Early diagnosis key for artery disease that can lead to limb loss

Blood circulation is not something most people think about until it becomes an issue, but a vascular surgeon at Baylor College of Medicine suggests that those with a certain medical history be evaluated for peripheral artery disease – or the narrowing of the peripheral arteries to the legs, stomach, arms and head that is associated with poor blood circulation – ahead of time to prevent serious complications.

"About 10 to 15 percent of the American population has peripheral artery disease, and out of these, 1 to 2 percent have a severe form of the disease that puts them at great risk of limb loss," said Dr. Miguel Montero-Baker, associate professor of surgery in the division of vascular surgery and endovascular therapy at Baylor.

Montero-Baker said the disease is progressive, which is why it's important to identify and intervene early. He suggests that those with the following medical history consider getting some degree of evaluation:

• Those who have suffered diabetes for a long period of time
• Those who are currently heavy smokers or who have had a history of heavy smoking
• Those with non-healing wounds on their feet
• Those over the age of 75
• Those who have progressive pain in their legs, primarily their calves, during exercise, specifically while walking or running

He said that these factors imply that a person has a high likelihood of having peripheral artery disease.

People with a history of diabetes or smoking are more likely to have issues with high cholesterol, high blood pressure and an inactive lifestyle, making them at higher risk for the disease, Montero-Baker said. Those who have pain in the calves during walking or running tend to feel better when they stop because their muscles get time to breathe and relax.

"You should get an evaluation if you have an odd pain in your legs that you can't explain," he said.

Evaluation involves simple tools that measure the blood pressure at the level of the feet and toes – low blood pressure here implies obstruction of blood flow. Using ultrasound-guided technology, physicians also can look at the inside of arteries and provide a more in-depth evaluation by finding exactly where there are obstructions along the arteries. If needed, physicians can also use advance imaging, such as CT scans or MRIs, that give more robust information about the degree and location of the disease, which helps plan an intervention if needed.

When it comes to intervention, vascular surgeons have moved away from open vascular surgery to catheter-based procedures, which can be done under local anesthesia, require little to no recovery time and are more cost-friendly.

"We find that 70 to 80 percent of patients can be well-served by catheter-based interventions," said Montero-Baker, who specializes in these types of interventions.

He also noted that the catheter-based interventions have allowed surgeons to expand their patient population to those who previously were too sick to have open surgery. These patients now have a less invasive option to treat peripheral artery disease.

To prevent peripheral artery disease, Montero-Baker suggests: quitting smoking, controlling blood sugar, exercising regularly and adhering to any medical regiment such as taking blood pressure or cholesterol medications.