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Health & Fitness

Blocked Arteries Could Cost You a Limb

Peripheral artery disease affects millions and can lead to amputation

By James Armstrong, DO, Cardiovascular and Thoracic Surgeon

Garden City Hospital and Oakwood Hospital 

When you think of the consequences of blocked arteries, a heart attack or stroke is probably the first thing that comes to mind. Chances are you are unlikely to consider a condition called Peripheral Artery Disease (PAD), but perhaps you should. PAD impacts 8-10 million people in the United States alone and can lead to the loss of limbs and ultimately, death.

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Like its coronary counterpart, PAD is a vascular disorder that impacts the flow of blood through an artery. It occurs when an artery narrows due to plaque buildup, restricting a limb’s ability to receive oxygen through the blood.  Although PAD can impact any blood vessel, the condition is most common in the pelvis and legs.

Today, it is estimated that 8-10 million Americans have PAD and increased age can be a risk factor. In fact, the Centers for Disease Control and Prevention estimates that between 12-20 percent of individuals over 60, and as many as one in three people over 70, suffers from PAD. Men and women are equally affected, but African-Americans and Hispanics tend to have higher rates of PAD than Caucasians.  Smokers, as well as those suffering from diabetes, high blood pressure, high cholesterol and obesity are at high-risk for PAD. Lifestyle factors, such as poor nutrition and lack of exercise, can also increase risk.

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Many patients do not experience symptoms in the earliest stages of PAD. However, leg pain or discomfort brought on by walking is a common first symptom. This initial discomfort is not always painful, and may feel more like weakness, cramping or tightness. PAD may cause pain or discomfort in the hips, buttocks, thighs, knees, shins or upper feet. It is common for patients to experience difficulty walking, ulcers, sores and in some cases, skin discoloration.

In advanced stages of PAD, patients may develop a chronic total occlusion (CTO), which is a total blockage of an artery that has lasted more than three months and is responsible for a significant decrease in blood flow. CTOs may be seen in as many as 40 percent of patients with symptomatic PAD and significantly increases the risk of amputation when present in the lower leg.

It is important that treatment for suspected PAD begin as soon as possible and there are several options if the condition is detected early, including lifestyle changes (such as quitting smoking and increasing exercise levels) and medication that reduces cholesterol, blood pressure and clotting.

 

More invasive procedures include bypass surgery, where a detour is created around a narrowed portion of an artery, and endarterectomy, whereby a vascular surgeon makes an incision in the limb and removes the plaque contained in the inner lining of a the artery.

Minimally invasive treatments, such as angioplasty and stenting are being rapidly adopted.  I am particularly excited about one of the more recent advancements in technology, a catheter that can be used in chronic total occlusions. Historically, a completely blocked artery required more invasive treatment, but for many of my patients, I use a device called the CROSSER® CTO Recanalization Catheter, which forms a new canal within a blocked artery for blood to pass through so that subsequent treatment options such as angioplasty and stenting can be performed.

The CROSSER® Catheter has a specialized tip that transmits high-frequency vibrations directly to the location where plaque has built up. Think of it as a medical jackhammer. The treatment is delivered throughout the entire length of the blockage until it crosses through the end of the other side so that a new canal is created and blood flow can be restored.

Minimally invasive treatments such as the CROSSER® Catheter allow physicians to effectively cross a CTO without the complications of major surgery.

In extreme cases of PAD, amputation of the leg may be required and is performed when circulation is severely reduced and cannot be improved by any other treatment method. A majority of PAD patients can avoid amputation of the leg or have it limited to only a small portion of the foot or toes. Due to rising levels of diabetes and vascular disease, limb loss as a result of PAD is expected to significantly increase over the next several decades.

In July 2012, my 52-year-old patient Kellee began experiencing severe pain in her left leg. Initially thinking it was a pulled muscle, Kellie didn’t seek immediate medical attention until the pain increased to the point that it was too difficult to walk. Her primary care physician diagnosed Kellee with peripheral artery disease (PAD) and prescribed medication. However, this course of treatment had no effect and within a few months, Kellee was forced to live a sedentary life which took a toll on her emotional well-being.

After an initial consultation, I performed a simple procedure using the CROSSER CTO Recanalization Catheter, a high-tech medical jackhammer that plows from one end of the blockage in her artery to the other so that a new canal is created and blood flow is restored.  Only one month after I successfully cleared the blockage in mid-August 2013, Kellee resumed the quality of life that she was accustomed to. She quit smoking and began walking faster and further distances than she had in a long time. Today Kellee enjoys taking long walks with her dog, golfing and bowling with friends, activities that were all but impossible to do when she was in pain.

If you have any concerns about PAD, please consult your primary care physician or a vascular specialist. To learn more about the condition and treatment options, please visit www.loveyourlimbs.com.

 

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