Early Detection of Peripheral Artery Disease Allows for Several Treatment Options

September 3, 2009

“Vascular surgery is all about improving blood flow, preserving quality of life, reducing pain and maintaining limbs. It can really improve someone’s life and allow them to resume activities that they may have found difficult when they had blockages.”

Waheed Ahmad, MD
Board Certified Vascular Surgeon

Strong, unrestricted blood flow is one of the central elements of having a healthy body. It enables the body to heal from injuries, enjoy pain-free mobility and the heart to pump blood. For many people, though, vascular disease hinders blood flow and can severely affect quality of life. For those with vascular disease, prevention is key – and so is early diagnosis.

Understanding and Diagnosing Vascular Disease The most common vascular disease is peripheral artery disease, or PAD, which involves the hardening or blocking of arteries that carry blood outside the heart. Most commonly PAD occurs in the legs, but it can also affect arteries that go to the aorta, brain, arms, kidneys and stomach. According to Thoracic and Vascular Surgeon, Denis Raleigh, MD, “Forty to 50 percent of people afflicted with PAD are symptomatic. Because so many people do not experience warning signs, screenings are important for those who are over 50 years old and have risk factors such as diabetes, heart disease or who smoke. Screenings should be performed on all patients 70 years and older.”

The first step to diagnosing PAD is determining the patient’s ankle-brachial index (ABI), which involves a comparison of blood pressure in the ankles with blood pressure in the arms. If the screening is abnormal, the next test we use is a noninvasive arterial Doppler study, using sound waves to find possible occlusion in the arteries. The next step in diagnosis is more invasive. One option is a Magnetic Resonance Angiography (MRA), a procedure where the patient is injected with a tracer to see how it travels through the arteries. Another option, an arteriogram, involves the injection of a dye that makes the arteries visible on an X-ray.

Vascular Surgeon Waheed Ahmad, MD added, “The vascular area of medicine can be greatly assisted by preventive techniques. Don’t smoke and keep your weight down. Eat properly and exercise. Following these basic rules could drastically reduce your risk of developing vascular problems.”

“In some cases, patients have been taking pain medications for years, believing their pain is due to muscle aches or joint pain. They are finally able to stop taking them once the blood flow to the affected area has been restored.”

Kevin White, MD
Board Certified Vascular and Interventional Radiologist
Radiology Associates, Inc.

Treating PAD

Advances in treatment have made it possible for PAD and other types of blockages to be corrected using endovascular techniques, for example, working inside the artery through a 1/4 inch incision in the groin area. “We want to diagnose it as soon as possible and treat it as soon as it makes sense to do so,” said Vascular and Interventional Radiologist Kevin White, MD, “If tissue is lost or there is pain while the person is resting, it needs to be treated right away, because that indicates severe ischemia (obstruction of blood flow).”

There are three surgical procedures for opening the arteries and improving blood flow:

  • Angioplasty is a procedure where a tiny balloon is inserted into the blood vessel and then inflated to open the artery. Once opened, sometimes a small mesh tube, known as a stent, is inserted to help keep the artery open.
  • Atherectomy removes plaque from the arteries by shaving it off using a tiny, rotating shaver on the end of a catheter.
  • Arterial bypass is a process that harvests healthy vessels from another area of the body to replace the vessels that are blocked.

According to Thoracic and Vascular Surgeon Franco Rea, MD, “If patients have blockage in the legs, they usually have blockages elsewhere in their body. It’s not unusual to find blockages near the heart or in the neck as well.”

“To avoid vascular problems, there are many things you can do to help. Keep your weight under control and be as physically active as possible. For those who smoke, the best thing they can do to positively affect vascular health is to quit smoking.”

Franco Rea, MD, FACS
Board Certified Thoracic and Vascular Surgeon
Kentuckiana Thoracic and Vascular Surgery

Recovering from Surgery

Following a period of observation, most patients are able to go home following surgery and are advised to rest for 48 hours following the procedure and to avoid heavy lifting.

For patients who have undergone vascular surgery, it can make a huge difference in their lives. “The main difference is pain relief and improved function,” said Dr. White. “Often,the worst pain comes while the person is walking or when they are in bed at night. After treatment, function improves, and some patients even begin to exercise and start healthier habits, which helps their overall health.”

Know the Warning Signs of PAD

  • Fatigue, tiredness or pain in your legs, thighs or buttocks that always happens when you walk but goes away when you rest.
  • Foot or toe pain at rest that often disturbs your sleep.
  • Skin wounds or ulcers on your feet or toes that are slow to heal (or that do not heal for 8 to 12 weeks).

“Patients now recognize peripheral artery disease (PAD) for being the second or third largest disease category in the country. People are watching out for it and many know the signs and symptoms.”

Denis P. Raleigh, MD
Board Certified Thoracic and Vascular Surgeon
Kentuckiana Cardiovascular Institute

“Get a Leg Up on PAD” Screening

actionFloyd Memorial’s Heart and Vascular Center is holding a free screening to test for Peripheral Artery Disease on Saturday, Oct. 24 from 8 to 11 a.m. in Floyd Memorial’s Outpatient Cardiovascular Unit. To learn more, see the Calendar of Events on page 14.

Diabetes Fair and Foot Screening

Floyd Memorial’s Wound Healing Center and Joslin Diabetes Center Affiliate are actionoffering a free diabetes fair and foot screening on Saturday, Nov. 7 from 8 to 11 a.m. in the Paris Health Education Center. In addition to free foot screenings, the event will offer free blood sugar checks and AIC readings and educational information on diabetes. For more information, see the Calendar of Events.