Healthy Life

Holland Hospital

Our Services

Health Resources

Physician Directory






ABOUT THE DOCTOR



Dennis Dunning, MD
West Michigan Heart, PC
904 S. Washington,
Ste. 120, Holland
(616) 392-3824

Getting a Leg Up On
Peripheral Arterial Disease

Leg cramps, pain and fatigue. These are leg ailments you might expect when you've just run a marathon, but what if they plague you when you're simply walking or going up stairs, causing you to stop until the pain goes away?

Intense leg pain that appears when walking and then disappears with rest is called intermittent claudication, and it may be a sign of a common but serious vascular problem, peripheral arterial disease (PAD). As its name suggests, PAD affects the peripheral, or "non-trunk," parts of the body, such as the extremities. The condition occurs when the larger arteries carrying oxygenated blood to the legs (or, less commonly, the arms) become narrowed or blocked with plaque, restricting blood flow.

Fennville resident Dave Raddatz describes the effect: "When I walked about a city block at a brisk pace, my calves would cramp terribly. I'd have to stop until the cramps subsided, and then continue at a slower pace."

Symptoms of PAD also include an aching in the leg or hip muscles and, in some cases, numbness, tingling or a cold feeling in the lower legs and feet.

A stent inserted into a blocked artery can help treat PAD by expanding to keep the artery open. At left, a Holland Hospital medical team demonstrates the new all-digital imaging system for cardiac and vascular exams.

  

A heart attack in the leg
"What's happening is that when you're walking, your leg muscles are demanding more oxygen and it's not being supplied because there's an occlusion (obstruction) to that artery. It's like having a heart attack in your leg," explains Todd Knight, RN, clinical manager of ICU, Telemetry and the Cardiovascular Lab at Holland Hospital.

Knight's advice for those who experience symptoms: don't ignore them. See your doctor.

"The bottom line is, you could occlude blood flow to a particular region, and if that happens, then you have lack of circulation and, eventually, the tissue could die," he says. "A major complication of prolonged occlusion could lead to limb amputation."

There is, however, plenty of reason for optimism for the 8 million to 12 million Americans with PAD.

Diagnosis and treatment
Diagnosis of PAD generally begins with a symptom-limited stress test, which involves the patient taking a brisk walk on a treadmill while symptoms are monitored. Not surprisingly, leg pain is often the most problematic symptom. The doctor may also order an ankle-brachial index, which measures the patient's blood pressure in the ankles and the arms (it should be equal) in order to assess whether there is restricted flow in one or more limbs.

An angiography or catheterization may also be done, usually on an outpatient basis. For this procedure, access to the leg arteries is typically gained through a small "poke" in the upper thigh or groin, a small, spaghetti-like catheter is threaded in, and contrast dye is injected so that it travels through the artery being evaluated. Digital pictures of the process give cardiologists an overview of the patient's arterial highway and make blockages clearly visible.

If arterial disease is detected, credentialed invasive physicians have many tools, beginning with the simplest and least invasive: make lifestyle changes that improve cardiovascular health. First of all, advises Dennis Dunning, MD, a cardiologist and vascular specialist with West Michigan Heart who performs several hundred peripheral procedures each year, "Stop smoking and exercise as much as possible." (See "Get healthy and minimize your risk" for more tips.) Mild PAD might also be treated with medications to help improve walking distance and lower cholesterol.

"In patients with claudication, the goal is to relieve the majority of symptoms and enable them to walk farther," says Dunning. One of the best treatments calls for the patient to do what often hurts most: walk, with rests to alleviate pain, until greater distances can be achieved. (For more information on exercise rehabilitation, call Holland Hospital Cardiac Rehabilitation at (616) 394-3398.)

A cutting-edge treatment
Patients with narrowed arteries due to plaque may require a slightly more invasive approach that actually removes the fatty buildup from the arteries. To do this, Dunning uses the SilverHawk Plaque Excision System, a newer device that is threaded into an artery (again, through a poke in the thigh or groin) and uses a tiny, rotating blade to slice away and remove plaque.

Dunning was one of only 60 doctors in the country trained to use the SilverHawk when it was introduced, and in 2003 became the first physician in Michigan to perform the procedure. Since then, he notes, its use has become common among interventional cardiologists and vascular surgeons, and the device has been refined to treat not just the larger leg arteries, but smaller vessels in the lower part of the leg.

Angioplasty, another invasive but non-surgical treatment for narrowed arteries, works by propping open the blocked artery with the insertion of either a tiny balloon, which is inflated to widen the artery and then removed, or a stent — a cylindrical, wire mesh tube — which expands and locks open to keep the diseased artery open. Stents have largely replaced balloon angioplasty because of their effectiveness in keeping arteries open while allowing blood to flow through.

A more invasive option for diseased peripheral arteries is bypass surgery, usually reserved for people with multiple or very long blockages not treatable with stents.

For Raddatz, 53, who was diagnosed with PAD two years ago, a combination of having plaque removed (an atherectomy) and a stent inserted to keep his artery open has made a big difference. "I'm on my feet 10 to 11 hours a day," reports Raddatz, who owns a restaurant. "I really don't have problems anymore."

Get healthy and minimize your risk
The same risk factors that foster peripheral arterial disease — diabetes, cigarette smoking and high cholesterol, for instance — also contribute to clogged heart and brain arteries. PAD, therefore, takes on added significance, notes Dunning, as "it is a strong indicator for coronary or carotid disease." According to the American Heart Association, people with PAD face a six-to-seven times higher risk of heart attack or stroke.

Although two risk factors for PAD — being over 50 and having a family history of heart or vascular disease — cannot be controlled, most others can. Patients are advised to:

  • Stop smoking (smoking narrows blood vessels and raises blood pressure).
  • Keep blood pressure in the normal range.
  • Eat a low-fat, low-cholesterol diet.
  • If you have diabetes, maintain good blood sugar control.
  • Walk and be more active; lose weight if necessary.
Unfortunately, many people with PAD experience no symptoms. In fact, only about one third of PAD patients feel any pain, and by that time, it's likely that arteries have narrowed by 60 percent or more. So it's important to talk to your doctor about PAD if you have any of the risk factors outlined above.

TO LEARN MORE ABOUT PERIPHERAL ARTERIAL DISEASE AND ITS TREATMENTS, call (616) 394-3824 .

CARDIOVASCULAR IMAGING JUST GOT BETTER!

Using a new, all-digital catheterization imaging system, medical specialists at Holland Hospital are now able to perform both cardiac and vascular exams on patients with a single system. The GE Innova® 3100 imaging system, implemented at Holland Hospital in June, allows physicians to view vessels and anatomy of the heart as well as blood vessels throughout the entire body — all the way down to fingertips and toes.

The real-time moving images are so detailed that physicians are able to safely maneuver the smallest medical devices — such as catheters and stents — during angioplasties, vascular interventions and other clinical procedures.

Holland Hospital is only the second site in Michigan to use the dual-software imaging technology. It is the first phase of a planned renovation of Holland Hospital's Cardiovascular Lab.

Todd Knight, RN, clinical manager of ICU, Telemetry and the Cardiovascular
Lab at Holland Hospital.

Home>