You walk up a flight of stairs or down the driveway to get the mail, and your legs are screaming with pain as though you’d just climbed Mt. McKinley. After a few minutes rest, however, you’re feeling as good as new.
You blame it on muscle stiffness, just another of the indignities of age, along with the ache in your arms when you raise them to wash your hair and the unremitting cold feeling in your fingers.
What you don’t consider is cardiovascular disease.
The truth is, says Jon George, MD, an interventional cardiologist at Einstein, those pain symptoms may be caused by the same process that brings on the chest pain known as angina—atherosclerosis, or stiffness and blockage of the arteries. (Graphic: National Heart, Lung, and Blood Institute)
“Unfortunately, people tend to think of it as something they can live with rather than a clue to a process in their body,” says Dr. George. “They won’t dismiss heart symptoms. If they have chest pain, they call their doctor. But they do dismiss arm and leg pain.”
Ignoring what is known as peripheral artery disease (PAD), which can occur anywhere in the body, won’t make it go away—it will just allow it to get worse. Not only does PAD interfere with your daily life—you may not be able to work, do housework, go shopping, or walk for very long—people with PAD are three to six times more likely to have a heart attack or stroke than those who don’t have it. “This is a life-threatening condition, and the threat is not coming from the periphery but from the heart,” says Dr. George. It’s often been called “the most dangerous disease you never heard of.”
Like heart attack and stroke, PAD is caused by a narrowing of the arteries in the extremities. The culprit: plaque, a fatty substance that clings to the walls of the arteries—the vast, circuitous highway that carries blood, oxygen and nutrients to all the organs and tissues of your body. Not only does plaque block blood flow through the arteries, it causes damage to arterial walls, making them less flexible and able to expand to allow blood to flow around these peninsulas of plaque.
“The reason why people get chest pain is they don’t have enough blood getting to the heart,” says Dr. George, who joined the Einstein staff from the Deborah Heart and Lung Center in Browns Mills, NJ, in August. “The heart muscle is continually working and requires a constant supply of oxygen, which is delivered by the blood. If enough blood isn’t getting to the heart, you get chest pain, or angina."
If not enough blood and oxygen are reaching your leg and arm muscles, you get the same cramping pain as someone with angina, just in a different place. “In the extremities it’s called claudication,” says Dr. George.
While PAD is unlikely to kill you, it can ultimately lead to amputation. The loss of circulation can become so severe—a condition called Critical Limb Ischemia—that tissue starts to die, a condition called gangrene.
What that extremity pain should be telling you, says Dr. George, is that if you have blockages in the arteries of your arms or legs, chances are you have them elsewhere. The quicker you get a diagnosis, the quicker and more effective the treatment.
While medication and lifestyle changes—drugs to lower cholesterol, weight loss and healthy eating and exercise—can treat and slow the progress of PAD, Einstein offers some cutting edge treatments that offer lasting results and are minimally invasive.
Angioplasty with medicated balloons and stents. Angioplasty—the insertion of a balloon via catheter, is a minimally invasive procedure that can open up a clogged artery. The balloon is positioned at the blockage, and then inflated for a short time, pressing the plaque flat against the artery wall, creating a corridor for blood to pass through. The effect unfortunately, is short-lived. But coating the balloon with a chemotherapy drug called paclitaxel limits the artery from closing up again, says Dr. George. At much lower doses than used for cancer treatment, chemotherapeutic drugs can prevent the growth of cells that can form scar tissue which can block the affected artery, just as they halt the overgrowth of cancer cells, says Dr. George.
One of the newest treatments for PAD, offered at Einstein, is a drug-coated stent—a small tube or scaffold used to keep an artery open. It’s delivered to the narrowed artery the same way as the balloon, and coated with medications that halt cell growth to keep the artery open as long as possible.
Atherectomy. Using a variety of tools, including laser, an interventionalist can literally shave or vaporize plaque off the walls of clogged arteries. In directional atherectomy, the physician inserts a cutter that shaves plaque from one side of the blood vessel. In orbital atherectomy, which Dr. George describes as “like Roto-Rooter,” the rotating drill shreds the plaque all around the vessel. Peripheral laser atherectomy uses a catheter that emits high energy light—a laser—to vaporize arterial blockages.
Optical Coherence Tomography (OCT) Image-Guided Therapy. Einstein’s interventional cardiologists were among the first in the region to use this breakthrough technology. The procedure allows the physician, using OCT technology, to see inside the artery, as a catheter and a tiny camera, is threaded through a small incision in the patient’s groin. Now, blockages inside the artery can be crossed using this technology with real-time direct visualization of the inside of the artery.
Furthermore, using the same imaging technology installed on a cutter, the doctor can shave plaque off the artery wall, opening any blockage. “It allows us to see inside the arteries, directly to where the cutting needs to happen,” says Dr. George.
The results of these interventions: Usually “immediate relief,” says Dr. George. “You’re basically going from low or reduced blood flow to wide open arteries. People can go walking, dancing, bowling again, things they’re assuming they can’t do because of old age. It’s a reversible condition—and the only danger is thinking that it isn’t. If you have those symptoms, get diagnosed.”
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