency, or poorly controlled risk factors.
• Once patients transition into Rutherford 4 (ischemic rest pain), the risk curve steepens dramatically.
• Within one year of developing CLTI, studies demonstrate:
• 15–25% risk of major amputation
• 20–25% mortality rate
• Up to 50% mortality at 5 years

These are not minor statistics. These are life-altering trajectories.

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The Challenge Before Us

We face more than plaque and calcification.
We face:
• Insurance restrictions that shape care pathways
• Conservative treatment barriers
• Delayed referrals
• Underdiagnosis in primary settings
• Inconsistent surveillance
• Fragmented responsibility

And yet the solution remains remarkably consistent:

1. Risk Factor Modification
• Smoking cessation
• Aggressive lipid control
• Antiplatelet therapy
• Glycemic optimization
• Blood pressure management

2. Supervised and Structured Walking

Walking is not trivial advice.
Walking promotes collateral vessel development, improves endothelial function, and enhances functional capacity. It is biologic therapy.

3. Early Recognition of Subtle Change

Patients must be educated to report:
• Shorter walking distances
• Night pain in the foot
• Dependent rubor
• New numbness
• Slow-healing wounds

Small changes precede catastrophic ones.

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A Call to Physicians

I say this clearly and without apology:

Physicians must remain directly involved in the care of patients with PAD.

Examine your patients.
Lay hands on your patients.
Palpate pulses.
Inspect the skin.
Look at the toes.
Ask the hard questions.

Delegation has its place — but responsibility cannot be delegated.

The roles are distinct.
The training is distinct.
The burden of decision-making is distinct.

At the end of the day, the physician carries the final accountability — not just to the patient, but to society.

Our responsibility is not reimbursement.
Our responsibility is limb salvage.
Our responsibility is life preservation.

Reimbursement is secondary.
Excellence is primary.

And when excellence is primary, reward follows naturally.

As I have said before:

Let the dollar chase you — do not chase the dollar.

If we educate the next generation early, intervene decisively when necessary, and remain hands-on stewards of this disease, we can alter the trajectory.

PAD is progressive — but neglect is optional.

Let us choose vigilance.
Let us choose responsibility.
Let us choose life and limb salvage.

— Dr. James N. Antezana
FSVS, RPVI

11/11/2025

🩸 Understanding Peripheral Artery Disease (PAD): Saving Limbs, Saving Lives

Peripheral Artery Disease (PAD) affects over 8.5 million Americans, and millions more worldwide — often silently. It happens when plaque builds up inside the arteries that carry blood to your legs and feet, causing them to narrow or even block.
What does that mean? Less oxygen, less flow, and more pain.

Patients often describe it as:
• Pain in the legs while walking (that goes away with rest)
• Cold or discolored feet
• Wounds that don’t heal easily
• Or in severe cases, threats to the limb itself

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But there’s good news.

We’ve come a long way in treating PAD.
Today’s technology allows us to restore blood flow in a minimally invasive way — often without open surgery.

Atherectomy, for example, is a technique that removes plaque directly from inside the arteries.
It’s often used to prepare the artery before using a balloon or stent — giving the vessel a chance to heal and remain open longer.

Recent studies have shown that atherectomy:
✅ Reduces the risk of artery dissection (tearing)
✅ Lowers the need for emergency stenting
✅ Improves blood flow when combined with drug-coated balloons
✅ Helps preserve limbs and enhance quality of life

Every patient is different, and the best approach depends on your anatomy, your overall health, and your goals.

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The Takeaway

PAD isn’t just about pain — it’s about preserving your mobility, your independence, and your life.
If you experience leg pain, non-healing wounds, or notice changes in your feet, don’t wait.
Early diagnosis can prevent amputation and restore the quality of life you deserve.

Together, through awareness and innovation, we can fight PAD — one leg, one life at a time.

— Dr. James N. Antezana, MD, FSVS, RPVI
Vascular & Endovascular Surgeon
South Charlotte General & Vascular Surgery

🩸 Entendiendo la Enfermedad Arterial Periférica (EAP): Salvando Piernas, Salvando Vidas

La Enfermedad Arterial Periférica (EAP) afecta a más de 8.5 millones de estadounidenses y a millones más en todo el mundo — muchas veces en silencio.
Ocurre cuando la placa se acumula dentro de las arterias que llevan sangre a las piernas y los pies, haciendo que se estrechen o se bloqueen.
¿El resultado? Menor oxígeno, menor flujo y más dolor.

Los pacientes suelen describir síntomas como:
• Dolor en las piernas al caminar (que desaparece al descansar)
• Pies fríos o descoloridos
• Heridas que no cicatrizan fácilmente
• O en casos más graves, riesgo de perder la extremidad

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Pero hay buenas noticias.

Hemos avanzado enormemente en el tratamiento de la EAP.
Hoy, la tecnología nos permite restaurar el flujo sanguíneo de forma mínimamente invasiva, muchas veces sin cirugía abierta.

Uno de estos tratamientos es la Aterectomía, un procedimiento que elimina directamente la placa del interior de las arterias.
A menudo se usa para preparar la arteria antes de aplicar un balón o un stent — ayudando a que el vaso se mantenga abierto y sano por más tiempo.

Estudios recientes han demostrado que la aterectomía:
✅ Reduce el riesgo de desgarro arterial (disección)
✅ Disminuye la necesidad de colocar stents de emergencia
✅ Mejora el flujo sanguíneo cuando se combina con balones recubiertos con fármacos
✅ Ayuda a preservar las extremidades y mejora la calidad de vida

Cada paciente es único, y el mejor tratamiento depende de su anatomía, su salud general y sus objetivos.

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En resumen

La EAP no se trata solo de dolor — se trata de preservar su movilidad, su independencia y su vida.
Si experimenta dolor en las piernas, heridas que no sanan o cambios en la temperatura o color de sus pies, no espere.
Un diagnóstico temprano puede prevenir una amputación y devolverle la calidad de vida que merece.

Juntos, a través de la conciencia y la innovación, podemos luchar contra la EAP — una pierna, una vida a la vez.

— Dr. James N. Antezana, MD, FSVS, RPVI
Cirujano Vascular y Endovascular
South Charlotte General & Vascular Surgery

10/29/2025

“The Stone in the Path”
—A Reflection on Peripheral Artery Disease
By Dr. James Antezana

We walk through life unaware,
our bodies vessels, temples—
yet treated like broken carts
dragged through dusty roads,
neglected and worn.

We grow accustomed to pain,
to that silent murmur beneath the skin,
until one day—
a stone in the path.
A halt. A limp. A whisper
from the body that becomes a scream.

A vice grips the calf, the thigh, the buttock—
a pain not born of effort,
but of time, and choice,
and fire.
The spirit wishes to go on,
but the body says, no more.

This is Peripheral Artery Disease—
PAD—
the thief in the shadow
that robs us slowly
and only shows its face
when the road is nearly gone.

It begins with a flame,
not one that warms,
but one that scars.
The cigarette—
a ritual of breath and poison—
slowly dressing your arteries
in armor they never asked for.

I tell my patients:
Imagine walking barefoot
on cobblestones—
but not with your feet.
The soles of pain are inside you,
within the walls of vessels
once supple, now stiff.
That is inflammation.
That is smoking.
That is time, turned against you.

And yet,
diabetes joins the march,
so does pressure,
so does cholesterol,
and the inheritance
written in your blood
long before you took your first step.

And when the body breaks,
they turn to Dr. Google—
the oracle of fear.
He speaks with authority,
but not with wisdom.
He gives information,
but no context, no soul.
He tells you what may go wrong,
but never how to live right.

But I am not Google.
I am a surgeon.
A steward of blood and breath,
a craftsman of vessels,
a witness to miracles—
but only if you believe.

I tell my patients:
Do not lose hope.
Do not fall again
into the seduction of the very habits
that brought you here.

There is no going back,
but there is always a new path—
less dusty,
lined with light,
guided by hands
that know the terrain.

Listen.
Listen not with panic,
but with purpose.
Follow not the loudest voice,
but the wisest one.

And when healing comes,
as it often does,
do not return
to the sins that hardened you.

Because even Christ said:
Your faith has healed you.

So I say:
Your faith has healed you.
Not just in God,
but in the power of change,
in the art of medicine,
and in the will to rise again—
one step at a time,
beyond the stone
in the path.

“La Piedra en el Camino”
—Una reflexión sobre la Enfermedad Arterial Periférica (EAP)
Por el Dr. James Antezana

Caminamos por la vida sin darnos cuenta,
nuestros cuerpos, templos sagrados—
tratados como carretas rotas
arrastradas por caminos polvorientos,
descuidadas, desgastadas.

Nos acostumbramos al dolor,
a ese susurro silente bajo la piel,
hasta que un día—
una piedra en el camino.
Un alto. Una cojera. Una señal
del cuerpo que se convierte en grito.

Una tenaza aprieta la pantorrilla, el muslo, la cadera—
un dolor que no nace del esfuerzo,
sino del tiempo, de las decisiones,
y del fuego.
El espíritu desea seguir,
pero el cuerpo dice: no más.

Esto es la Enfermedad Arterial Periférica—
EAP—
el ladrón en la sombra
que roba lentamente
y solo muestra su rostro
cuando el camino casi se ha perdido.

Comienza con una llama,
no una que da calor,
sino una que deja cicatrices.
El cigarrillo—
ritual de aliento y veneno—
vistiéndo las arterias
con una armadura jamás pedida.

Les digo a mis pacientes:
Imaginen caminar descalzos
sobre adoquines—
pero no con los pies.
Las plantas del dolor están dentro de ustedes,
en las paredes de los vasos
que antes eran suaves, y ahora son piedra.
Eso es inflamación.
Eso es fumar.
Eso es el tiempo, vuelto en contra.

Y sin embargo,
la diabetes se une a la marcha,
también la presión,
el colesterol,
y la herencia
escrita en su sangre
mucho antes de su primer paso.

Y cuando el cuerpo falla,
buscan a Dr. Google—
el oráculo del temor.
Habla con autoridad,
pero no con sabiduría.
Ofrece información,
pero sin contexto, sin alma.
Dice lo que puede ir mal,
pero nunca enseña a vivir bien.

Pero yo no soy Google.
Soy cirujano.
Guardián de la sangre y el aliento,
artesano de los vasos,
testigo de milagros—
pero solo si usted cree.

Les digo a mis pacientes:
No pierdan la esperanza.
No vuelvan a caer
en los hábitos que los trajeron hasta aquí.

No se puede retroceder,
pero siempre hay un nuevo camino—
menos polvoriento,
iluminado,
guiado por manos
que conocen el terreno.

Escuchen.
No con pánico,
sino con propósito.
No sigan la voz más fuerte,
sino la más sabia.

Y cuando llegue la sanación,
como suele llegar,
no regresen
a los pecados que los endurecieron.

Porque incluso Cristo dijo:
Tu fe te ha sanado.

Y yo les digo:
Tu fe te ha sanado.
No solo en Dios,
sino en el poder del cambio,
en el arte de la medicina,
y en la voluntad de levantarse otra vez—
paso a paso,
más allá de la piedra
en el camino.

Dr. Leg Saver

10/28/2025

The Silent Disease of Our Time

By James N. Antezana, MD, FSVS, RPVI

In the moment we are born, the clock begins to tick.
We grow, we move, we live — and with the passing of time, through years of use and misuse, of standing and sitting, of labor and neglect — our bodies begin to reveal the wear of existence.

The veins, those silent rivers beneath our skin, begin to descend. The valves that once lifted our blood back toward the heart start to fail — not because of weakness alone, but because of inheritance, a gift from generations past.

Slowly, the legs begin to change.
At first, we feel the heaviness — the weight of retained water, the inefficiency of our inner plumbing. At the end of a long day, we pull off our socks and notice the faint ring around our ankles.
Not deep at first. But as years pass, it deepens.

Soon, the ankles darken — a shadowed hue of blue and purple. Some notice a web of spider veins tracing their way up the calf or behind the knee. Others begin to see worm-like bulges snaking along the inner leg or thigh.

Each presentation tells a story — of genetics and gravity, of time and habit, of our daily rituals and inherited design.

So I urge you: look at your predecessors.
Observe your mother, your father, your aunts, your uncles. Study the legs that carried your lineage through life. There lies a reflection of your own destiny.

But destiny can be altered.
With awareness and action, with medical insight and early care, we can change the course of what once seemed inevitable.

For too long, this condition was dismissed — labeled cosmetic, trivial. But knowledge is now at our fingertips. And with conviction, we can choose differently.

Let not this silent destroyer corrode the image, strength, and confidence that carry you through your journey.
Your legs are your pillars — protect them, honor them, heal them.

La Enfermedad Silenciosa de Nuestros Tiempos

Por James N. Antezana, MD, FSVS, RPVI

En el momento en que nacemos, el reloj comienza a marcar su paso.
Crecemos, nos desarrollamos, vivimos, y con los años de uso y abuso, de estar de pie, de sentarnos, de caminar y de esperar, el cuerpo empieza a mostrar los signos del tiempo.

Las venas — esos ríos silenciosos que fluyen bajo nuestra piel — comienzan a descender.
Las válvulas que alguna vez impulsaron la sangre de regreso al corazón con fuerza y ritmo, comienzan a fallar.
Y no lo hacen por debilidad, sino por herencia — un legado invisible que nos fue entregado desde generaciones anteriores.

Así, poco a poco, las piernas comienzan a transformarse.
Primero llega la sensación de pesadez, el cansancio del final del día, la hinchazón leve que deja su marca cuando quitamos los calcetines.
Ese anillo en los tobillos — tenue al principio — se va profundizando con el paso del tiempo.

Después aparecen los tonos violáceos, las sombras azuladas que tiñen los tobillos y los pies.
Surgen las finas telarañas de venas detrás de las rodillas, alrededor de los tobillos, en los muslos.
Y para algunos, se dibujan venas gruesas, retorcidas, que serpentean bajo la piel como raíces que buscan escapar.

Cada una de estas manifestaciones es el resultado de una ecuación antigua:
genética, ambiente, y los hábitos que repetimos día tras día.
Por eso invito a todos a mirar con atención a sus predecesores — a la madre, al padre, a los tíos, a las tías, a los hermanos, a los primos.
Observen sus piernas.
Vean si también ellos han sufrido de esta enfermedad silenciosa.

Porque allí, en la historia de su sangre, está escrita parte de la suya.
Pero el destino, aunque heredado, no es inmutable.
Podemos cambiar su curso.
Podemos prevenir lo inevitable si escuchamos las señales tempranas, si no lo reducimos a una cuestión estética.

Durante años, muchos médicos — incluso con buena intención — restaron importancia a esta condición, llamándola “solo un problema de apariencia.”
Pero quienes la padecen saben que no lo es.
Que es una carga física, emocional y espiritual.
Una dolencia que no solo afecta las piernas, sino también la mente y el alma.

Hoy tenemos el privilegio del conocimiento.
La información ya no pertenece solo a los libros o las universidades; está en nuestras manos, en nuestros dispositivos, en nuestra conciencia.
Y con conocimiento, viene la libertad.
La libertad de actuar, de cambiar, de sanar.

No permitas que este enemigo silencioso — que corroe poco a poco la imagen y la confianza — destruya aquello que te sostiene.
Tus piernas son tus pilares, los cimientos de tu vida.
Protégelas.
Honra su camino.
Y devuélveles la fuerza de la que nacieron.

09/30/2025

✨ A New Chapter at SCGVS ✨

I have always spoken of God’s perfect universe — a universe that reveals itself in mysterious ways, guiding us through people, places, and moments of meaning.

Today, as I watched my dear friend and colleague, Dr. Steven Weston, perform a masterful tummy tuck, I was reminded once again of how purpose is revealed through skill, vision, and faith.

Dr. Weston is a board-certified general surgeon, a board-certified anti-aging physician, and an extraordinary cosmetic surgeon. He trained in one of the most demanding eras of surgery — a time when surgeons were expected to be complete and versatile, mastering skills that stretched across vascular, orthopedic, plastic, and general surgery. This foundation shaped him into a surgeon of rare breadth and depth.

But life is more than training. After his divorce, Dr. Weston found the love of his life — a former Virginia Slims model who became his wife, his partner, and his inspiration. She encouraged him to embrace the world of aesthetics, and with discipline and devotion, he expanded his surgical mastery into the art of beauty.

Today, I see the culmination of that remarkable journey — the mountains climbed, the sacrifices made, and the mastery achieved. It is with profound honor that I welcome Dr. Steven Weston, along with Weston MedSurge, Weston Veins Clinic, and Azura MedSpa, into the South Charlotte General & Vascular Surgery (SCGVS) family.

Together, under one umbrella, we step forward into a future of healing, innovation, and beauty — guided always by grace, grounded in faith, and committed to serving our patients with excellence.

— JNA

04/03/2025

Another year, another honor. I’m proud to share that I’ve once again been invited to participate in the International Venous Conference in Miami. It’s always a privilege to join some of the world’s leading minds in vascular surgery to advance the conversation and contribute to the future of venous care.

12/18/2024

“The unpacking process and room setup have officially begun! Here’s a little glimpse of what’s coming together. Stay tuned for more updates!”

12/17/2024

Here we go!!!

12/17/2024

Exciting News at SCGVS!

Today marks the start of the installation of our long-awaited Azurion Philips ceiling-mounted cath lab! This cutting-edge addition is a milestone we’ve been anticipating for two years, and it represents our unwavering commitment to advancing care for our patients.

I want to take a moment to congratulate the entire SCGVS team for their hard work and dedication in making this vision a reality. This achievement would not have been possible without the incredible support of our referring physicians who continue to trust us in our shared mission to advance limb salvage and vascular care.

This is just the beginning, and I can’t wait to see how this new technology helps us elevate outcomes for our patients.

Here’s to progress, teamwork, and better care!

10/14/2024

It is such an honor to be recognized, thank you, Charlotte!

09/22/2024

08/18/2024

Interviewing, Dr. Antezana