You know that feeling you get when adrenaline is rushing through your body? Maybe it’s from the rush of winning a big game or skydiving out of an airplane (some of us are braver than others). You can feel your heart beating harder and faster, the blood pumping quickly, just to keep up with the excitement. However, in order for blood to flow freely throughout your body, your arteries must be clear of any kind of plaque or buildup. So when those vessels become clogged, it can create serious issues.
Dr. Grace Wang, vascular surgeon and endovascular specialist at Penn Medicine, answers questions about the different types of arterial disease and their treatment options.
What are the different types of arterial disease?
When I think about arterial disease, I like to break it up into two separate categories. The first is arterial occlusive disease, which is caused by a buildup of plaque in the blood vessels and in turn, those vessels begin to narrow. This is commonly referred to as atherosclerosis. It can cause serious issues with blood flow throughout the body and have a very damaging effect on either an extremity (typically in the legs and feet) and lead to the development of peripheral artery disease (PAD), or in the case of the carotid artery, the artery located on either side on the neck, it can lead to a stroke.
The other type of arterial disease is the development of an aneurysm, which is also caused by atherosclerosis, but tends to weaken the actual wall of the artery. This could lead to a breakdown of the aorta, the main blood vessel that carries most of blood throughout the body, and even lead to an aortic aneurysm.
What type of patients are at risk for developing an arterial disease?
It is recommended anyone who is older than 50 years old with a history of smoking or diabetes or over the age of 70 years should undergo testing to determine their risk of developing this disease. These are the risk factors that we consider to be highly linked with the development of PAD.
Is there a link between carotid artery disease and PAD?
Yes, in about 30 to 60 percent of patients with PAD, they will also have some form of carotid artery disease. If a patient comes to me with evidence of PAD, then I also look for evidence of carotid artery disease, and vice versa.
What are some of the symptoms of PAD?
A large majority of patients have symptoms that are very atypical, or symptoms that can be associated with many different diseases. One of the most common signs of PAD is cramping in the leg, hip or calf muscles following activities such as climbing stairs or walking. One of the ways we diagnose PAD is by looking at how consistent the symptoms are and how soon they start when an individual begins walking. For example, they walk 1 or 2 blocks and develop cramping or pain in their leg and then when they stop, the pain stops, too. Then, they resume walking, and the pain starts back up in another 1 to 2 blocks.
Why is it so important to get these diseases diagnosed and treated as early as possible?
I do believe that with earlier detection of a mild disease, we would be able to counsel patients on the importance of smoking cessation, eating healthy, exercising and all of the other things that we know are good for the arteries and the heart. If we could do more in terms of prevention in the earlier stages of PAD, we would be able to treat the disease in a much more effective way.
For those with carotid artery disease, prevention of stroke is very important. If we know a patient is suffering from this form of arterial disease and perform an endarterectomy, a surgical procedure to fix the narrowing of the carotid artery and remove plaque buildup due to atherosclerosis, we can prevent that stroke from happening. Stroke is the fourth leading cause of death in the United States, and if we detect the carotid artery disease early enough, we can prevent a potential massive stroke in these patients.
As vascular medicine specialists, not just surgeons, we are really trying to encourage patients to be responsible for their own health before they reach those end stages of arterial disease and need surgical intervention.
When surgical intervention is needed, what are the options available for each disease?
For PAD, when intervention is required, I will generally do a CT (computed tomography) scan so we have a better picture of where the lesions may have formed. In general, any lesions that form in larger arteries respond very well to non-invasive endovascular therapies, such as inserting a stent or balloon into the clogged artery to open up blood flow. For any lesions that cross the joint in the knee or are below the knee, I tend to favor bypass, a surgical procedure to redirect and open up blood flow throughout the arteries, simply because we know that stents or balloons in smaller vessels do not perform as well.
For carotid artery disease, whether the patient is symptomatic or asymptomatic, carotid endarterectomy is typically the route I choose. Depending on the percentage of the blockage, surgical intervention is required to prevent stroke. For whatever reason, if the patient is considered a high surgical risk, I would take a look at their options for stenting. Our goal is to accomplish the best possible outcome, regardless of how severe our patients’ arterial disease may be.