St. John's Vascular Center screenings detect variety of conditions
By Jay Sparks, M.D.

Peripheral vascular disease (PVD) is predominantly an atherosclerotic condition resulting in narrowing of arteries supplying extremities and organs. This compromised flow results in organ damage with significant morbidity and mortality. It affects roughly 10 million people, men and women alike, especially over the age of 50. Only 25 percent are diagnosed with the majority being medically managed. An estimated 10-12 percent of the adult population is affected and up to 30 percent of individuals over the age of 75. Prevalence rates continually increase generally between 9-30 percent as screening programs are initiated.

Locally, data in 10/03 based on the local 13 county area estimates the population of 50 + at about 266,000 with growth rate of 17 percent, of which 5 percent have PVD. Those 65+ number 76,000 with a growth rate of 11 percent, and 20 percent have PVD. Those 75+ number 21,000 with a growth rate of 9 percent, and over 29 percent have PVD. These numbers are alarming as up to 75 percent of people with peripheral vascular disease will ultimately have a coronary or cerebral vascular event.

Screening for PVD should become a part of ongoing patient care. Only 50 percent will actually present with a complaint of claudication - painful cramping or tightening of calves, legs, or hips which is relieved with rest. More subtle complaints include distal numbness, weakness, tingling, burning, or a cold sensation. Risk factors include age over 50, tobacco use, diabetes mellitus, hypertension, hyperlipidemia, obesity, lack of exercise, and a family history of vascular disease. Physical exam may reveal ulcerations, loss of hair on the legs or toes, or distal redness to dusky appearance.

An ankle-brachial index is a simple screening tool that can be used in the office setting. A handheld Doppler is used to locate pulses in each arm and ankle. A standard blood pressure cuff is the utilized with the Doppler to determine the systolic blood pressure. The highest reading in the ankles is then divided by the highest reading in the A value of 0.9 or greater is normal but a value below this signifies PVD.

Treatments generally fall into three categories. The first is risk factor modification such as tobacco cessation, weight loss, exercise, and control of diabetes, blood pressure, and cholesterol. Patients may also benefit from cilostazol 100 mg twice daily combined with walking 30-60 minutes 5-7 days per week and re-screening in six to eight weeks. Finally, multiple varieties of interventions are utilized such as angioplasty, stenting, arthrectomy, thrombolysis, grafting, and bypass.

St. John’s Vascular Center offers reduced-rate screenings Wednesdays from 9 a.m. to 2:30 p.m. at St. John’s Hospital in Springfield. The screenings are recommended for patients over the age of 50 and smoke or are diabetic and/or have high cholesterol.

The $60 painless screenings consist of three parts. First, a risk factor history is reviewed noting age, hypertension, hyperlipidemia, diabetes mellitus, coronary artery or vascular disease, and family history. Second, the exams consist of abdominal aortic ultrasound, carotid Dopplers, and ankle-brachial indices. Finally, the results are provided to the patients and their primary care physicians in a standardized format with recommendations for ongoing care.

St. Johns' Vascular Center is a coordinated team of cardiologists, cardiothoracic and vascular surgeons, interventional radiologists, and support staff. For additional information, please contact Debbie Horine, APRN, BC, at 417-820-3302.

Read more about St. John's Cardiovascular Services.