- The Washington Times - Monday, May 10, 2004

People don’t drop dead on athletic fields from vascular disease, says Dr. Bruce M. Smith, director of vascular surgery at the Washington Hospital Center in the District.

However, those at risk of the disease can develop debilitating strokes and other serious complications, making the lesser-known disease a concern for older, health-conscious people.

Vascular disease, blockages that prevent blood flow throughout the body, comes in several forms.

Carotid artery disease involves plaque buildup in the arteries on each side of the neck that carry blood to the brain. Should the plaque get too thick, a stroke can occur. Strokes are the third-leading cause of death in the country and rank first in disability cases among older people, according to the American Vascular Association (AVA).

Peripheral artery disease occurs when plaque lines the walls of arteries transporting blood to the extremities, which can cause pain and fatigue if untreated. Abdominal aortic aneurysms, the 10th-leading cause of death in the United States in men older than 50, involve ruptures in the aorta, the main blood vessel carrying blood to the rest of the body.

Predicting vascular disease is an inexact science. Sometimes, advanced cases lead to ministrokes, weakness or other telltale signs of trouble. Other situations prove asymptomatic.

That makes this week’s free national screening program for vascular disease all the more vital. The AVA announced the findings of a research study last year showing more than 10 million Americans suffer from vascular disease but have yet to be diagnosed.

On Friday, the AVA will sponsor free nationwide screenings at 150 centers in more than 40 states across the country. Last year, about 50 medical centers took part in the free screenings.

The painless, noninvasive tests take less than 15 minutes to complete and involve ultrasound technology.

A full diagnostic screening exam can cost between $500 and $1,000 and take up to an hour, depending on how many of the three vascular diseases are being screened. The test isn’t always covered by medical insurance.

Locally, the Walter Reed Medical Center will offer free screenings to military personnel, while the Washington Hospital Center will offer screenings for all. Those who want the screening must contact the centers before Friday to make an appointment.

Dr. Smith says the risk factors for vascular disease are similar to those for cardiac disease: hypertension, high blood cholesterol, diabetes, smoking or a previous stroke or heart ailment.

People with one or more of those conditions are at much greater risk than the general population. The high-risk group should be screened once every three to five years, he says. Should someone from that group show signs of vascular disease, that person should seek out screenings every two or three years to make sure it doesn’t escalate.

Persons without such risk factors should consider getting screened every four to six years.

Some types of vascular disease make themselves known as they become more serious. Patients can feel pain in their legs or suffer ministrokes that can set the stage for more serious blockages down the road.

Other vascular diseases offer no warning signs.

“The screening is looking for the silent manifestations of these illnesses,” Dr. Smith says.

Some diseased patients don’t discover their condition until it’s at an advanced stage.

George Lowrance, 70, of Falls Church, learned he suffered from vascular disease when he first felt intense burning in his ankles four years ago while on a routine walk following open-heart surgery.

After a battery of tests, his doctors steered him to a vascular specialist who determined he had blockages in his legs.

The vascular surgeon suggested Mr. Lowrance hold off on any surgery. Instead, he was given a medication called Pletal that alleviates pain associated with activity and told to continue a modified exercise regimen.

He hit the treadmill again, but for much shorter periods of time. Slowly, he built up his body’s ability to walk greater distances, but he says he still can’t walk too far without feeling leg fatigue.

“I’m not happy with it, but it’s enough,” he says of his progress. “I don’t believe in surgery unless its necessary.”

Dr. William R. Flinn, professor of surgery and chief of the University of Maryland School of Medicine’s vascular surgery division, says the public at large has yet to catch on about the dangers of vascular disease.

“Everybody in the country knows about heart disease,” Dr. Flinn says. “All of that public education effort has been phenomenally successful.”

The AVA hopes its national screening day starts to awaken the public to a very critical concern— and senior citizens aren’t the only ones who should be aware of vascular disease.

Aortic aneurysms can strike people as early as in their 50s, at ages when they have plenty of productive years remaining, says Dr. Flinn, who also serves as chairman of the Public Education Task Force of the AVA.

“With an aging population, all the problems are increasing,” Dr. Flinn says.

Early prevention can result in modest lifestyle changes, including low-cholesterol diets and more exercise, that can keep the disease at bay, he says. If vein-graft surgery is required, the procedure is fairly commonplace and also can prevent future attacks. A vascular surgeon can replace the vessel in question with a vein from another part of the body or a synthetic graft.

Dr. Samuel Potolicchio, professor of neurology at George Washington University Hospital in Northwest, cautions that vein-graft surgery isn’t always a viable option. Surgery works best when the doctor can identify where the plaque is obstructing the vein, particularly if the blockage is relegated to just one area, he says.

“Your arteries may be diseased for more than just one segment,” Dr. Potolicchio says.

In those cases, surgery isn’t the best option.

“With carotid artery disease, often there’s a long part that’s diseased, not just one artery,” he says.

The use of stents, commonly applied for heart disease patients, also are being considered for vascular disease sufferers. The stents help dilate the arteries to open them up and allow for better blood flow.

The downside, Dr. Potolicchio says, is that inserting stents via a catheter leaves doctors with little control over its eventual placement, which means the blocked portion may not be opened as much as a doctor might like. The stent also could damage the artery at the same time it breaks up the blockage, he says.

Medications, some as simple as a basic aspirin, can help prevent future vascular disease damage. Another successful medication is Aggrenox, which prevents the formations of clots.

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