Unclogging Advances Heart Care
Less than five years ago, many of the 17 million American suffering from clogged arteries just lived with it. Others suffered serious health consequences or underwent major surgery. Today, those with atherosclerosis have more options available in angioplasty and the treatment of vascular disease.
Angioplasty advances
Angioplasty, a procedure that uses a catheter and balloon to remove plaque inside the artery, has been used for years to treat coronary atherosclerosis. Recently, it was enhanced with the use of a stent, a mesh tube inserted into the artery after angioplasty to keep the artery open.
Even with stents, however, the problem of restenosis, or re-narrowing, of the artery continued to plague physicians and patients. At Columbia-St. Mary's, physicians use a technique called brachytherapy to combat restenosis.
According to Mark Leitschuh, a cardiologist at Columbia-St. Mary's, restenosis occurs in approximately 15 to 20% of patients anywhere from one to six months following their angioplasty.
"Traditionally, if patients experienced restenosis after angioplasty, we would repeat the angioplasty or place a stent within the stent," says Leitschuh. "But now we would consider those patients candidates for brachytherapy."
Although physicians are unsure as to why restenosis actually occurs, brachytherapy works by placing a catheter source of radiation inside the artery to inhibit the build-up of cellular material.
Leitschuh, who has performed brachytherapy since its approval by the Food and Drug Administration, believes it will be used frequently until coated stents are available. "Brachytherapy works. We see a much lower rate of repeat restenosis in patients who are treated with the procedure. But, coated stents, which involves placing a stent coated with medication, will probably decrease the need for brachytherapy." Dr. Leitschuh says. Coated stents are expected to be approved in about one year. Until then, this procedure continues to make angioplasty a successful, minimally-invasive option for thousands of people with coronary artery disease.
Not just the heart
Clogged arteries do not always occur in the heart. Atherosclerosis can occur anywhere along the complex vascular system in the body. Dr. Andrew Feiring, an interventional vascular cardiologist at Advanced Healthcare, specializes in high-risk coronary work and has devoted the last 5 to 7 years focusing on vascular disease.
"Peripheral vascular disease (PVD) is the most under-diagnosed and under appreciated disease in modern medicine. If you had moderately advanced vascular disease, you mortality rate is higher than if you had cancer," Feiring says.
Four main arteries, including the carotid (in the neck), abdominal, renal (kidney) and leg, can fall victim to atherosclerosis and cause a number of health problems, such as stroke, claudication (inability to walk), and limb loss. As serious and debilitating as vascular disease can be, it often goes undetected, and even if it is diagnosed, left untreated.
Diagnosing vascular disease
Diagnosis of vascular disease is difficult because it usually occurs in older adults who suffer from a wide range of medical problems.
"Peripheral vascular disease symptoms are masked by other conditions, such as arthritis or muscular aches and pains," says Dr. Feiring. "I encourage people who think they may have PVD to be assertive with their doctor and request testing."
A simple non-invasive screening involves comparing blood pressure readings from the ankles and arms. An ultrasound of the carotid artery can also determine if vascular disease is present.
Risk factors and symptoms
Age, diabetes, smoking, high blood pressure and being overweight place people at a higher risk for developing vascular disease.
Symptoms include having difficulty walking or sores on the feet that will not heal. Many times people who experience difficulty with walking dismiss it as a normal part of aging.
Dr. Feiring suggests, "Ask yourself if you feel discomfort when you walk, such as tightness or cramping in the calves, thighs or hips. And does it stop when you rest?" If you answer 'yes,' then it may be a sign of vascular disease."
Treating vascular disease
In the past, options for treating vascular disease ranged from major surgery to doing nothing. Today, there are options in between that can restore quality of life for many individuals.
Treating vascular disease is complex because most people who have it also have heart problems and other conditions such as diabetes. "Unless you treat a patient as a whole vascular package, you are not going to be able to provide the best option for treatment," says Dr. Feiring.
Dr. Feiring often receives referrals for a second opinion for patients facing amputation due to the disease. "Amputation is a life-altering event, that, in many cases, can cause a swift decline in health as well as a decline in quality of life due to lack of mobility," explains Dr. Feiring. Angioplasty and stenting can provide a limb-saving option for many of these patients.
Dr. Feiring has seen the dramatic impact this non-surgical option can have on a patient. He says, "I had a 58 year old patient who couldn't walk more than two blocks for the last six years. He had been told for years that his pain was due to spine or back problems, until it got so bad he could hardly walk at all. We performed angioplasty and stented the artery, and the next day the patient woke up and wanted to take a walk. He left for his walk and the family grew concerned when he didn't return. It turns out that he was so over-joyed with the ability to walk again that he had kept on going and walked 14 miles to his home from the hospital!" He adds, "The most gratifying part of my job is restoring independence to my older patients."
