Peripheral arterial disease (PAD), also known as peripheral vascular disease (PVD), is a very common condition affecting 12-20 percent of Americans (both men and women) age 65 and older.4 PAD develops most commonly as a result of atherosclerosis, or “hardening of the arteries,” which occurs when cholesterol and scar tissue build- up, forming a substance called plaque inside the arteries that narrows and clogs the arteries. This is a very serious condition. The clogged arteries cause decreased blood flow to the legs, which can result in pain when walking, and eventually gangrene and amputation.
Because atherosclerosis is a systemic disease, people with PAD are likely to have blocked arteries in other areas of the body.2 Thus, people with PAD are at increased risk for:
PAD is also a marker for diabetes, hypertension and other conditions. This is a major public health issue and the Society of Interventional Radiology recommends greater screening efforts through the use of the ankle-brachial index (ABI) test. This simple, painless test compares the blood pressure in the legs to the blood pressure in the arms to determine how well the blood is flowing and whether further tests are needed.
Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor. If you, or someone you know, are experiencing any of the symptoms above, please call our Memphis Vascular Center office and schedule what could be a potentially life-saving screening test today. (901) 683-1890
Get tested if you:
Often PAD can often be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease. PAD is not curable but we have treatments at Memphis Vascular Center to manage symptoms and help your risk of heart disease and stroke.
Often our Interventional Radiologist will make a small incision in your groin and, using X-rays or other imaging to guide him, thread a very thin catheter through your blood vessels to the blockage or narrowed artery. Depending on where the blockage is and how it looks, it may be treated it in several ways.
Angioplasty and stenting
Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, our board certified interventional radiologist threads a catheter through the femoral artery in the groin, to the blocked artery in the legs. Then the heist inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases, this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.
Balloon angioplasty and stenting has generally replaced invasive surgery as the first-line treatment for PAD. Early randomized trials have shown interventional therapy to be as effective as surgery for many arterial occlusions, and in the past five to seven years, a very large clinical experience in centers throughout the world has shown that stenting and angioplasty are preferred as a first-line treatment for more and more processes throughout the body.567
The long-term clinical results of stent placement to treat PAD are comparable to those of aortofemoral artery bypass surgery, with a much lower risk of associated morbidity and mortality. Surgery should be reserved for the rare patient in whom stenting can’t be done or fails.5
Early Warning Symptom for the #1 Killer of Women Is Under-recognized
Heart disease is the #1 killer of women in the United States. Peripheral arterial disease (PAD)—clogged or narrowed arteries in the legs—is a red flag that the same process may be going on elsewhere because PAD is associated with other life-threatening vascular diseases. Through early detection, The Memphis Vascular Center interventional radiologists can save women from future stroke, heart attack, and early death. To combat this major public health issue, the Society of Interventional Radiology recommends greater screening efforts by the medical community through the use of the ankle-brachial index (ABI) test.
Like heart disease, peripheral arterial disease is under-recognized in women. According to a survey of primary care physicians conducted in 2002, nearly all recognized that older people are more susceptible to PAD, and identified men as being susceptible to PAD. However, they mostly excluded women as likely to have PAD, which is incorrect.1 The prevalence is actually equal on the diagnostic ABI test.3 As vascular experts, interventional radiologists are partnering with primary care physicians to increase early screening.
Twelve to 20 percent of Americans older than 65 suffer from peripheral arterial disease but only one-third are symptomatic. Symptoms can include pain when walking that subsides at rest, leg cramps, pain at rest, numbness and skin discoloration, sores or other symptoms of skin breakdown. Women may be more likely than men to have PAD without experiencing symptoms; 50 to 90 percent are asymptomatic or have unrecognized symptoms of the disease, which could put them at greater risk of developing the serious disease before it is diagnosed and treated.3 Specifically, women are also less likely to have intermittent claudication symptoms, i.e., pain when walking that subsides at rest.
However, identifying PAD while asymptomatic may be life-saving for women, since it allows the easy, cheap identification of a systemic disease that may be treated. Treatment may greatly influence the woman’s outcome. These treatments may include further investigation into the state of disease in the coronaries, which could lead to heart disease, and carotids, which could lead to stroke, as well as the legs, and treating the significant areas of blockage that are found. Treatment with lifestyle modification and medication may slow the natural advancement of the disease.
The ABI, a comparative blood pressure reading in the arm and ankle, is used to screen for peripheral arterial disease. It is a direct measure of fatty plaque buildup in leg arteries and an indirect gauge of plaque accumulations throughout the entire cardiovascular system. Because atherosclerosis is a systemic disease, women developing plaque in their legs are likely to have plaque building up in the carotid arteries, which can lead to stroke, or the coronary arteries, which can lead to heart attack. Early detection of PAD is important because these women are at significantly increased risk, and preventive measures can be taken.
Memphis Vascular Center is located in Germantown, TN and serves patients for Peripheral Arterial Disease throughout the greater Memphis, TN area. For more information on PAD or to schedule an appointment, please call 901-683-1890 or schedule an appointment online HERE.
Minimally Invasive Treatment Options Available for Many Smoking-related Diseases
In the United States, nearly one in five deaths, or an estimated 440,000 deaths per year, are related to tobacco use.1 Approximately half of all Americans who continue to smoke will die due to smoking-related complications.1 Second-hand smoke alone causes 150,000 to 300,000 lower respiratory tract infections, such as bronchitis and pneumonia, in young children each year.1 Of these, between 7,500 and 15,000 result in hospitalization.1 Plus, a pregnant woman can harm or kill her unborn child by smoking.
Of the more than 4,000 chemicals that are emitted by a lit cigarette, 43 are known to cause cancer. Tar that can cause cancer in the tissues it reaches, highly addictive nicotine which affects the nervous system and carbon monoxide that reduces the ability of blood to carry oxygen throughout the body are the most dangerous chemicals. When the chemicals come into direct contact with tissues or organs, such as the mouth, throat, or lung, the rate for cancer is from twice to 14 times as high as that for non-smokers. Although most people are well aware of the risk of cancer from smoking, few people realize the damage smoking causes throughout the body’s vascular system.
Smoking damages the blood vessels and smokers are at risk for all vascular diseases including peripheral arterial disease, stroke, heart attack, abdominal aortic aneurysm and subsequent death.
In a healthy blood vessel, the inner lining of the arteries, known as the endothelium, constricts and dilates with blood flow. Smoking damages the endothelium, making arteries prone to spasms and deposits of diffuse plaque that diminish their ability to dilate properly. This condition is known as atherosclerosis, often called “hardening of the arteries.” Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called plaque that clogs the blood vessels and makes them less elastic.
Smokers are at increased risk for peripheral arterial disease, clogged arteries in the legs, that cause insufficient blood flow to get to the leg muscles. This causes pain, especially when walking and, left untreated, this insufficient blood flow can lead to limb amputation. While this may require angioplasty and stenting to improve blood flow, many people can avoid these procedures and alleviate their symptoms just by quitting smoking and beginning a specific exercise regimen. Smoking makes that big a difference in vascular disease.
Interventional radiologists provide treatment for many smoking-related diseases. Since they are first trained in diagnostic radiology, they use imaging to understand, visualize, and diagnose the full scope of the disease’s pathology and to map out the procedure tailored to the individual patient. Then during the procedure, they image as they go, literally watching and guiding their catheter through the vascular system or through the skin to the site of the problem. Following are some of the conditions that can be treated by interventional radiologists:
Aortic Abdominal Aneurysm – A weak area in the aorta, the main blood vessel that carries blood from the heart to the rest of the body. As blood flows through the aorta, the weak area bulges like a balloon and can burst resulting in death if it gets too big. An interventional radiologist can perform a stent graft to reinforce the weak artery wall and avoid major abdominal surgery.
Peripheral Arterial Disease – Hardening of the arteries (atherosclerosis) in the legs that can cause intermittent claudication—pain that occurs when a person walks and subsides when s/he stops. Atherosclerosis causes the arteries that carry blood to the arms or legs to become narrowed or clogged. Interventional radiologists can treat this by performing a balloon angioplasty to open a blocked artery and placing a stent to hold the artery open, if needed. However, many people are treated just with smoking cessation and a medically supervised exercise program.
Carotid Artery Disease and Stroke – In some patients, atherosclerosis in the carotid artery in the neck can lead to ischemic stroke. Plaque build-up in the carotid artery may result in a stroke by either decreasing blood flow to the brain or by breaking loose and floating into a smaller vessel, depriving a portion of the brain of blood flow. In patients at high risk of having a stroke, the narrowed section of artery may be reopened by an interventional radiologist through angioplasty and reinforced with a stent, thereby preventing the stroke from occurring.
Stroke – Most commonly caused by a blood clot in the brain that starves the brain from receiving oxygen, which can cause the affected sections of the brain to die. If caught in time, within six hours of the symptoms, an interventional radiologist can deliver a clot-busting drug directly into the brain to the site of the clot to dissolve it and restore blood flow to the brain. This treatment can often prevent the disabling effects of a stroke.
Lung Cancer – Cigarette smoking is the most common cause of lung cancer.2 Interventional radiologists can treat lung cancer patients nonsurgically by “freezing” tumors with cryotherapy or “cooking” them with radiofrequency heat.
Kidney Cancer – 32,000 Americans are diagnosed with kidney cancer each year.2 Although surgical removal of the kidney offers the best chance for a cure, some patients are not surgical candidates. Interventional radiologists offer nonsurgical treatment using radiofrequency heat that “cooks” and kills the tumor.
Osteoporosis – Because smokers have lower levels of estrogen, smoking is bad for their bones and is a risk factor for osteoporosis, which can result in spinal fractures.3 By injecting bone cement through a needle into fractured vertebrae, interventional radiologists can shore up the vertebra and relieve pain. This procedure, known as vertebroplasty, is a pain treatment for people with spinal fractures that have not responded to medical management.