Millions of Americans are at risk for vascular diseases, which can lead to serious health conditions such as a stroke.
Learn from a UVA expert in vascular surgery if you should consider getting screened for vascular disease.
DEMO: Should You Get Screened for Vascular Disease?
Featuring:
UVA Heart and Vascular Center
Dr. Gilbert R. Upchurch Jr.
Dr. Gilbert R. Upchurch Jr. is a board-certified vascular surgeon and chief of the Division of Vascular and Endovascular Surgery at UVA Health System.UVA Heart and Vascular Center
Transcription:
Melanie Cole (Host): Millions of Americans are at risk for vascular diseases, which can lead to serious health conditions such as stroke. My guest is Dr. Gilbert Upchurch, Jr. He’s a board certified vascular surgeon and Chief of the Division of Vascular and Endovascular Surgery at UVA Health System. Welcome to the show, Dr. Upchurch. Tell us a little bit about vascular disease. What are the most common types?
Dr. Gilbert Upchurch (Guest): Well, thanks, Melanie, for having me on. The two most common types, really, are atherosclerosis or hardening of the arteries, as it used to be called, which is really plaque buildup in an artery over time. It could be really almost in any artery. The arteries that it most commonly occur in are arteries to your brain, which, if you have a plaque going in your carotid artery, you may end up having a stroke; atherosclerosis in your coronary arteries, which are more centrally, and that can lead to heart attack; or blockages going to your legs, which can lead to pain when you walk, all the way from pain when you walk to gangrene and loss of limb. That’s really number one. The second most common vascular disease we see is an aneurysm. An aneurysm also can really occur in almost any artery in the body, most often occurs in the abdominal aorta, which is relevant to this vascular screening conversation we’re going to have. You think about aneurysm as sort of a worn-out tire. Your blood vessels are a certain size when you’re born and they get somewhat larger as your grow, but the inner tubes give out over time. And so, an aortic aneurysm, for example, can grow from two centimeters or an inch to five, six, seven, ten centimeters. With that growth, there’s always the risk of rupture and if patient -- depending on what bed it is, if an aneurysm ruptures, often, it’s lethal. So I would say atherosclerosis, blockage in the arteries, and aneurysms are the two most common diseases we treat.
Melanie: What people are at risk, Dr. Upchurch? Who would be the people that would want to get screened?
Dr. Upchurch: We divide the risk factors into non-modifiable and modifiable. The non-modifiable ones are people as they get older, people who have a strong family history of either atherosclerosis or aneurysms, people who, for instance, have atherosclerosis in other beds, or people who have high cholesterol. Those are sort of the people who are most at risk. There’s another group of people that I think the ones you can do the most about. That is the group of people who smoke. Smoking is a risk factor for causing both atherosclerosis or hardening of the arteries as well as aneurysm formation. It’s a big-time inducer of both of those things. And I think high blood pressure is another thing that induces both atherosclerosis as well as aortic aneurysms, and so having your blood pressure well-managed and being on the right cardiovascular protective medications are really important.
Melanie: We have the controllable risk factors and the uncontrollable risk factors. So what’s involved in the screening process? If somebody has high blood pressure or diabetes or they smoke or a family history of heart disease, any of these things, vascular disease that might put them at risk, what’s involved in the screening process?
Dr. Upchurch: The screening process is really just a non-painful ultrasound, and this particular screening process involves taking a snapshot of the blood vessels going to your neck or your carotid arteries looking at the carotid bifurcation to see if there’s plaque there. It looks at your infrarenal aorta and does a snapshot of that to see whether there is blockage and/or an aneurysm in your infrarenal aorta, and then it uses a blood pressure cuff on your arm, in your legs, to check the amount of blood flow going to your legs. And your arms. But most of the time, peripheral vascular disease affects the legs. These are non-invasive tests that’s done rapidly, relatively inexpensively, and will give you a good snapshot of what your cardiovascular health risks are.
Melanie: Dr. Upchurch, do you feel that even people that are not necessarily at risk should have these done? And how often? Is this part of our yearly physical? Is it something that’s only done if it needs to be done?
Dr. Upchurch: I think a lot of it depends on how old you are when you’re screened. The aortic aneurysm is just in your infrarenal aorta. There is pretty good literature looking at your aorta once at the age of 60 or 65. If there’s no aneurysm there, you’re likely never going to develop aneurysm in your lifetime. Carotid disease, especially if you’re a non-smoker, a single look at your carotid bifurcation is probably adequate. And really, unless you have worsening symptoms of what’s called claudication or pain in your calves, hip, or buttocks when walking a reproducible distance, if you have a normal screening ABI or ankle brachial index, then you should be capable of not needing to be screened again—unless you develop symptoms, of course. And then, of course, you could always have another test done.
Melanie: Let’s speak about symptoms for a minute, Dr. Upchurch. When does chest pain -- people want to know -- or pain in their arms, or, as you described, pain the legs, claudication during activity, when does that warrant seeing a doctor versus saying, “Oh, it’s probably gas or muscular,” something like that? People are never quite sure about those symptoms.
Dr. Upchurch: Yes. The coronary symptoms are actually -- in my own biases, the chest pain, especially with exertion, radiating down the left arm, those should always be evaluated and taken very seriously. The lower extremity pain in your legs, the blockages in your arteries can often be confused, and these patients are sort of taken aback a little bit by this. It can also be confused with what’s called neurogenic claudication or pain from having your discs, your spinal roots compressed by your vertebral column, so you end up getting pain shooting down the back of your leg when you walk or when you stretch or whatever. It’s a test like this, this ankle brachial index, where we use the blood pressure cuffs, that often helps us to distinguish whether it’s some radiation pain from your back or whether it’s actually legitimate blockage in your legs. What people fear—and this is with the peripheral vascular occlusive disease or atherosclerotic disease or PAD—is that when they’re having pain when they walk, that means they’re heading towards gangrene and losing a limb. The truth is that people who have pain when they walk, only about one percent per year will go on to require an amputation, which means 99 percent of people will be fine. And the truth is, especially in the beginning, the best therapy is exercise and stopping smoking and getting your diet under control. Our job as vascular surgeons and care providers with patients of vascular disease is to help them modify what they’re doing. And to be honest, exercise works almost all the time in these patients if you can get them to, as I said, stop smoking, start exercising. So that’s the first line therapy—no stent, balloon, et cetera are needed.
Melanie: Why should patients come to UVA for their vascular screening and come to see you?
Dr. Upchurch: I think we have an amazing group of experts as good as anywhere in the country at taking care of patients with vascular disease. We have vascular surgeons, cardiac surgeons, cardiovascular medicine physicians, physicians who are specialist in management of your lipids, smoking sensation, and we’ll help you from that critical transition if you need it—from lifestyle changes, et cetera, to more invasive imaging, perhaps an angiogram or just a CAT scan, all the way to the most invasive options, which are ballooning, stenting, and open bypass surgery. So I think you’ve come to a place like this, you will find an amazing group of care providers. And really, for the whole spectrum of your needs, not just making the diagnosis but also taking care of you should you require something to prevent you from having a stroke or prevent you from having your aneurysm rupture or prevent you from losing a leg. That’s one of the things that we in the Heart and Vascular Center here at the University of Virginia pride ourselves on. It’s just sort of one-stop shopping.
Melanie: Thank you so much, Dr. Gilbert Upchurch, Jr., Chief of the Division of Vascular and Endovascular Surgery at the UVA Health System. You’re listening to UVA Health System Radio. For more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
Melanie Cole (Host): Millions of Americans are at risk for vascular diseases, which can lead to serious health conditions such as stroke. My guest is Dr. Gilbert Upchurch, Jr. He’s a board certified vascular surgeon and Chief of the Division of Vascular and Endovascular Surgery at UVA Health System. Welcome to the show, Dr. Upchurch. Tell us a little bit about vascular disease. What are the most common types?
Dr. Gilbert Upchurch (Guest): Well, thanks, Melanie, for having me on. The two most common types, really, are atherosclerosis or hardening of the arteries, as it used to be called, which is really plaque buildup in an artery over time. It could be really almost in any artery. The arteries that it most commonly occur in are arteries to your brain, which, if you have a plaque going in your carotid artery, you may end up having a stroke; atherosclerosis in your coronary arteries, which are more centrally, and that can lead to heart attack; or blockages going to your legs, which can lead to pain when you walk, all the way from pain when you walk to gangrene and loss of limb. That’s really number one. The second most common vascular disease we see is an aneurysm. An aneurysm also can really occur in almost any artery in the body, most often occurs in the abdominal aorta, which is relevant to this vascular screening conversation we’re going to have. You think about aneurysm as sort of a worn-out tire. Your blood vessels are a certain size when you’re born and they get somewhat larger as your grow, but the inner tubes give out over time. And so, an aortic aneurysm, for example, can grow from two centimeters or an inch to five, six, seven, ten centimeters. With that growth, there’s always the risk of rupture and if patient -- depending on what bed it is, if an aneurysm ruptures, often, it’s lethal. So I would say atherosclerosis, blockage in the arteries, and aneurysms are the two most common diseases we treat.
Melanie: What people are at risk, Dr. Upchurch? Who would be the people that would want to get screened?
Dr. Upchurch: We divide the risk factors into non-modifiable and modifiable. The non-modifiable ones are people as they get older, people who have a strong family history of either atherosclerosis or aneurysms, people who, for instance, have atherosclerosis in other beds, or people who have high cholesterol. Those are sort of the people who are most at risk. There’s another group of people that I think the ones you can do the most about. That is the group of people who smoke. Smoking is a risk factor for causing both atherosclerosis or hardening of the arteries as well as aneurysm formation. It’s a big-time inducer of both of those things. And I think high blood pressure is another thing that induces both atherosclerosis as well as aortic aneurysms, and so having your blood pressure well-managed and being on the right cardiovascular protective medications are really important.
Melanie: We have the controllable risk factors and the uncontrollable risk factors. So what’s involved in the screening process? If somebody has high blood pressure or diabetes or they smoke or a family history of heart disease, any of these things, vascular disease that might put them at risk, what’s involved in the screening process?
Dr. Upchurch: The screening process is really just a non-painful ultrasound, and this particular screening process involves taking a snapshot of the blood vessels going to your neck or your carotid arteries looking at the carotid bifurcation to see if there’s plaque there. It looks at your infrarenal aorta and does a snapshot of that to see whether there is blockage and/or an aneurysm in your infrarenal aorta, and then it uses a blood pressure cuff on your arm, in your legs, to check the amount of blood flow going to your legs. And your arms. But most of the time, peripheral vascular disease affects the legs. These are non-invasive tests that’s done rapidly, relatively inexpensively, and will give you a good snapshot of what your cardiovascular health risks are.
Melanie: Dr. Upchurch, do you feel that even people that are not necessarily at risk should have these done? And how often? Is this part of our yearly physical? Is it something that’s only done if it needs to be done?
Dr. Upchurch: I think a lot of it depends on how old you are when you’re screened. The aortic aneurysm is just in your infrarenal aorta. There is pretty good literature looking at your aorta once at the age of 60 or 65. If there’s no aneurysm there, you’re likely never going to develop aneurysm in your lifetime. Carotid disease, especially if you’re a non-smoker, a single look at your carotid bifurcation is probably adequate. And really, unless you have worsening symptoms of what’s called claudication or pain in your calves, hip, or buttocks when walking a reproducible distance, if you have a normal screening ABI or ankle brachial index, then you should be capable of not needing to be screened again—unless you develop symptoms, of course. And then, of course, you could always have another test done.
Melanie: Let’s speak about symptoms for a minute, Dr. Upchurch. When does chest pain -- people want to know -- or pain in their arms, or, as you described, pain the legs, claudication during activity, when does that warrant seeing a doctor versus saying, “Oh, it’s probably gas or muscular,” something like that? People are never quite sure about those symptoms.
Dr. Upchurch: Yes. The coronary symptoms are actually -- in my own biases, the chest pain, especially with exertion, radiating down the left arm, those should always be evaluated and taken very seriously. The lower extremity pain in your legs, the blockages in your arteries can often be confused, and these patients are sort of taken aback a little bit by this. It can also be confused with what’s called neurogenic claudication or pain from having your discs, your spinal roots compressed by your vertebral column, so you end up getting pain shooting down the back of your leg when you walk or when you stretch or whatever. It’s a test like this, this ankle brachial index, where we use the blood pressure cuffs, that often helps us to distinguish whether it’s some radiation pain from your back or whether it’s actually legitimate blockage in your legs. What people fear—and this is with the peripheral vascular occlusive disease or atherosclerotic disease or PAD—is that when they’re having pain when they walk, that means they’re heading towards gangrene and losing a limb. The truth is that people who have pain when they walk, only about one percent per year will go on to require an amputation, which means 99 percent of people will be fine. And the truth is, especially in the beginning, the best therapy is exercise and stopping smoking and getting your diet under control. Our job as vascular surgeons and care providers with patients of vascular disease is to help them modify what they’re doing. And to be honest, exercise works almost all the time in these patients if you can get them to, as I said, stop smoking, start exercising. So that’s the first line therapy—no stent, balloon, et cetera are needed.
Melanie: Why should patients come to UVA for their vascular screening and come to see you?
Dr. Upchurch: I think we have an amazing group of experts as good as anywhere in the country at taking care of patients with vascular disease. We have vascular surgeons, cardiac surgeons, cardiovascular medicine physicians, physicians who are specialist in management of your lipids, smoking sensation, and we’ll help you from that critical transition if you need it—from lifestyle changes, et cetera, to more invasive imaging, perhaps an angiogram or just a CAT scan, all the way to the most invasive options, which are ballooning, stenting, and open bypass surgery. So I think you’ve come to a place like this, you will find an amazing group of care providers. And really, for the whole spectrum of your needs, not just making the diagnosis but also taking care of you should you require something to prevent you from having a stroke or prevent you from having your aneurysm rupture or prevent you from losing a leg. That’s one of the things that we in the Heart and Vascular Center here at the University of Virginia pride ourselves on. It’s just sort of one-stop shopping.
Melanie: Thank you so much, Dr. Gilbert Upchurch, Jr., Chief of the Division of Vascular and Endovascular Surgery at the UVA Health System. You’re listening to UVA Health System Radio. For more information on the UVA Heart and Vascular Center, you can go to uvahealth.com. This is Melanie Cole. Thanks for listening.
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