About 15 years ago, ex-Marine Gary Rexroad noticed cramping in his calves. He blamed the hard concrete floors of the tool and die shop where he worked, but his pain increased as his mobility declined. The cramping slowly climbed his legs, working through the thighs before making it to the buttocks. It was then that he finally sought medical help.

“I didn’t have a clue what it was,” he said. “You can blame it on 10,000 things.”

Two years after the cramping began, Rexroad visited Toledo Clinic, where newly hired cardiologist Dr. Ghiath Yazji diagnosed him with Peripheral Arterial Disease (PAD).

PAD is a condition in which non-coronary arteries become congested, limiting blood flow to the extremities. It occurs most frequently in the legs, but the arms also can be affected. Most cases of PAD form from atherosclerosis, the same process that blocks coronary arteries and can lead to a heart attack.

Blood carries oxygen throughout the body. When circulation is limited, oxygen flow is hindered, eventually causing muscles to cramp below the blockage site. Over time, the blockage may become extensive, leading to gangrene and possibly amputation.

In its early stages, PAD may exist without any pain or symptoms, and most people do not visit a doctor until cramping develops. Blockages often appear in a similar location in both legs.

“Many of the patients that I see are patients who have gotten to the point where they’re significantly limited in their lifestyle,” said Dr. Mark Burket, director of vascular medicine at University of Toledo Medical Center.

“They try to walk and their leg tightens up, and they can’t do what they would normally do.”

Burket uses several techniques to detect PAD. A pulse test on the back of the ankle and top of the foot can determine the strength of blood flow reaching the lower leg. Diminished or absent pulses typically indicate PAD. A Doppler probe is slightly more advanced and produces an audible pulse if an artery is open. A magnetic resonance angiogram and CT scan are more advanced techniques.

Once detected, treatment has two objectives: addressing the known blockage and preventing other cardiovascular incidents, such as heart attack and stroke.

“Anytime that we find PAD, we know that person is at risk for other cardiac and vascular events,” Burket said.

Aspirin and cholesterol-reducing drugs, such as statins, may lower the risk of heart attack and stroke. Statins may also inhibit the expansion of a blockage in the leg, delaying symptoms and prolonging mobility.

Once pain develops, several courses of treatment are possible. One is atherectomy, in which the doctor scrapes away and removes the buildup in the artery.

Stents may also be used to reline a blood vessel. In more severe cases, surgical bypass may be required.

Rexroad underwent two atherectomies in each leg — one set in 1997 and another last year — to remove blockages in his femoral and iliac arteries. Burket assisted Yazji the first time and led the effort on the latest procedures. Each leg is done separately. The femoral artery in Rexroad’s left leg burst during his latest round of procedures, but Burket stopped the bleeding right away. Rexroad has nearly a foot of stents in each leg

“I can’t thank the man enough,” Rexroad said. “He’s the reason I’m walking. I’m hearing pulses in my feet I haven’t heard in 20 years.”

Burket said about 70 percent of patients with PAD are stable or show improvement over five years. Of patients diagnosed after cramping develops, about 5 percent will go on to an amputation within five years. Sometimes, he said, aggressive atherosclerosis will force an amputation, which doctors “avoid like the plague,” even when the patient has done everything possible to avoid it.

“In that case, though, usually the amputation has been delayed,” he said. “Many times when we treat people we realize at some point we may have to give up and do an amputation.”

Several risk factors contribute to PAD. Diabetics and African-Americans have a greater risk of developing the condition, and a family history of atherosclerosis also increases its likelihood. Because the disease develops over time, age is another determining factor. U.S. Census Bureau data and the American Heart Association show that more than 360,000 Ohioans will likely develop PAD by 2015, including one-third of Ohioans older than 50.

Like many circulatory conditions, the No. 1 cause is cigarette smoking.

“To avoid developing peripheral arterial disease, far and away the most important thing is to not smoke cigarettes,” Burket said. “And then the general efforts to maintain a healthy lifestyle are also important.”

Treatment for PAD is covered by most insurance plans, Burket said. With coverage and treatment available, Rexroad encourages patients to do all they can to fight back.

“There’s a lot of people that are afraid to have it done,” he said. “I tell them when I die I plan on leaving skid marks on the ground. As long as there’s a chance that you can fix something, why not?”

Tags: PAD, UT Medical Center

This entry was posted on Thursday, July 22nd, 2010 at 11:16 am and is filed under Community, Health Care.
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