Scott Webb: Today, I'm going to discuss the importance of vascular screenings, especially if you have a family history of vascular disease, or if you have high blood pressure, diabetes, or are a smoker with Dr. Justin Nelms. He's the Chief of Vascular and Endovascular Surgery at University of Maryland, Baltimore Washington Medical Center.

 Welcome to the Llive Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Scott Webb. Dr. Nelms, thanks for your time today. We're going to talk about vascular screening and everything involved. So as we get rolling here, briefly explain if you can what vascular screening is and why it's important for patients to have one.

Dr. Justin Nelms: A vascular screening is a means of detecting disease in arteries. And what I really mean by disease, are blockages in arteries. And of course we have arteries all over the body and their job is to take the blood to the organs that need them, to perfuse those organs.

And, each of these arteries is vulnerable to developing blockages. And there are some risk factors that can increase that risk. But what a screening is, is an ultrasound study that looks at certain select areas of the body to assess these arteries for disease. And the value in it is it can potentially identify disease before it becomes a problem and allow these arteries to be appropriately treated.

Scott Webb: Okay. So let's talk then, you know, from a patient's perspective, what can they expect to learn, you know, when they go for a vascular screening. What can they expect to learn and what do the different outcomes indicate?

Dr. Justin Nelms: A typical screening involves an ultrasound study of the aorta, the major artery in the abdomen, the carotid arteries, the arteries in the neck, as well as the arteries that perfuse the legs, the arteries that go down to the legs and feet. In the screening, as the patient walks in, they'll be registered and they'll meet a sonographer an ultrasound technologist, who will then conduct this test. Now, ultrasound test is non invasive. There's no pain involved. Most people identify ultrasound with babies, you know, it's a little bit of jelly, jelly goes on the skin and they can take pictures of these arteries, and those three components that I mentioned, the carotids, the abdominal aorta, and the lower extremities, will be assessed and the patients will get a result at each of those locations. Overwhelmingly, a majority of our patients who come in to get a screening, have normal studies, and there's nothing further that needs to be done or followed up upon. If there is an abnormality, a blockage, or an area of narrowing or something else that's concerning, then a provider at the screening will have a conversation with the patient and instruct them as to next steps for follow up.

Scott Webb: Yeah, and that leads perfectly into my next question. Let's talk about those next steps. So as you say, you know, most people won't need to do anything, but for those that do, after that vascular screening, what are some of the additional tests or appointments that might be necessary?

Dr. Justin Nelms: So any positive screening study warrants a referral to our vascular surgery practice or a vascular surgery practice. And the purpose for that is to have a one on one meeting with the provider and discuss, you know, in more detail, what the results of the screening mean and what the appropriate treatment is.

 Now, it's kind of hard to just issue a blanket statement that's saying if this is positive, this happens because; the treatment depends on what is identified. For example, if there are blockages in the arteries that go down to the legs, a patient may meet with a vascular surgeon and an arteriogram might be recommended, which is a study that involves contrast injected into the legs and possible ballooning or stenting of those arteries.

 If, for example, there's an aneurysm identified, an enlargement of the artery, the aorta, the artery in the belly, then a procedure to fix that aneurysm may be warranted. Or, probably most commonly, it will be, you know, we've identified this disease, it's not causing a problem right now, but it's important that we continue to track it and monitor it with regular surveillance, ultrasound studies, in our vascular laboratory.

Scott Webb: Yeah. I thought you might use the word surveillance. I don't know why I just enjoy that word so much. Uh, maybe from a patient's perspective. Let's do nothing for now. Let's just surveil. Okay. Sounds good, Doc. Uh, what are some lifestyle modifications? Cause you know, none of us can outrun our family history and genetics. But when we think about lifestyle modifications, what might be recommended based on the screening results and how ultimately do they impact vascular health?

Dr. Justin Nelms: Yeah, great question. So there certainly are some significant risk factors for vascular disease. Probably the most important one is smoking. Cigarette smoking, as most of us know, is pretty bad for your health overall, but it is particularly bad for your arteries and it affects arteries all over the body.

It can affect the arteries that go to your heart, the coronary arteries, or your carotid arteries or, the arteries that go to your legs or your abdomen. And so stopping smoking, or at least cutting back smoking is probably the most important modifiable risk factor that we have for vascular disease.

Other risk factors are diabetes. Patients with diabetes have an increased risk of vascular disease and control of glucose and good control of diabetes, can go a long way to mitigating those risks. Family history can also increase your risk of aneurysmal disease. Hypertension, high blood pressure is also another risk, and high cholesterol. I think those are the main ones.

Scott Webb: Yeah. And I never talked to an expert who says, oh, it's fine if you smoke, you know, we'll, we'll just work around that. No, that's always right at the top of the list to stop smoking. And then we'll dig in. We'll roll up our sleeves here. And we think about that, you know, in terms of treatment options, you know, let's talk about medications, treatments that might be prescribed after screening and how they really help individuals through some of these vascular issues or a positive test, as you say.

Dr. Justin Nelms: If vascular disease is identified, antiplatelet therapy, meaning usually just aspirin, is warranted. Aspirin has been shown in this particular patient population to reduce the chances of major adverse cardiovascular events, such as stroke, heart attack, acute lower leg ischemia or blockages.

And so generally we'll recommend just a baby aspirin, 81 milligrams, once a day for these patients. The other therapy, the other main medication in our, in our arsenal, if you will, is, statin therapy. So statins are a class of medication that are designed to treat cholesterol. But interestingly, statins have also had an unintended benefit of having an effect to stabilize atherosclerotic plaques or blockages that build up in arteries. And so patients with significant disease, often benefit from high intensity statin therapy, as well. And then of course, we talked about smoking already, of course, but exercise is also helpful. It's beneficial to your arteries as well. So we generally recommend exercise, particularly in patients who have lower extremity disease.

Scott Webb: I want to talk about follow up screenings. So if somebody's, whether they've had a positive results or not, but in general, you know, how often do folks need to be re-screened or follow up? And, what might that mean ultimately, if they're told, oh, you need to come back in six months or a year or whatever it is, but let's talk about that, the follow-up screenings.

Dr. Justin Nelms: It largely depends on what the specific results of the screening study are, what the positive result is. So for most patients, most patients walk in, they get the screening study and everything is completely normal. They will not need another screening study unless something changes or maybe their primary care physician is concerned about their risk factors and their likelihood of developing subsequent disease. So that's a majority, you know, probably 95 percent of our patients who get a screening have that clinical course.

 If there is a positive result, depends on where it is. Probably the most common positive result we see is an asymptomatic carotid stenosis, so a little narrowing in one of the arteries that goes to the brain, maybe in the 50 percent range. It's asymptomatic. It's not concerning. It doesn't need to be treated, but it should be monitored.

So those patients, for example, would get ultrasound studies one at six months, and then if that's stable, annually after that, and generally those studies are done in our vascular lab with our practice, but I suppose annual screening visits would be a substitute for that as well.

Scott Webb: Sure. Yeah, I know that you're the Chief of Vascular and Endovascular Surgery at the University of Maryland Baltimore Washington Medical Center, so, you know, I don't know what it takes to get to you, but I'm assuming there's other specialists and surgeons along the way before we get to the head honcho, if you will. But wondering in what situations, you know, should someone consider consulting a vascular specialist or a surgeon? In other words, how do they find the right healthcare provider for their needs?

Dr. Justin Nelms: I'm kind of biased. You know, I'd prefer that anyone with a vascular abnormality should see a vascular surgeon. That's my bias. And so, we're pretty accessible. I know at our practice, it's a simple Google search will bring you to our office information and you can call and make an appointment, but wherever patients may be, they should be able to find a reliable vascular surgeon. Now if it's, you know, minor stable disease, a lot of it can be monitored by primary care physicians as well. So I certainly don't object to that approach either.

Scott Webb: Yeah, I can certainly understand the value, especially if someone's had a positive result and surveillance has been ordered. It just seems prudent, I guess, is the word, to speak with you or another surgeon just to, you know, talk things through, go over our options, just to make sure that nothing surgical, let's say, is needed now. I'm with you on that one, doctor.

Dr. Justin Nelms: A hundred percent.

Scott Webb: Yeah, and this has been really educational. I love learning from these things and I was excited. I don't know that you get as excited as I did about talking about vascular screenings, but I'm always interested in learning more about things like this and the value of the screenings and so on.

So, as we wrap up here, just final thoughts and takeaways when it comes to vascular screening. If folks are at higher risk, encouraging them to get those screenings and do what their doctors and or surgeons say. Let's hear it from you, Doctor.

Dr. Justin Nelms: So one of the things that we haven't gone over yet is who should get a screening. And so what we generally recommend is a one time screening for any men older than 65 or at age 55, if they have a family history of aneurysmal disease. And for women, the prevalence of ianeurysmal disease is lower in women. So we'll generally recommend a screening for women who are 65 years or older. And then, risk factors are important as well. Anyone really over the age of 55, man or woman, who has a history of diabetes, smoking, hypertension, or the family history that we've discussed, should get a screening.

And, you know, the nice thing about screenings is there's really no downside to it. Uh, non-invasive. There's no risk to it. There's no discomfort or anything like that. And the advantage is, of course, detecting disease before it becomes a problem. So it's the old ounce of prevention is worth a pound of cure mantra.

Scott Webb: Yeah, when you think about the other types of screenings that one might go through, let's say like a colonoscopy, right, there's much more involved. For a vascular screening, it's pretty relaxed for the patient and good to know those results, especially if we are at higher risk or have a family history and so on.

So, that's perfect today, Doctor. Thank you so much. You stay well.

Dr. Justin Nelms: Okay. Thanks. You too.

Scott Webb: That's Dr. Justin Nelms, Chief of Vascular and Endovascular Surgery at University of Maryland, Baltimore Washington Medical Center.

And find more shows like this one at umms.org/podcast and on YouTube. Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System.

We look forward to you joining us again and please share this on your social media.

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