If you think of your circulatory system as your body's plumbing work, how would you know if your pipes were clogged?

• Do you have leg pain or fatigue when walking or standing?
• Do you have a burning or aching pain in your feet or toes when you are resting?
• Do you have sores, ulcers or "black and blue" marks on your feet that don't heal?
• Do you have numbness, tingling and/or weakness in your legs or feet?
• Are your legs or feet cold to the touch?
• Have you noticed a change in the skin color of, or a loss of hair on your legs or feet?

If you answered yes to any of these questions, you might have peripheral vascular disease (PVD). About 10 million people in the United States have it, but only 1.25 million cases are identi- fied and treated.

"Many people mistakenly think that these symptoms are just a natural part of getting older and don't seek treatment," says Paula Jefferson, RN, BSN, Director of Cardiology at Manatee Memorial Hospital.

She explains that people with PVD have poor circulation in their feet and legs due to a buildup of the same plaque that causes coronary artery disease. Plaque is the buildup of fat, cholesterol and other substances in an artery's inner lining. "Many people who have this [PVD] also have heart disease. The risk factors are the same," Jefferson says.

Those risk factors include smoking, diabetes, high blood pressure, obesity, a sedentary lifestyle, a family history of vascular disease and elevated cholesterol levels.

	David Schreibman, MD Bradenton Cardiology 316 Manatee Ave. West Bradenton, FL 34205 941-748-1958
	Paula Jefferson, RN, BSN Director of Cardiology

David Schreibman, MD, an interventional cardiologist specializing in the diagnosis and treatment of coronary and peripheral vascular disease at Manatee Memorial, says everyone with these risk factors should be tested for PVD because many people in the early stages of disease don't have symptoms.

"This is when lifestyle changes can have the biggest payoff," Dr. Schreibman says. "If you smoke, discontinuing tobacco use is an essential first step." Other important lifestyle changes include regular exercise and weight management. It's also important to control such chronic diseases as diabetes, hypertension and high cholesterol by taking the appropriate medication, he says.

Jefferson adds that stress management is an important aspect of lifestyle modifi- cation. "Our lives are so cluttered these days, it's common to have stress-related health issues," she says. She recommends yoga, meditation or taking up a relaxing hobby to relieve daily stress.

Often, lifestyle changes and medication are not enough to reverse the condition. "Some people have such debilitating leg pain that they are unable to exercise," says Dr. Schreibman. He adds that dramatic treatment advances have been developed in the past few years, allowing interventional cardiologists to remove most blockages with minimally invasive techniques.

Dr. Schreibman cautions that when interventional treatment is required it is even more essential to combine risk factor reduction and lifestyle modification to prevent further progression of this disease.

Diagnosis
Doctors use three tests to diagnose PVD. The ankle brachial index (ABI) is a test in which the blood pressure in a patient's arm is measured and compared with the blood pressure in his or her ankle. This gives the doctor a good idea about the blood flow in the legs.

The doppler ultrasound test uses sound waves to determine blood flow in the legs. It allows the doctor to determine if a specific artery has plaque buildup.

Before a doctor makes a final diagnosis, he may perform an angiogram. In this test, a special dye is injected into the arteries and X-rays are taken. The X-rays show any narrowed or blocked arteries.

About 20 percent of the population age 75 and older suffers from PVD. Since Florida has a large percentage of elderly residents, the need for PVD treatment here is high. "Five years ago, we were doing only coronary procedures, but now up to a third of our patients are being treated for PVD," says Jefferson.

Demand is so high that once a month physicians from the surrounding region come for training on the latest surgical procedures from Gino Sedillo, MD, a board certified interventional cardiologist at Manatee Memorial.

Treatment
There are a number of minimally invasive techniques used to clear blockages from the arteries. These include:

Percutaneous transluminal angioplasty (PTA) is the term used to describe all methods of treating narrowing and blockage of the vascular system by inserting a catheter through an artery to the blockage. Of these, balloon angioplasty is the most commonly used technique. A catheter with a small balloon-like device is threaded to the site of the blockage where the balloon is inflated. This opens the blockage, and in some cases, a small wire mesh called a stent is inserted to keep the artery open at the site. This procedure usually does not require hospitalization.

If the blockage is caused by a blood clot, the interventional cardiologist may perform thrombolysis, a procedure in which thrombolytic drugs are injected through a catheter to dissolve the clot and open the blood vessel. This procedure also may include angioplasty and stenting.

Atherectomy has recently become the "treatment of choice" to remove plaque from arteries, according to Dr. Schreibman. The surgeon uses a laser or rotating shaver to remove plaque. Balloon angioplasty or stenting may be used after an atherectomy.

Cryoplasty is a new vascular intervention designed to simultaneously dilate and treat a diseased blood vessel by cooling it to a precise temperature then allowing it to return to normal body temperature. A balloon is inserted into the site of the blockage and liquid nitrous oxide is delivered, cooling the artery and expanding the balloon. The cooling helps minimize the growth of new tissue. The growth of new tissue can lead to a reclogging of the vessel.

In cases where an artery is too badly damaged to be treated with these techniques, a surgeon may recommend a bypass graft, which involves taking a vein from another part of the body or using a graft made from synthetic material to create a detour around the blocked artery.

If untreated, PVD can lead to serious health problems, including gangrene and loss of a limb. It can even shorten your life. So ask your doctor if you should be tested for this disease.