When healthy arteries slowly begin to narrow or become blocked, Gregory Robertson, MD, of the Emory Heart & Vascular Center, uses a wealth of knowledge and skill to help solve this problem.
An internationally known endovascular cardiologist, Dr. Robertson is working at Emory Crawford Long Hospital and Emory Johns Creek Hospital to help people understand a serious problem called peripheral artery disease, or PAD. Dr. Robertson is assistant professor in the Emory University School of Medicine.
PAD is a disease that can close an artery by 60 percent before it has symptoms that send up a red flag. At least half of the people who have PAD don't have any signs or symptoms of the disease.
PAD affects eight to 12 million people in the U.S. About 5 percent of U.S. adults over age 50 have PAD. Among adults age 65 and older, 12 percent to 20 percent may have PAD. Men are more likely to have symptoms of PAD, but both men and women can develop the disease. Risk factors include smoking, diabetes, ages 50 and older, race - African-Americans have a two-fold higher risk, history of heart or vessel disease, and high blood pressure.
PAD occurs when a fatty material called plaque builds up on the inside walls of the arteries that carry blood from the heart to the head, internal organs and limbs.
The buildup of plaque on the artery walls is called atherosclerosis, and PAD most commonly affects blood flow to the legs. Blocked blood flow can cause pain and numbness. It also can increase a person's chance of getting an infection, and it can make it difficult for the person's body to fight the infection.
"PAD can impair physical health and diminish the ability to walk," says Dr. Robertson. "In the advanced stages of PAD, blood flow to one or both legs can be completely or mostly blocked. Painful leg or foot sores, and it could eventually lead to gangrene."
What can heart and vascular experts do to help rule out PAD? Emory doctors can use considerable expertise in this area to test individuals using a physical exam, measure blood pressure and blood volume in the lower legs, and possibly test with ultrasound, angiography, CT or MRI.
If PAD is found, Dr. Robertson recommends lifestyle changes that could make a difference -- such as smoking cessation, eating a low-fat, low-sodium diet, increasing exercise under a doctor's care, and managing other health problems such as diabetes, high cholesterol and high blood pressure. And, importantly, he recommends practicing good foot and skin care, by examining legs and feet everyday, and applying moisturizing cream or lotion to prevent dry skin.
Should PAD persist medications may be used to address the problem, but many times advanced cases require a state-of-the-art solution.
This is where Dr. Robertson's experience using an outpatient option helps rid the arteries of life-threatening plaque. Using a recently developed devise that shaves away plaque in the arteries to restore blood flow, Dr. Robertson regularly helps patients prevent blood flow problems that could result in something as serious as amputation.
The unique device used in this procedure deploys a tiny rotating blade on the tip of a catheter to remove plaque from the arterial wall. It is the first technology to remove significant amounts of atherosclerotic tissue from long, diffusely diseased lesions.
Unlike the use of stents, it does not stretch the vessel wall. It can be used to treat both calcified and non-calcified lesions of any length. The device is designed to enable physicians to remove plaque from the device as the procedure is conducted.
"When we remove the plaque during a procedure we often see a patient's foot change color and feel it warm up," says Dr. Robertson. "This procedure routinely takes only 60 to 90 minutes, and procedures like this one have considerably diminished the need for more invasive bypass operations. We are very hopeful that with earlier recognition and treatment of PAD, leg amputations will be significantly lessoned."
This month, Dr. Robertson presented at an international conference for heart and vascular doctors in Zurich, Switzerland, at the 30-Year Anniversary of Coronary Angioplasty, a program honoring Dr. Andreas Gruntzig -- an Emory cardiologist who pioneered the procedure while at the Emory University School of Medicine. Dr. Robertson presented the pioneering work of his former colleague of 20 years Johns Simpson, MD, the inventor of atherectomy and Silverhawk. In addition, Dr. Robertson is teaching other doctors about PAD at an upcoming annual Emory Heart & Vascular Center educational conference held in Atlanta.
Dr. Robertson and his colleagues Christopher Cates, MD, Khusrow Niazi, MD, and Chandan Devireddy, MD, at the Emory Heart & Vascular Center are committed to providing clinically excellent cardiovascular patient care, pioneering innovative clinical research and training the best heart specialists in the world. The Center is consistently recognized by U.S. News & World Report as one of the top heart centers in the country. In addition, many of Emory's cardiologists and surgeons consistently are recognized as Atlanta's Top Doctors by Atlanta Magazine and as America's Top Doctors.
Emory's board-certified physicians provide a comprehensive spectrum of cardiovascular services in a variety of convenient locations, including: Emory University Hospital, Midtown's Emory Crawford Long Hospital, Emory-Adventist Hospital at Smyrna, Emory Johns Creek Hospital, Wesley Woods Center and 18 clinics in Atlanta, Western Georgia, Northern Georgia and North Carolina.
For more information, or to make an appointment, call the Emory Heart & Vascular Center at 404-778-8240.
More about Peripheral Artery Disease, or PAD
People who do have signs or symptoms may have pain when walking or climbing stairs, which may be relieved after resting. This pain is called intermittent claudication. Blood brings oxygen to the muscles, but during exercise, muscles need more blood flow. If there is a blockage in the blood vessels, muscles won't get enough blood.
If a person has intermittent claudication and exercises while in pain, his or her muscles may be harmed. When resting, the muscles require less blood flow and the pain goes away. Claudication is more likely in people who also have atherosclerosis in other arteries, such as the heart and brain. About 10 percent of people with PAD have intermittent claudication.
Other signs and symptoms of PAD include:
- Pain, numbness, aching, and heaviness in the muscles
- Cramping in the legs, thighs, calves, and feet
- A weak or absent pulse in the legs or feet
- Sores or wounds on toes, feet, or legs that heal slowly, poorly, or not at all
- Color changes in skin, paleness, or blueness (called cyanosis)
- A decreased temperature in one leg compared to the other leg
- Poor nail growth and decreased hair growth on toes and legs
- Erectile dysfunction, especially among people with diabetes