Vascular disease is any condition that affects the network of blood vessels in your body. It’s common in people over age 50, but is treatable thanks to new procedures available at Presence Saint Joseph Hospital, in Elgin.
Walking was a problem for Kathy Kasner three years ago. Without going very far, her legs would cramp up and she’d wince in pain.
“I had just moved out to Huntley, and walking anywhere hurt like heck,” she says. “I got charley horses that would stop me in my tracks.”
Unable to ignore the problem any longer, Kasner sought medical attention. A referral led her to Dr. David Bromet, an interventional cardiologist and chief of cardiology at Presence Saint Joseph Hospital, in Elgin. That’s when Kasner discovered she had a common condition found in people over age 50: peripheral vascular disease (PVD).
The human body has an intricate web of blood vessels – arteries, veins and capillaries – that carry blood throughout the body. If stretched end to end, one person’s blood vessels could circle the earth multiple times. This network of vessels is known as your vascular system, and vascular disease is any condition that affects this system.
As an interventional cardiologist, Bromet treats vascular disease by unclogging blockages in blood vessels and re-establishing blood flow.
“I have a very interesting job,” Bromet says. “I take care of heart attacks in the middle of the night and there’s the excitement of saving someone’s life, but more common than heart attacks, and just as important, is contributing to the general community wellness. I tend to be more of a vascular specialist where I’m fixing blood vessels, and a lot of the general work that I do is prevention work – things like getting blood pressure under control and convincing people to stop smoking.”
Risk factors for vascular disease are diabetes, hypertension, high cholesterol, smoking, family history, an unhealthy diet and an unhealthy weight. Bromet recommends controlling these factors as much as possible.
“The No. 1 thing is to know your numbers,” he says. “Know your blood pressure, blood sugar levels and cholesterol levels. Maintain these in a healthy range. Obviously, don’t smoke. These are things that are more controllable.”
If not controlled, however, these risk factors can escalate to vascular disease – a much more complicated issue.
Over time, a buildup of cholesterol or other substances in your vessels can make it hard for blood to flow. Eventually, the vessel becomes so narrow that your body’s tissues can’t receive enough blood. This can happen anywhere in the body. For example, a blockage in the coronary arteries that supply blood to your heart can cause chest pain, and eventually a heart attack. A blockage in the carotid arteries that lead to your brain can eventually cause a stroke.
Peripheral vascular disease is any blockage outside of your heart and brain.
“Blockages can happen anywhere, but the most common place is a big vessel in the thigh called the superficial femoral artery,” Bromet says. “If you’re having cramps in your legs with less than one to two blocks of walking, it’s time to see a doctor for a physical exam.”
After a patient has a physical exam, Bromet uses various non-invasive techniques to distinguish if a patient does indeed have PVD, and not another issue. Blood pressure cuffs can determine where one’s blood pressure drops, and ultrasounds, CT scans or MRI scans can indicate the location of blockages.
Bromet also performs angiograms, where he places an IV and uses catheters, similar to complicated drinking straws, to put contrast dye into a patient’s blood vessels. He can then follow the dye with X-ray machines to determine where blood is flowing or being blocked.
Once it is clear where a blockage is, Bromet can begin treatment.
With PVD, Bromet typically addresses risk factors first by starting people on walking programs and risk factor modification to get the vessels to unclog on their own.
“If you work on risk factors long enough, medical trials have shown you can begin to unclog in an 18- to 24-month period,” Bromet says. “The walking programs convince the body to build new blood vessels around blockages, a process called angiogenesis. When we can’t re-establish blood flow that way, or if the patient can only do less than two blocks of walking, or if there are other complications such as a skin ulcer, we have to turn to other options.”
If this is the case, Bromet begins with the least invasive form of treatment possible.
“What I do most commonly is interventional therapy – where we use little balloons or various atherectomy ‘Roto-Rooter’ devices or metal scaffold devices called stents to open the blood vessel and clean the vessel from the inside,” he says. “Beyond that, options are surgical to get blood around a blockage. The last-case scenario is an amputation, and we try to avoid that.”
Bromet was the first in the Fox River Valley to use Ocelot and Pantheris devices to help treat patients. These highly advanced forms of technology use optical tomography medical imaging to look at a vessel from the inside. Then, Bromet can use a laser or other device to go through the blockage and clean out the vessel.
Kasner’s blood vessels were cleaned out using the laser method. She remembers the surgery being virtually painless.
“I actually had blockages in both legs that had to get fixed,” she says. “But I was fine afterwards – no problems whatsoever. There was no pain involved, and I had no restrictions.”
However, about a year later Kasner had another blockage in one leg. This time, Bromet used a stent called a Supera to fix the problem. A Supera is a strong and flexible stent that mimics your anatomy’s natural movement. Again, Kasner had no pain afterward.
“It fixed my veins that felt all knotted up and pinched,” she says.
When Bromet began working at Presence Saint Joseph in 2004, there was just a fledgling program for treating vascular disease. Now, the hospital offers a full spectrum of care, from monitoring vascular disease to providing treatment through all modalities available. Several new doctors have also joined the team.
As people are now living well into their 90s and early 100s, it has become increasingly important to Bromet to have a strong program for vascular disease treatment.
“Maintaining quality of life is critical so you can be happy,” Bromet says. “It’s rewarding to help someone who couldn’t walk across a football field to see their grandchild’s game, and now all of a sudden they can do it.”
Bromet stresses how important it is to see a doctor early. Unfortunately, people often wait too long to seek help. By then, it can sometimes be too late.
“We should see people at the first sign of a problem, not when an ulcer develops,” he says. “Knowing your numbers is the main thing. Make sure your blood sugar and blood pressure are under good control. If you’re displaying any signs or symptoms, give us a call right away and we’ll help you out.”
Kasner is thankful she acted quickly enough and received proper care from Dr. Bromet.
“I walk without pain,” she says. “I can shop; I can swim. Life is much better now.”