Vascular Disease

Coronary artery disease (CAD)—also known as atherosclerosis, hardening of the arteries or coronary heart disease—is the leading cause of death in the United States for both men and women. Many people do not know they have it until they have a heart attack.

Narrowed arteries restrict blood flow to the heart muscle, starving it of the oxygen and nutrients it needs to operate properly. The main symptom of coronary artery disease is angina, or chest pain.

Diagnosis begins with a physical examination and a discussion of your medical history and risk factors, and tests or procedures. These may include an electrocardiogram (ECG/EKG), an echocardiogram or catheterization to spot any blockages.

Treatment ranges from lifestyle changes such as starting or increasing exercise routines, removing cholesterol, fat and salt from your diet and, if you are diabetic, controlling your blood sugar levels. There are a number of medications available to treat CAD and you doctor will prescribe the best one to fit your specific medical circumstances. In serious cases, invasive procedures such as balloon angioplasty with or without stent placement, or heart surgery, may be necessary.

Peripheral artery disease (PAD) is a narrowing or blockage of the blood vessels carrying oxygen- and nutrient-rich blood to outlying or peripheral, areas of the body. PAD affects the arteries in the legs or pelvic region. Like other cardiac ailments, it is caused by the buildup of fat, cholesterol and calcium on the interior walls of blood vessels. Cramping, pain or tiredness in the leg or hip muscles during such mild exertion as climbing stairs or even just walking is the most common symptom of PAD.

Diagnosis starts with a discussion of your medical history and risk factors and a physical exam, including a check for weak pulse rates in your legs. One of the first tests for PAD is an ABI, or ankle-brachial index test, in which the blood pressure in your feet is compared to the blood pressure of your arm. Other tests include ultrasound and several types of catheterization procedures.

The most common and effective treatment for PAD is regular physical activity, as prescribed by your healthcare professional. Medications designed for treating high blood pressure and high cholesterol also can work on PAD as do anti-clotting drugs. In some instances, such minimally invasive procedures as balloon angioplasty or stent placement can be necessary and—in severe cases—a blood vessel from another part of the body can be placed to “bypass” the closed artery.

Peripheral venous disease (PVD) involves damaged or blocked veins that carry blood from the hands and feet back to the heart. It occurs most often in the arms and legs. It is also known as venous insufficiency.

Blood clots are the most common cause of PVD. These clots form in areas where the vein wall has been weakened and blood flow has slowed. A clot that forms in a vein just under the skin is called a superficial vein thrombosis while one developing far beneath the surface is known as a deep vein thrombosis (DVT). Varicose veins are another form of PVD.

Veins can be damaged or weakened and develop peripheral venous disease in a number of ways, including injury, major surgery or an extended period of bed rest or inactivity. Smoking and obesity contribute to the problem as do some types of cancer. Women who are pregnant or are using birth control pills also face an increased risk of suffering from PVD.

Your doctor will assess the area and check your blood pressure and heart as part of a physical examination to check for PVD. Tests can include ultrasound or venography (an X-ray using special contrast dye).

Treatments can include exercising, elevating the affected area, bandaging or special compression stockings. High-risk patients may also need to take blood-thinning medications. Minimally invasive, non-surgical treatments include balloon angioplasty or stent placement for more serious forms of PVD such as clots, or sclerotherapy for varicose veins.