Transcription:
What You Need to Know about Vascular Health

Prakash Chandran (Host): Your body's vascular system is a complex network of blood vessels that are constantly working to support your heart. Without this network, our organs wouldn't get the oxygen they need to function, causing the entire body to fail. By protecting our blood vessels from disease, we protect the delicate ecosystem that keeps us alive. Here with us to discuss is Dr. Eddie Luh. He's a vascular surgeon and senior partner at Vegas Vascular Specialists.

Host: Welcome to Health Talk with the Valley Health System, presented by The Valley. I'm your host, Prakash Chandran. Dr. Luh, thank you so much for joining us today. I really appreciate your time. Now, I gave a definition up at the top, but I would love for you to explain to us what exactly is vascular disease.

Dr. Eddy Luh: First off, thank you for having me. Vascular disease is nothing more than the circulatory system of the human body. Think about the plumbing of your house. The vascular disease is the plumbing of your body. Arteries take blood away from the heart, veins take blood back to your heart.

Host: Now when you have disease, are you saying that there's something broken with the plumbing of your body?

Dr. Eddy Luh: Something's not necessarily broken, but maybe some buildup or blockage or narrowing of an artery. Pretty much everyone's heard about heart disease and they know that if you have heart disease, you could have a heart attack, you could die from that. What many people don't realize is that the plumbing or the circulatory system is the exact same thing. You could get plaque buildup, you could get cholesterol buildup as you get older, poor health. And this blockage would then go ahead and affect the various parts of the body that that artery was supposed to take nutrients to, such as your legs, your organs, your brain.

Host: Understood, and that's very helpful. So, what are some of the most common forms of vascular disease?

Dr. Eddy Luh: When we talk about vascular disease, we primarily want to talk about the arteries that take blood again away from the heart. One form is what's called an abdominal aortic aneurysm. Many people refer to it as a AAA. Pretty much it's a bulge or ballooning of the largest artery in the human body, which is located in the abdomen, kind of in the area between the bottom of your ribcage and your belly button. This can expand to the point that the wall becomes so brittle that it ruptures. When it ruptures or blows up, it carries a very high mortality rate. So, the goal of a AAA is to treat it before it ruptures. Now that said, not all abdominal aortic aneurysms need immediate treatment. It's usually based on the size, how fast it's been growing, your comorbid risk factors. I tell my patients, think about a balloon. When you were a young kid blowing up a balloon, it's really hard to blow it up at first, but then it expands really rapidly and then it pops. We don't want it to get to the point where it's been expanding really rapidly and then pops on you before you can get it treated and taken care of.

Host: Okay, I understand that. And I'm curious as to what actually causes the artery to balloon in the first place.

Dr. Eddy Luh: Good question. There are many things that could cause hardening of the arteries or weeping of the arterial wall. There could be a family history of atherosclerotic occlusive disease. Smoking, of course, is a very big risk factor in our population. Diabetes, overweight, high cholesterol, high blood pressure, all these could contribute to an issue with your vascular system that you should get evaluated for.

Host: Okay. So, let's talk about that evaluation. I was going to ask if you could screen for vascular disease. Why don't you tell us a little bit about that.

Dr. Eddy Luh: Most definitely you can screen for vascular disease, depending on the vascular disease that you're concerned about. One very quick screening study that's available is called an ultrasound. It's just like a probe that they run over your abdomen or your neck or your legs, depending on what part of the body we're looking at. There's no needlestick, there's no radiation, there's no dye required. It's pretty much just an ultrasound scan similar to how other doctors use to view a baby and the mother's abdomen, and it helps give us a clearer picture as to the extent of narrowing or blockage within various arteries of the body. So, you can use the ultrasound to screen for carotid disease or carotid stenosis, peripheral artery disease, arterial aneurysms, which we've already spoken about, and vein insufficiency or varicose veins.

Host: Okay. So then, my question becomes who should be getting screened? Now, you talked about sometimes there's a family history. I imagine if there is family history, you should get screened sooner, but talk broadly about when you should be thinking about getting screened.

Dr. Eddy Luh: I think anyone that is over the age of 50 should consider some sort of screening or at least talk to your primary care physician about peripheral artery disease and vascular disease. Usually, it starts with a good physical exam. And if there's any concern at all, the next step would be moving to one of these screening studies that I mentioned earlier.

Host: Okay. Understood. So, as I hear you talk about all this and some of the causes of vascular disease, I can't help but wonder about how can we proactively improve our vascular health. Do you have recommendations around what a person can do?

Dr. Eddy Luh: Of course. Regular checkups are important. Control your blood pressure, control your cholesterol level, either with diet or with medication, regular exercise. And of course, don't smoke. These basic things in life that tell you to live more healthy, they will help your vascular disease. If you think about it, if you are told to do this or do that to help your heart be stronger, the same thing would happen to help your vascular system be stronger.

Host: Okay. That makes a lot of sense. And one thing that I've always wondered about, you kind of mentioned checking your blood pressure, your cholesterol, do you have numbers that people should be aiming for or numbers that, if they are exceeded, people should be worried about?

Dr. Eddy Luh: So, not really, other than they keep changing the number that what is considered high blood pressure or severe hypertension, the cholesterol number keeps coming down or up based on the latest recommendations. I would say the best referral for something like this is your primary care physician who's up-to-date with the latest recommendations from the various medical societies.

Host: Yeah. And I think that's probably why your first recommendation was regular checkups because they're able to establish a baseline and a pattern to see if there are extreme fluctuations. Isn't that correct?

Dr. Eddy Luh: That is correct.

Host: Now, I know that technology is always improving, and I'm wondering if there is any new technology that's been released to help treat vascular disease.

Dr. Eddy Luh: So vascular surgery, like most fields of medicine, is moving more and more toward what is called minimal intervention or endovascular intervention. Twenty plus years ago when I was in training, most of vascular surgery was treated with what is called open surgery. We took you to the operating room. You underwent general anesthesia. You had long incisions on various portions of your body for us to gain access to the artery or vein that needed to be treated. And we cleaned things out. We did bypasses. Well, now, with the advent of technology, most of this is done as an outpatient setting through very small incisions or even needle puncture sites that we call venipuncture or percutaneous. And through these little sheaths, we can treat most disease with lasers, balloons, stents, which are like a metal scaffolding to help keep an artery open; atherectomy devices, which I commonly explain to patients is like a Roto-Rooter to help clean out your arteries. Newer devices even include something called lithotripsy. Similar to how kidney stones are broken up with high frequency ultrasound, we're now breaking up plaque and hardening of the arteries with high frequency ultrasound within the artery. So, the field is moving quickly, evolving quickly, to the point that most procedures today are very well tolerated by patients.

Host: I mean, this really does sound like the future. So, you're saying that no longer do you have to go through an open surgery under general anesthesia. It's these minimally invasive really incisions and you're using lasers and things to eliminate the plaque and really do the treatment, which I imagine not only improves outcomes, but also reduces recovery time.

Dr. Eddy Luh: One-hundred percent. That is one of the great things about my field. The evolving technology and the innovation that's been coming out over the last 20 years is amazing. Now, I don't think we're ever going to get to the point where someone's just going to wave their hand or one of those Star Trek generators over your body and you're going to be fine. But the way that is going right now, with heart disease being more and more readily treated, the population is growing stronger and growing older. And because of that, we've had to step up our game to make sure that we can treat more and more people in a fashion that is more comfortable to them and more engaging, so they're not so scared about undergoing surgery or treatment for vascular disease.

Host: Now, one of the things that we did not address is, I guess, the symptoms of when you have a vascular disease. And I realize that there are different types, but how can someone know through what they're feeling physically that they may want to get checked out?

Dr. Eddy Luh: Well, let's talk about two of the common vascular diseases that we haven't brought up yet. Let's first talk about, let's say, peripheral arterial disease, which is hardening of the arteries caused by plaque buildup in the blood vessels that carry oxygen away from your body. The most common symptom would be the hardening of the arteries in the legs when we refer to PAD or peripheral vascular disease. Usually, it manifests first as a calf cramp that exacerbates itself short distance ambulation every time. For instance, "Doc, every time I walk 50 yards, my calf cramps. I have to stop, the pressure goes away, then I can walk again." Now if that were to get worse, and you actually have pain all the time at rest when you're sleeping or you have an open wound on your foot because you stepped on a nail or the dog nicked you or something that won't heal, and even discoloration, blue toes, black toes, those could be signs or symptoms of even worsening peripheral artery disease, of which you definitely should get evaluated and checked for.

Host: Yeah. And just to be clear, what I've heard, and you can confirm if this is true, if you are not proactive at dealing with peripheral artery disease, especially like that could lead to amputation. Is that correct?

Dr. Eddy Luh: Yes. Amputation is something that vascular surgeons, we do our best to keep you from having to have done. Unfortunately, many times we see the patient too late when they've waited too long, thinking that it had nothing to do with vascular disease or is unaware it was peripheral artery disease and there is no alternative but amputation.

Host: Yes. And I think that is why it is so important, even if you are experiencing a minor cramp, to go in and get it checked out. Now, you mentioned PAD. What is the second disease that we should expand on?

Dr. Eddy Luh: So, there's another vascular disease, which is just as important, and it's not necessarily PAD to the brain, but it's similar. It's called a stroke or carotid disease. The carotid arteries are your two primary arteries on the front of your neck that supply blood to your brain. Similar to the heart, similar to the legs, you can develop buildup a plaque or narrowing of these arteries. When it becomes so severe, blood flow is diminished or stopped completely leading to what is called an ischemic stroke where there's actually blood flow circulation to the brain that is cut off. Many times that is very lifestyle limiting. I mean, stroke is one of the top three leading causes of death in the United States. So this is something that, as vascular surgeons, we really do our best to try to control, treat, and follow to make sure that patients get treated appropriately.

Host: And as far as I know with a stroke, there's no real warning signs, right? It's almost like too late by the time that comes around. Or are there symptoms that people can be aware of to get ahead of it?

Dr. Eddy Luh: A large number of people, unfortunately, the first time they know about carotid disease is a stroke, but there is a symptom called a transient ischemic attack, which is a weakness in an arm or a leg, slurred speech, maybe you have a little facial palsy or a drooping of one side of your face that could suggest you have carotid disease. If one of those symptoms last less than 24 hours, then we call it a transient ischemic attack. If it's greater than 24 hours, then technically you've had a stroke.

Host: So Dr. Luh, you know, we talked all about arteries, but you also mentioned that veins are part of the vascular system as well. Can you expand on this a bit?

Dr. Eddy Luh: Sure. Venous disease actually affects over 10 million Americans. They just don't know because they never get it evaluated. When most people think about venous disease, they're thinking about the small spider veins or the varicose veins, which are those bulging veins that many people get on their legs that are unsightly. But what they don't understand is that leg swelling, leg discoloration, itching, non-healing skin wounds can also be secondary to venous disease that is very treatable. Now, more severe than that, of course, is the deep vein thrombosis. You always hear about the long plane ride or the long car ride called a DVT, which could be potentially life-threatening if part of that clot breaks off and goes into your lung called a pulmonary embolism. The way I look at it is that if you have any of those symptoms I just mentioned, the varicose veins, the leg swelling, or you have heaviness, fatigue, discomfort, aching, itching in your legs, we see a lot of people for that, and our job is to figure out how severe or how complex it could be. And whether we can just treat you with leg elevation, regular exercise, compression stockings, or are you looking at something that needs to be more invasive? We have lasers. We have high frequency ultrasound machines. We have glue. We have medication we can inject into your veins these days to not only make them look better, but also feel better and not require a trip to the operating room to do what's been traditionally called vein stripping, which is like passe from 20 years ago now.

Host: Yeah. I think the one thing to take away there is that so many people just live with the pain or they're just kind of resided to the fact that, "Hey, I'm getting older" or maybe "I've experienced this for a long time. This is just the way things are." But there are so many modalities to get treated, to have things look better, to have you feel better, that it is really worth going in to see your primary care to see what options you have.

Dr. Eddy Luh: I would agree. And I want to add that most people, when they go see their primary care doctor, don't be afraid to ask to see a specialist, not just a vascular surgeon, but whatever problem you're having to see your primary care physician for. Usually when you come to see a vascular surgeon, we will be seeing you probably for your lifetime. We're not just going to see you treat the one little thing and send you on your way. I mean, if you have vascular disease in one part of the body, there's a 20% chance you're going to have it elsewhere. So, it behooves us to treat you as an entire person, not just a carotid here or an aneurysm there. We get to know you. I've been in practice for 20 plus years now, and I still have patients that see me every year that I saw from my first year in practice.

Host: Wow. So on that note, if someone in our audience wanted to get an assessment of their vascular health, how do you recommend they get started or where should they go?

Dr. Eddy Luh: Again, I would say you start with your primary care doctor. The primary care doctor can usually order the appropriate screening ultrasound of whatever part of the body that you're concerned about. If something is seen unclear, they believe it should be worked up further, that's when they will probably refer you to the specialist such as myself.

Host: And just before we close, one question that I always like to end with is being a vascular surgeon, you have seen so many patients, so many different types of vascular disease, in your experience, what is one thing that you know to be true that you wish more patients knew?

Dr. Eddy Luh: I wish more patients would know that vascular disease is a true condition that is treatable, could be preventable with healthy living and that vascular surgeons are agnostic. And what I mean by that is that we will treat you the best way we feel how. Many patients are scared coming to a surgeon thinking they're going to need a procedure. But many times than not, we recommend conservative management or no surgery and lifestyle-limiting modifications to help you keep from getting worsening vascular disease.

Host: Wonderful advice and the perfect place to end, Dr. Luh. Thank you so much for your time today.

Dr. Eddy Luh: You're very welcome, and thank you for having me.

Host: That was Dr. Eddie Luh, a vascular surgeon and senior partner at Vegas Vascular Specialists. For more information, you can visit valleyhealthsystemlv.com. Thanks for checking out this episode of Health Talk with the Valley Health System, presented by the Valley Health System. My name is Prakash Chandran, and we'll talk next time.

Physicians are independent practitioners who are not employees or agents of the Valley Health System. The system shall not be liable for actions or treatments provided by physicians.