|Several years ago, my
husband and I tackled
a monumental task—
renovating a centuryold
The foundation and
structure were good,
but the house had
suffered the effects of
years of neglect.
Restoring it required TLC,
consultation from experts in plumbing,
electricity and carpentry, and a ready
supply of over-the-counter pain
relief for the many headaches we
encountered along the way.
Eventually, we would make our
house a home, but it took time, effort,
education and support. As I round the
corner into middle age, I am surprised
by how much that project reminds
me of my health.
Our bodies are amazing structures that are
created to last a lifetime. As we age, however, we
become more susceptible to certain diseases and
health problems, like vascular disease. It’s important
to be aware of our risks and to work closely with a
family physician. Together, it is possible to create a
blueprint for staying healthy and active long into the
Think of it as a routine maintenance schedule for
Consider vascular disease.
The vascular system consists of arteries and veins that carry oxygenrich
blood throughout the body. In essence, this complex network of
blood vessels bears a strong resemblance to the plumbing system of a
With age, arteries tend to thicken through a build-up of plaque and
cholesterol. They may become stiffer and narrower. Blood flow is
restricted as a result.
Eventually, this may lead to stroke, problems walking, foot ulcers,
gangrene and even death if the condition isn’t treated appropriately.
There is good news, however.
Vascular disease can be controlled if it is diagnosed and treated early.
Effective treatments include lifestyle changes, medical management,
minimally invasive endovascular angioplasty and stent procedures, as
well as open bypass surgery.
“The most commonly identified vascular diseases include carotid artery
disease, peripheral vascular disease and abdominal aortic aneurysm,” says
Clinton Atkinson, M.D., a vascular surgeon with Pinehurst Surgical.
A blocked carotid artery in the neck can reduce blood flow to the
brain, resulting in stroke. It is estimated, in fact, that 60 percent of all
strokes are caused by carotid artery disease.
Peripheral vascular disease (PVD) refers to blood vessel problems in
regions that affect the organs and limbs. As muscles or organs become
starved for oxygen, a person may experience pain—and sometimes, over
time, gangrene—as the undernourished tissue suffers.
A weakened area of the abdominal aorta
can result in an abdominal aortic aneurysm.
The pressure from blood flowing through the
abdominal aorta can cause the weakened spot
to bulge, much like a balloon. If this bulge, or
aneurysm, bursts or ruptures, the person may
go into shock or even die.
Other forms of vascular disease include varicose
veins, hyperlipidemia (high fat in the bloodstream),
deep vein thrombosis (a blood clot, usually in
a deep vein in the lower leg) and pulmonary
embolism (a blood clot in an artery in the lungs).
“Vascular disease is a body wide problem,” says
Dr. Atkinson. “It does not necessarily confine itself
to one area or one organ. The best outcomes are
achieved through early detection and treatment.”
Vascular specialists employ a variety of tests
to determine the cause and location of specific
problems. CT scans, MRIs, ultrasound and
pressure testing in the legs are commonly used to
identify vascular disease.
“We often use dyes in combination with
imaging to pinpoint the blocked area,” says Robert
J. Albrecht, M.D., who is also a vascular surgeon with Pinehurst
Surgical. “Sometimes we can even dissolve the blockage through these
The key ingredient for a successful diagnosis is a clear understanding
of each patient’s medical history and risk factors.
“Family history is very important,” says John Streitman, M.D., a
cardiothoracic and vascular surgeon with Pinehurst Surgical. “You
need to be aware of any problems your parents or grandparents may
have encountered as well as other risks such as
a history of smoking, poor nutrition or lack of
exercise, diabetes or heart disease. These red flags
help physicians know what screenings and early
detection procedures you need and when to begin
Often, patients with vascular disease experience
few symptoms. However, pain in limbs on exertion
that subsides with rest, shortness of breath, or
pain around or near an organ is cause for concern.
Other warning signs include temporary weakness,
numbness or paralysis on one side of the body;
temporary, sudden vision changes in one or both
eyes; difficulty speaking or difficulty understanding
words; falling for no apparent reason; and nonhealing
wounds of the feet or legs.
“Patients downplay symptoms, but over time
their world actually gets smaller as they make
concessions for their pain,” Dr. Atkinson says. “I
recommend that anyone who is modifying behavior
due to pain seek help from a physician. The odds
are good that the cause is treatable.”
Vascular disease is treatable. The options range
from behavior changes to medical treatment or
“Preventing the problem is undeniably the best
standard of treatment,” says Dr. Streitman. “Quit
smoking. Exercise. Eat healthy foods. Visit your
physician regularly for check-ups. Control your
weight. If you have high blood pressure or diabetes,
follow your physician’s directions. Be compliant.”
“We’ve done a good job of informing people
about heart disease, but we need to build awareness
of vascular problems,” says Dr. Albrecht. “Too
often, our patients assume that their symptoms are
merely a result of the aging process. We need to
encourage them to talk with their physicians before
the symptoms become unbearable or affect quality
of life. Treatments have advanced, and often simple
steps make a huge difference.”
A growing number of non-surgical therapies
are available for patients with vascular disease.
Certain medications can affect plaque build-up
or even thin the blood to enhance circulation.
Balloon angioplasty, vascular stenting, laser therapy
and endoscopic vein ligation are used to open up
blocked veins and arteries.
More complex procedures such as carotid
endarterectomy, lower extremity bypass, aneurysm
repair and varicose vein surgery are also effective
“The risks and outcomes differ from patient
to patient,” Dr. Streitman says. “The decision on
which treatment is best in a particular situation is
an individual one.”
|A walk in the park
For Sue Lang of Aberdeen, a quick
stop at the grocery store to pick up a
few simple items was neither quick nor
“Just walking from the lot into the store
was next to impossible,” says Lang who
turned 50 earlier this year. “I could only
make it about 30 feet; then I had to stop
and rest. It might as well have been 30
miles from my car to the front door.”
Clinton Atkinson, M.D.
Robert J. Albrecht, M.D.
Lang, who had triple bypass surgery
six years ago, had a blockage in her left
femoral artery. “I thought it was my back
to begin with,” she says. “I had pain
and numbness in my foot, and it steadily
After repeated back injections failed to
ease the pain, Lang’s physician ordered
a CT scan. The scan clearly identified
the source of her growing discomfort
– peripheral vascular disease, or a
blocked blood vessel in her leg.
Clinton Atkinson, M.D., a vascular
surgeon associated with Pinehurst
Surgical, inserted a stent into Lang’s leg
to open up the blockage. “The day after
I had the surgery, I was walking around
without pain,” Lang says. “I should have
listened to my body sooner.”
“Too often, people assume that their
symptoms are simply part of the normal
aging process and put off treatment,”
says Dr. Atkinson. “If patients are unable
to perform common tasks like grocery
shopping or walking to the mailbox,
they need to schedule an appointment
with their physician. Chances are good
that simple treatments will help them
resume a better quality of life.”
For Lang, the results were nothing
short of miraculous. But she isn’t the only
one who has benefited from the change.
J.J., a 125-pound Yellow Lab and Lang’s
special companion, is excited about
their long visits to the park.
“Walking J.J. was one of my first
activities after surgery,” says Lang. “I
put him on a leash and off we went. It’s
been great for both of us.”
|The role of interventional radiology
Through special training and medical technologies, radiologists offer us the unique opportunity to “see” what is happening inside the body. Typically, these specially trained physicians use tools such as X-rays, ultrasound and CT scans to identify abnormalities and assist with determining the best treatment options for individual patients.
With continued advances in medicine, new windows are opening that ultimately result in improved diagnosis and treatment of various illnesses including vascular disease and even cancer. Take interventional radiology for example.
A rapidly growing area of medicine, interventional radiology specializes in minimally invasive, targeted treatments using imaging guidance. Often, these procedures replace open surgical techniques. They are generally easier for the patient, because they involve no large incisions, less risk, minimal pain and shorter recovery times.
Samuel Wahl, M.D.
“We have the ability to provide certain treatments under real-time conditions using advanced imaging,” says Samuel Wahl, M.D., an interventional radiologist with Pinehurst Radiology Associates and FirstHealth of the Carolinas. “We employ specialized catheters and guide wires in order to visualize arteries, veins or other areas. Based on our findings, we are able to target the problem and provide specific treatment.”
Interventional radiology was introduced in the mid-1970s. Interventional radiologists are credited with inventing angioplasty and used the first catheter-delivered stents in the legs to save patients with vascular disease from amputation or other surgery.
Techniques commonly associated with interventional radiology include angiography, balloon angioplasty, needle biopsy, stents, embolization, special ablation techniques and dialysis maintenance. Interventional radiologists also place ports for patients who are undergoing chemotherapy treatments.
FirstHealth currently has three interventional radiologists on staff: Lawrence Martin, M.D.; David Furie, M.D.; and Samuel Wahl, M.D.
As interventional radiology has expanded, other specialists, such as cardiologists and vascular surgeons, are also being trained in the techniques.
“Medicine is evolving in both diagnosis and treatment,” says Dr. Wahl. “As this happens, the boundaries between the specialties often become blurred. Our field is dynamic and changing all the time. The bottom stays the same, however. We are all committed to doing what is best for the patient.”