Millions of Americans have vascular disease, and that number is expected to grow as the population ages.
Alternatively, many people with the disease may experience no warning signs.
Because vascular diseases are so variable and complex, the Lourdes team provides a unique multidisciplinary approach to the screening, diagnosis and treatment of patients.
Dr. Anthony Smeglin, Interventional cardiologist and vascular specialist with Lourdes Health System is here to help bettter understand vascular disease.
Selected Podcast
Legs Hurt? You Could Have Peripheral Artery Disease
Featured Speaker:
Learn more about Anthony G. Smeglin, MD
Anthony Smeglin, MD
Cherry Hill resident Anthony G. Smeglin, MD, RVPI, an interventional cardiologist and vascular specialist at Associated Cardiology Consultants, an affiliate of Lourdes Cardiovascular Services, recently became board-certified in Endovascular Medicine. This certification is in addition to his board-certifications in Internal Medicine, Cardiovascular Disease, Interventional Cardiology, Nuclear Cardiology, Vascular Medicine, and Vascular Ultrasound. Dr. Smeglin is the first physician at Our Lady of Lourdes Medical Center to gain certification in Endovascular Medicine. In addition, he is one of few in the state of New Jersey to hold board certification in all three major vascular boards. He joins a select group of physicians nationwide to hold active board certification in seven specialty areas.Learn more about Anthony G. Smeglin, MD
Transcription:
Legs Hurt? You Could Have Peripheral Artery Disease
Melanie Cole (Host): Millions of Americans have vascular disease and that number is expected to grow as the population ages. Alternatively, many people with the disease may experience no warning signs. My guest today is Dr. Anthony Smeglin. He is an interventional cardiologist and vascular specialist with Lourdes Health System. Welcome to the show, Dr. Smeglin. Tell us, what is peripheral artery disease? How does it differ from peripheral vascular disease? Are they the same thing?
Dr. Anthony Smeglin (Guest): They are not the same thing. Peripheral artery disease is a process that affects the arterial blood vessels in the body. Peripheral vascular disease encompasses peripheral artery disease but also includes other things like venus disease or disease processes that affects the organs, etc.
Melanie: The periphery being the outsides of our bodies – arms and legs – are we talking about the arteries in those areas?
Dr. Smeglin: Yes, we are talking about the arteries that lead to all areas of the body when we say “peripheral artery disease”. I think for today’s purposes focusing on those processes that involve the lower extremities would be best.
Melanie: So then, tell us what people might experience? How would you even know if you had peripheral artery disease?
Dr. Smeglin: That’s a good question. Unfortunately, it’s very under recognized and underdiagnosed both because patients don’t know what to look for and physicians often don’t focus on it. In particular, the majority of patients either don’t experience symptoms or they attribute their symptoms to other causes. Typically, peripheral artery disease can lead to symptoms such as pain in the legs with walking which we call “claudication”, achiness, heaviness. Sometimes, if it progresses, it can lead to ulcers or gangrene.
Melanie: They get this claudication while they’re walking. Is it a sharp pain? Do they experience dull aches? Because it can be confused for overuse muscular problems; it can be confused with shin splints and calf problems. How do they know this is what it is?
Dr. Smeglin: Yes, that’s correct. The majority of patients experience what we call “atypical symptoms”. What you are alluding to – the sort of pain when you walk is typical claudication, but most people manifest in different ways. Typical symptoms would be if you’re getting out of your car and going into a grocery store and while you’re walking, you’re using your muscles and you start to get an ache or a cramp, let’s say, in your calf muscle or thigh muscle. You stop and rest for a minute or two and that ache or cramp goes away. Then, that’s a classic type of claudication symptom. The majority of patients – some 4 out of 5--experience atypical symptoms. That can be that when they are walking they may just get a cramp and continue walking. They may have some numbness or some heaviness. These are the sort of symptoms that people will often just attribute to their other ailments. It can often be confused for spine issues, arthritis issues, and neuropathic issues. One of the most common causes of these types of symptoms is venus disease. That’s one of the things that, as a physician, we need to tease out.
Melanie: How is it diagnosed? If people are experiencing these symptoms and they come to see you, what do you do? What’s the first thing?
Dr. Smeglin: The first thing we do is take a thorough history. That history will often help us delineate whether if this is something that may be coming from a blockage in the arteries or that it’s more likely a nerve problem or a musculoskeletal problem or a spine problem, etc. After a thorough history is taken and discussed, usually the first diagnostic procedure, if there is a reasonable likelihood, is what we call an “ankle brachial index”. We currently recommend all patients over 65 with risk factors to undergo that screening test and anyone who has a history of smoking or diabetes and is over 50 we recommend undergoing an ABI at least at some point in their life.
Melanie: Does that let you know if this is something that they have or then, are further tests necessary?
Dr. Smeglin: The ABI is very sensitive and specific when done properly for picking up or screening for peripheral artery disease. There are certain circumstances where the ABI alone may not be enough and we would want the patient to either exercise on the treadmill – that translates into walking slowly while we perform an ABI--or doing more advanced tests called “pulse volume recording” or an ultrasound of the legs.
Melanie: What if you discover that they do have some form of peripheral artery disease? What’s the first line of defense in treatment?
Dr. Smeglin: That’s a good question. The majority of time, it’s modifying risk factors. So, the lifestyle modifications, if you will. There aren’t many medications that will cure peripheral artery disease. It’s a process and it’s changing habit. These include exercise, eating healthy, quitting smoking, controlling blood pressure, controlling cholesterol; things like that. Exercise is one of the most important treatment modalities that we have for patients with peripheral artery disease. Too often a patient will present and complain of pain when they walk and as a result they walk less or exercise less. It’s one of the common discussions I have in the office that we want the patient to walk more and exercise more. What that does is help the body develop and grow what we call “collaterals” or small blood vessels to help feed the muscle with more blood supply.
Melanie: If the people with claudication tell you that walking is so painful, even when they walk slow, and you are trying to develop this collateral circulation, does riding a bicycle do just the same thing? Are they in cardiac rehab at this point so that someone can be with them while they’re walking?
Dr. Smeglin: Yes, that’s a good point. If the patient would prefer to have a monitored exercise program, we do find that that works better. That can often be set up. Most insurance companies will approve at least a 12-week or so monitored exercise therapy program. Patients don’t have to do that and they can exercise on their own, whether it’s going outside and walking around the block. Sometimes in the winter, my patients will go to a mall and walk around the mall, riding a bicycle, swimming. There are a whole host of exercises that can help get that heart rate up and circulation improved.
Melanie: Dr. Smeglin, do they then usually have to go on some sort of blood thinner or is there a medication that you like to recommend so that they decrease their risk of stroke? Is there an increased risk of stroke if they have peripheral artery disease?
Dr. Smeglin: With peripheral artery disease, there is an increased risk of cardiovascular morbidity and mortality. What that translates into is that once someone has the diagnosis of peripheral artery disease, they have a five year elevated risk of a cardiovascular problem. As such, risk factors and therapies are directed not only at peripheral artery disease but also at the cardiovascular system in general. These can include aspirin. Some patients may be put on Plavix. These aren’t blood thinners specifically but their anti-platelet agents; they help the platelets in the blood be less sticky. We don’t have great medicines beyond that for peripheral artery disease. There are some medicines that may improve symptoms with walking but they don’t reverse the process of peripheral artery disease. Most patients will ultimately be on a cholesterol medicine or a statin but these are a mainstay.
Melanie: In just the last few minute here, Dr. Smeglin, please give your best advice for people that might be experiencing some of these symptoms who think they might have peripheral artery disease and why they should come to Lourdes Health System for their care.
Dr. Smeglin: You mentioned when you started, peripheral artery disease affects anywhere from 15-20% of the population. It’s often under recognized. If somebody feels like they have symptoms that may be concerning for peripheral artery disease, we recommend they talk to their physician. We would be happy to see them at Our Lady of Lourdes. We have a multidisciplinary team that is very talented. There are interventional cardiologists, vascular specialists, vascular surgeons, radiologists--all of whom participate in the care of patients. It often requires multiple specialties to effectively care for these types of patients but the first step is identifying it and talking to your physician about it.
Melanie: Thank you so much for such great information. You’re listening to Lourdes HealthTalk with Lourdes Health System. For more information you can go to Lourdesnet.org. That’s Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.
Legs Hurt? You Could Have Peripheral Artery Disease
Melanie Cole (Host): Millions of Americans have vascular disease and that number is expected to grow as the population ages. Alternatively, many people with the disease may experience no warning signs. My guest today is Dr. Anthony Smeglin. He is an interventional cardiologist and vascular specialist with Lourdes Health System. Welcome to the show, Dr. Smeglin. Tell us, what is peripheral artery disease? How does it differ from peripheral vascular disease? Are they the same thing?
Dr. Anthony Smeglin (Guest): They are not the same thing. Peripheral artery disease is a process that affects the arterial blood vessels in the body. Peripheral vascular disease encompasses peripheral artery disease but also includes other things like venus disease or disease processes that affects the organs, etc.
Melanie: The periphery being the outsides of our bodies – arms and legs – are we talking about the arteries in those areas?
Dr. Smeglin: Yes, we are talking about the arteries that lead to all areas of the body when we say “peripheral artery disease”. I think for today’s purposes focusing on those processes that involve the lower extremities would be best.
Melanie: So then, tell us what people might experience? How would you even know if you had peripheral artery disease?
Dr. Smeglin: That’s a good question. Unfortunately, it’s very under recognized and underdiagnosed both because patients don’t know what to look for and physicians often don’t focus on it. In particular, the majority of patients either don’t experience symptoms or they attribute their symptoms to other causes. Typically, peripheral artery disease can lead to symptoms such as pain in the legs with walking which we call “claudication”, achiness, heaviness. Sometimes, if it progresses, it can lead to ulcers or gangrene.
Melanie: They get this claudication while they’re walking. Is it a sharp pain? Do they experience dull aches? Because it can be confused for overuse muscular problems; it can be confused with shin splints and calf problems. How do they know this is what it is?
Dr. Smeglin: Yes, that’s correct. The majority of patients experience what we call “atypical symptoms”. What you are alluding to – the sort of pain when you walk is typical claudication, but most people manifest in different ways. Typical symptoms would be if you’re getting out of your car and going into a grocery store and while you’re walking, you’re using your muscles and you start to get an ache or a cramp, let’s say, in your calf muscle or thigh muscle. You stop and rest for a minute or two and that ache or cramp goes away. Then, that’s a classic type of claudication symptom. The majority of patients – some 4 out of 5--experience atypical symptoms. That can be that when they are walking they may just get a cramp and continue walking. They may have some numbness or some heaviness. These are the sort of symptoms that people will often just attribute to their other ailments. It can often be confused for spine issues, arthritis issues, and neuropathic issues. One of the most common causes of these types of symptoms is venus disease. That’s one of the things that, as a physician, we need to tease out.
Melanie: How is it diagnosed? If people are experiencing these symptoms and they come to see you, what do you do? What’s the first thing?
Dr. Smeglin: The first thing we do is take a thorough history. That history will often help us delineate whether if this is something that may be coming from a blockage in the arteries or that it’s more likely a nerve problem or a musculoskeletal problem or a spine problem, etc. After a thorough history is taken and discussed, usually the first diagnostic procedure, if there is a reasonable likelihood, is what we call an “ankle brachial index”. We currently recommend all patients over 65 with risk factors to undergo that screening test and anyone who has a history of smoking or diabetes and is over 50 we recommend undergoing an ABI at least at some point in their life.
Melanie: Does that let you know if this is something that they have or then, are further tests necessary?
Dr. Smeglin: The ABI is very sensitive and specific when done properly for picking up or screening for peripheral artery disease. There are certain circumstances where the ABI alone may not be enough and we would want the patient to either exercise on the treadmill – that translates into walking slowly while we perform an ABI--or doing more advanced tests called “pulse volume recording” or an ultrasound of the legs.
Melanie: What if you discover that they do have some form of peripheral artery disease? What’s the first line of defense in treatment?
Dr. Smeglin: That’s a good question. The majority of time, it’s modifying risk factors. So, the lifestyle modifications, if you will. There aren’t many medications that will cure peripheral artery disease. It’s a process and it’s changing habit. These include exercise, eating healthy, quitting smoking, controlling blood pressure, controlling cholesterol; things like that. Exercise is one of the most important treatment modalities that we have for patients with peripheral artery disease. Too often a patient will present and complain of pain when they walk and as a result they walk less or exercise less. It’s one of the common discussions I have in the office that we want the patient to walk more and exercise more. What that does is help the body develop and grow what we call “collaterals” or small blood vessels to help feed the muscle with more blood supply.
Melanie: If the people with claudication tell you that walking is so painful, even when they walk slow, and you are trying to develop this collateral circulation, does riding a bicycle do just the same thing? Are they in cardiac rehab at this point so that someone can be with them while they’re walking?
Dr. Smeglin: Yes, that’s a good point. If the patient would prefer to have a monitored exercise program, we do find that that works better. That can often be set up. Most insurance companies will approve at least a 12-week or so monitored exercise therapy program. Patients don’t have to do that and they can exercise on their own, whether it’s going outside and walking around the block. Sometimes in the winter, my patients will go to a mall and walk around the mall, riding a bicycle, swimming. There are a whole host of exercises that can help get that heart rate up and circulation improved.
Melanie: Dr. Smeglin, do they then usually have to go on some sort of blood thinner or is there a medication that you like to recommend so that they decrease their risk of stroke? Is there an increased risk of stroke if they have peripheral artery disease?
Dr. Smeglin: With peripheral artery disease, there is an increased risk of cardiovascular morbidity and mortality. What that translates into is that once someone has the diagnosis of peripheral artery disease, they have a five year elevated risk of a cardiovascular problem. As such, risk factors and therapies are directed not only at peripheral artery disease but also at the cardiovascular system in general. These can include aspirin. Some patients may be put on Plavix. These aren’t blood thinners specifically but their anti-platelet agents; they help the platelets in the blood be less sticky. We don’t have great medicines beyond that for peripheral artery disease. There are some medicines that may improve symptoms with walking but they don’t reverse the process of peripheral artery disease. Most patients will ultimately be on a cholesterol medicine or a statin but these are a mainstay.
Melanie: In just the last few minute here, Dr. Smeglin, please give your best advice for people that might be experiencing some of these symptoms who think they might have peripheral artery disease and why they should come to Lourdes Health System for their care.
Dr. Smeglin: You mentioned when you started, peripheral artery disease affects anywhere from 15-20% of the population. It’s often under recognized. If somebody feels like they have symptoms that may be concerning for peripheral artery disease, we recommend they talk to their physician. We would be happy to see them at Our Lady of Lourdes. We have a multidisciplinary team that is very talented. There are interventional cardiologists, vascular specialists, vascular surgeons, radiologists--all of whom participate in the care of patients. It often requires multiple specialties to effectively care for these types of patients but the first step is identifying it and talking to your physician about it.
Melanie: Thank you so much for such great information. You’re listening to Lourdes HealthTalk with Lourdes Health System. For more information you can go to Lourdesnet.org. That’s Lourdesnet.org. This is Melanie Cole. Thanks so much for listening.