Sep 16, 2014

Interviewer: Vascular disease, going to give you the run down. What is it? What are the symptoms? Is it bad? And what can you do about it? We'll examine that next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

What is Vascular Disease?

Interviewer: Dr. Benjamin Brooke, Assistant Professor of Surgery in the Division of Vascular Surgery at the University Utah School of Medicine. Vascular disease, let's talk about that for a couple seconds. First of all, is vascular disease a pretty big umbrella of things that could happen to a person?

Dr. Brooke: Yes, it is. The vascular system, first of all, it can both involve arterial disease as well as venous disease. Most people think of it from the arterial perspective because that's the kind of vascular disease that can lead to significant problems with loss of blood flow leading to [inaudible 00:00:46] organ damage such as people having to lose their legs or having a heart attack, or having a stroke. It's a pretty big umbrella.

Interviewer: I was going to ask you how serious is vascular disease, but heart attacks, strokes, and losing your legs, that's pretty serious stuff.

Dr. Brooke: It's one of those things that it doesn't happen over night. So vascular disease is the accumulation of many risk factors over a person's life time. Age is a risk factor. Smoking is a risk factor. Being a diabetic is a risk factor. And then just sort of sedentary lifestyle is also another big risk factor.

Interviewer: So what exactly is vascular disease? Is it essentially that you're just not getting the blood flow properly around your body?

Dr. Brooke: Well, vascular disease is more of a function of the blood vessels themselves that start to essentially misbehave. So either you develop blockages or occlusion of a blood vessel or the vessel wall becomes weakened and it can develop what we call an aneurysm. It's almost kind of like a balloon expanding and if it gets to a certain point, it's just going to rupture. It can lead to somebody bleeding to death.

Interviewer: So blockages and weakness, those are the two main things that you see.

Dr. Brooke: Correct, yeah.

Risk Factors

Interviewer: And what causes that? Is it something I'm doing? Is it I'm not eating the right foods? Am I eating the wrong foods? Do I need to move around more?

Dr. Brooke: Well, it's a combination of a lot of things. If you're not exercising a lot and keeping your vessels healthy, then that can lead to it. Smoking is probably the biggest risk factor that we see from a vascular disease stand point. And really what smoking does is it causes a chronic inflammation of the blood vessel wall. That inflammation can either lead to the accumulation of what we want to say artifact and cholesterol, or it can be blood cells, or it can be a blood clot that forms inside of the artery, or the things that make up the vessel wall can become weakened, and then that's when an aneurysm forms. It's that the blood vessel just doesn't have the same strength as it used to and that's why it can expand.

Interviewer: It seems like a lot of causes of a lot of health issues come down to two things.

Dr. Brooke: Right.

Interviewer: One, smoking. Two, obesity. Does obesity play a factor in vascular disease?

Dr. Brooke: It can. I'd actually say diabetes is the other big thing. And diabetes can be related to obesity that's linked to that, but I'd say smoking and diabetes are the two big risk factors that we see.

Interviewer: Genetics, does that play a factor as well?

Dr. Brooke: Absolutely. Diabetes is clearly something that has been found to have a hereditary component.

Interviewer: So this kind of sounds terrifying. Are there any symptoms that I would see to give me a little advanced warning so I could come and see an individual like you?

Blood Vessel Blockages

Dr. Brooke: Well, it kind of depends on where the vascular disease is. And what we usually tell people is that if you have vascular disease in one part of your body, there is a chance you might have it in another. So if you are developing what we call a claudication or crampy muscle pain in your legs when you walk, most people can't walk more than a block without having this pain. They stop, they rest, it gets better, then they start walking again, it comes on and very reproducible. That kind of pain can mean that you've got blood vessel blockages, but it can also mean that you have blood vessel blockages in other parts of your body such as your heart, in the neck arteries, in other areas that could be also critical but just aren't having symptoms. So it's sometimes a marker of worse things to come and you need to seek some diagnostic work-up.

Interviewer: Is that the main symptom, the leg issue?

Dr. Brooke: Some people will develop chest pain and that could mean that their coronary arteries are blocked, but at the same time when their coronary arteries are blocked it could also mean that they have some vascular disease in their leg [inaudible 00:04:20] as well.

Increasing Blood Vessel Circulation

Interviewer: So what are some of the treatments that people could . . .

Dr. Brooke: Well, in a lot of patients we like to start off being conservative if we can. We don't like to just rush into doing an operation. We like to talk to patients about their lifestyle and try to encourage any lifestyle changes that might help their blood vessel circulation. For people with lower extremity blood vessel disease, we encourage a regimented exercise program and that means going out and at least walking 30 minutes to 60 minutes a day, but doing that every day.
We also encourage making sure that people are on the right medications. For most people over the age of 60 that means taking a daily aspirin. There are other medications such as the stat medications. People have heard of Lipitor most likely. Those medications have been shown to be effective for reducing a lot of the inflammation that we find in blood vessels that lead to these blockages and problems.

Interviewer: If you could get on the mountain and scream the one message to anybody listening, what would that be?

Dr. Brooke: Seek treatment and consultation early because if you start having any symptoms, the worse thing you can do is just to kind of ignore it or brush it off, because I think the problems we see is that people have symptoms and they kind of brush them off. And then several years later they present and they've got a more serious problem that requires an urgent operation. And we'd rather do this in a way that doesn't have to do more drastic measures like that.

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