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FirstHealth of the Carolinas
The vascular system By By Erica Stacy
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Several years ago, my husband and I tackled a monumental task— renovating a centuryold Victorian cottage. 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 senior years.

Think of it as a routine maintenance schedule for your health.

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 house.

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.”

Diagnosis
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 procedures.”

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 using them.”

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.”

Treatment
Vascular disease is treatable. The options range from behavior changes to medical treatment or surgery.

“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 treatment options.

“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 simple.

“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 grew worse.”

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.”