Texas Public Radio: Peripheral Artery Disease Is Widely Undiagnosed

Vascular surgeons say Peripheral Artery Disease – or P.A.D. – is one of the most underdiagnosed medical conditions in America. If left untreated, it can cause major mobility problems, or it can even be fatal. In today’s TPR Lifeline, Bioscience-Medicine reporter Wendy Rigby talks to Lyssa Ochoa, MD, a vascular surgeon with Peripheral Vascular Associates in San Antonio.

Rigby: Dr. Ochoa, what is peripheral artery disease?

Ochoa: It’s a long name and people don’t understand what it is. So simply, it’s an accumulation of plaque and cholesterol that fills blood vessels to your legs and blocks blood flow to the legs.

So when you hear the phrase “circulatory problems” this is what people are talking about?

That’s exactly right. When people say you have circulation problems, we’re talking about the arteries that are being blocked up with that cholesterol and plaque.

Now we hear a lot about heart disease, of course, but why do you think we don’t hear as much about vascular disease?

I think the reason we don’t hear much about vascular disease partly is because most people go undiagnosed. The interesting thing, you bring up coronary artery disease or heart disease, and they all go hand in hand. What we know is that over 50 to 60 percent who are diagnosed or who have peripheral arterial disease have heart disease. And so this gives us a kind of an entryway to look for patients who may have heart disease. And this is why diagnosing early peripheral arterial disease is so important.

Now are there any symptoms?

In 66 percent of patients, or two-thirds of people, most people don’t have symptoms. And that’s why it’s so hard to diagnose. You have to look for peripheral arterial disease.

People with diabetes are more susceptible to PAD. Why is that and is there anything that diabetics can do to cut down on their risk of developing this side effect of their chronic illness?

In San Antonio, one of the biggest contributors or risk factors of peripheral arterial disease is diabetes, like you said. But there are other risk factors such as smoking, high blood pressure, high cholesterol, personal or family history of heart attack or stroke. And in San Antonio, like you said, diabetes is a big factor. It can be controlled. Most of our diabetics who come into my office, I always ask them if they’re eating a diabetic diet and exercising. And it seems like something that we always say. But those are the critical points of taking care of yourself. Taking your medication is important. But a diabetic diet and exercise goes hand in hand with the medication to control diabetes.

And is peripheral artery disease what leads to the need for amputations?

It is. And in diabetics, peripheral arterial disease kind of presents itself in a different way. In diabetics, peripheral arterial disease starts in our microvasculature or the small little blood vessels in the tips of the toes and works its way up. So by the time a patient has signs of peripheral arterial disease who are diabetic such as an ulcer, all those small blood vessels have already been affected. And that predisposes that person to be more at risk for amputations. People with diabetes and PAD versus PAD alone are two times as likely to end up with amputations.

Describe the tests people may undergo to see if they have this condition.

Well the test is very simple. And it’s something called an ankle-brachial index. Your primary care physician can perform it. You take a blood pressure in your arm, compare it to the blood pressure in your foot, and they should be equal. So that ratio should be around one. Anything less than one or less than about .9 is abnormal. And you should get further testing by a specialist or a vascular surgeon.

So you put a cuff like you do on your arm but on your ankle.

Exactly right. And the advantage of this test is that it’s simple and it’s easy to diagnose peripheral arterial disease. And the reason it’s important is that peripheral arterial disease, like I mentioned, goes hand in hand with heart disease as well as your risk of having stroke. So if you are diagnosed PAD, you know to look for those other life-threatening conditions.

Now I’ve had the pleasure of watching you work in a cath lab at Baptist Medical Center in San Antonio. What are some of the most common procedures you do as a vascular surgeon?

So as a vascular surgeon, the most common thing we do, we start with an angiogram and endovascular interventions. That’s usually what we start with. When we know that someone has blockage of blood flow, we start with a small catheter in the blood vessel. We shoot dye within the blood vessels and check where those blockages are. And then we try to get across the blockages with wires and open them up with multiple devices including balloons, devices to take out the plaque and sometimes stents. If that doesn’t work, our next step is open surgery. We do bypasses, similar to what people have heard about bypasses on the heart. We bypass blockages in the legs as well.

Why is this your passion and why did you choose this specialty?

I chose this specialty because it allows me to take care of patients in the best way that I can. As a vascular surgeon I am singularly specialized to take care of patients medically, with minimally invasive procedures as I’ve been trained to do, or with open surgery. And so I get to decide what each individual patient needs best. My patients I have lifelong. And so having that long term patient-physician relationship really is very rewarding to me.

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