Mark A. Adelman, MD
Mark A. Adelman, MD, associate professor, department of surgery, and chief of vascular and endovascular surgery at New York University Langone Medical Center in New York City, www.med.nyu.edu.
If you are like many Americans, you have been advised to pay attention to your cardiovascular health—and you have your blood pressure and cholesterol levels monitored regularly. But do you also pay attention to the health of your arteries, veins and capillaries? Your body has about 60,000 miles of blood vessels. Atherosclerosis (plaque buildup) in arteries anywhere can block blood flow and cause angina (chest pain), stroke or heart attack. (Problems with veins and capillaries generally pose much less of a health threat.)
Three tests can help determine blood vessel health. They are quick, easy to do and inexpensive. I recommend having them done once a year, especially if you have high blood pressure, high cholesterol, atherosclerosis or a family history of heart disease.
Because insurance companies won’t always pay for preventive vascular screening, ask your primary care doctor (or cardiologist or vascular surgeon) to categorize your tests as a medical evaluation. Most insurance will cover claims submitted under this category, particularly if you have cardiovascular risk factors.
It’s best to have all three exams done in one screening session, usually conducted at a hospital or scanning facility.
Key: Make sure that your tests will be performed by a registered vascular technician or a board-certified vascular specialist and that the results will be interpreted by a vascular surgeon. To find specialists in your area, contact the Society for Vascular Surgery (800-258-7188 or www.vascularweb.org).
This test measures stroke risk and is recommended for anyone age 50 and older… and those age 40 and older who have risk factors for stroke, such as family history, high blood pressure, high cholesterol, diabetes or obesity.
This noninvasive procedure, which involves an ultrasound scan of the major arteries in the neck that carry blood to the brain, looks for plaque blockage, which indicates increased stroke risk. Carotid artery ultrasound screen is the most basic version of the test—and can detect blockages of 50% or greater in the carotid arteries—the two arteries running up the front of the neck. Generally, a blockage of 50% or greater requires further evaluation, while a blockage of less than 50% is not considered an immediate risk.
If you have 50% or greater blockage, you are usually referred for a second, more detailed scan that also includes a look at the two vertebral arteries in the back of the neck. This scan will spot any degree of blockage in these four arteries. This test takes longer and is more expensive than the ultrasound screen, so it isn’t prescribed unless necessary.
The technician should also take an ultrasound measurement of the thickness of the carotid artery wall. Most technicians do this routinely, as it indicates the possibility of heart disease. A thicker-than-normal measurement indicates atherosclerosis.
If one or more arteries shows any sign of plaque buildup, your cardiologist will likely recommend statin medication, a reduced-fat diet and/or a daily dose of aspirin to help prevent blood clots. For blockages of 70% or greater, surgical removal of the plaque through a small incision in the artery may be recommended.
This test detects abdominal aortic aneurysms at risk of rupturing and is recommended for people over age 60 (especially men) or those who have a history of smoking, high blood pressure, atherosclerosis, chronic lung disease or a family history of aneurysms.
The abdominal aorta, which supplies blood to the lower half of your body, is the most common site for an aneurysm—a weakening in the artery wall that causes the artery to balloon out, making it vulnerable to rupturing. Detecting an aneurysm with an abdominal ultrasound scan can save your life. Medicare offers qualified seniors a free screening if done within the first six months of enrolling.
Reason: Once an aneurysm ruptures, there’s a 50% chance of death (some studies put this risk as high as 80%). Every year, 15,000 Americans die this way. Given the seriousness of this condition, it’s amazing that most people fail to get tested. One reason is that most patients have no symptoms — although some patients feel pulsing in their abdomens or unexplained severe back or abdominal pain. Most aneurysms are detected during a magnetic resonance imaging (MRI) or computerized tomography (CT) scan for back pain or kidney stones.
A basic screening takes just two minutes. A complete evaluation for patients with an abnormal basic screening, which compares the size of the abdominal aorta with the iliac arteries that run to the leg and the renal arteries going to the kidneys, can take 10 minutes or longer.
If an aneurysm of up to about two inches (five centimeters) in diameter is detected, ultrasound scans may be recommended to monitor it. Aneurysms larger than about two inches are more prone to rupture, and the patient should be referred to a vascular surgeon for further evaluation.
Aneurysms can be treated surgically by making an abdominal incision, then threading a stent graft into the artery at the aneurysm site to depressurize the weak area, preventing a rupture. Another alternative is open surgery, in which the aneurysm is removed by a vascular surgeon and replaced with a graft. The type of surgery that is right for you is determined by your anatomy.
An ABI test detects peripheral artery disease (PAD)—a condition in which blood flow in the lower extremities is impeded because of plaque-related blockage of the arteries in the legs or pelvis. It is recommended for those over 50 who smoke or have smoked or who have diabetes, high blood pressure and/or high cholesterol.
It compares the blood pressure in both arms with that of two points on each ankle. Blood pressure that is lower at an ankle than at an arm can indicate PAD. Because its primary symptoms are leg pain and fatigue, PAD is often mistaken for arthritis, sciatica or diabetic neuropathy.
Early-stage PAD isn’t dangerous in and of itself, though it can make walking difficult and painful. Left untreated, however, it can lead to cramping, leg pain even at rest and, eventually, limb loss. PAD is often an early sign of coronary artery disease or carotid artery blockage.
Treatment for PAD typically includes exercise, a reduced-fat diet, and blood pressure and cholesterol medication. Cilostazol (Pletal) or pentoxifylline (Trental), medications that promote arterial blood flow, may also be prescribed to relieve moderate blockage. If significant blockage is detected by the ABI test, then a CT angiography scan or magnetic resonance angiography of the legs may be recommended. In severe cases, a stenting of the blocked arteries, or even an arterial bypass operation in the blocked area, may be required.