Much attention is paid to a patient with coronary artery disease, and rightly so because of its proximity to the heart.
However, Dr. Joel E. Schneider, an interventional cardiologist and peripheral vascular specialist, with Wake Heart & Vascular Associates, doesn’t want patients to forget about keeping tabs on how the body gets blood to the extremities.
Peripheral arterial disease affects the primary paths the body uses to supply major parts with oxygen-rich blood. If the disease causes a lack of blood flow to the kidneys, it can result in high blood pressure and other renal ailments. If the disease restricts blood flow in the legs, constant pain can result and, in extreme cases, an onset on gangrene.
One of the main culprits that has led to insufficient treatment of peripheral arterial disease is how the symptoms can be confused with other potential ailments. Dr. Schneider comments that sometimes patients who develop pain in their legs and hips while walking attribute that discomfort to muscle strain, rather than the potential of peripheral arterial disease.
If someone has continued pain in areas such as the calf muscle, Dr. Schneider suggests the patient have their primary care physician conduct a simple test called the ankle-brachial index (ABI) test. This test compares the blood pressure at your upper and lower extremities.
“If you find that a blood pressure reading in the lower leg is less than the upper extremities, that’s peripheral arterial disease. There’s nothing else that causes this discrepancy in blood pressure readings,” Dr. Schneider said.
Leg pain, however, shouldn’t be the only trigger that should prompt a patient to have their physician conduct an ankle brachial test. If someone smokes or has diabetes, it is important to be checked for peripheral arterial disease. Research recently reported in the Journal of Vascular Surgery pointed out that 29 percent of the total population of a study who had one of these risk factors was diagnosed with peripheral arterial disease.
Furthermore, if you are older than 70 or already diagnosed with some form of coronary artery disease, routine checks for peripheral arterial disease should be conducted. Risk factors that are commonly associated with coronary artery disease are similar for peripheral arterial disease, including obesity, high blood pressure, high cholesterol levels and diabetes.
Dr. James Coxe, an endocrinologist with Capital Endocrine Consultants, understands how diabetes greatly affects the body’s ability to do natural repairs. As Dr. Coxe explains, elevated blood sugar levels sometimes result in abnormal cellular function, which can lead to forms of vascular ailments such as peripheral arterial disease.
“Diabetes is intertwined with vascular disease in both small and large arteries,” Dr. Coxe said. “You need to be ever vigilant to prevent the disease. Once it happens, you want to get early referrals to cardiologists so patients can get the best care.”
Peripheral arterial disease doesn’t just affect the lower extremities such as the legs. The disease also can affect kidney function and lead to other types of renal disease. Renal arteries can be checked easily through noninvasive methods such as the use of a CT scanner.
Treatment for peripheral arterial disease has improved dramatically in the past decade. In some cases, Dr. Schneider said peripheral arterial disease can be combated with an altered diet and a regular, supervised exercise regimen.
Medications such as Cilostazol® and Pentoxifylline® can be prescribed to treat peripheral arterial disease. However, Dr. Schneider cautions that patients already taking medicine to treat coronary artery disease likely cannot take these products because of the potential for adverse reactions.
In some cases, an outpatient peripheral vascular interventional procedure is necessary to treat peripheral arterial disease. There are various types of minimally invasive procedures that can be done by cardiologist like Dr. Schneider who are trained in peripheral vascular interventions, including angioplasty, stent insertion or removal of the blockage with a tiny catheter.
“The treatment is incredible for patients undergoing minimally invasive procedure,” Dr. Schneider said. “A patient can come in for a procedure in the morning, and they literally walk home without symptoms that evening. The vast majority have great long-term outcomes.”
Dr. Schneider stressed that only in extreme cases of severe, untreated peripheral arterial disease does a patient face the ramifications of limb amputation or dialysis because of kidney failure. Such dire consequences could be curtailed if patients regularly consult with their primary care physician and a cardiologist.
“With simple maneuvers, we can diagnose the vast majority of patients who have peripheral arterial disease,” Dr. Schneider said.
“That allows you then to engage these patients for lifestyle changes, cholesterol management and treatment for all vascular disease.”