MARQUETTE - Sandra Pangratz has always lived a very healthy lifestyle.
The 73-year-old walked three miles every day around the beautiful rural setting near her home outside of Iron River, and ate a healthy diet. A vascular condition was the last thing she thought would keep her from being active.
But that's exactly what happened.
Dr. William Jean, left, uses a monitor to guide a catheter during a procedure performed on Sandra Pangratz, with radiology techs Billy Akerley, center, and Brandy Jones assisting. (Photos courtesy MGH)
Jean examines Pangratz immediately prior to her undergoing a trans-catheter procedure to restore leg blood circulation. (Photos courtesy MGH)
Left to right, Left foot, pre-treatment and left foot, post treatment. (Photos courtesy MGH)
In February 2012, as Sandra proceeded along her daily walk, she began experiencing pain and cramping in her right leg. After seeing her primary care provider to address her pain, she was referred to a neurologist at the Marquette General Brain and Spine Center. Providers there determined there that it was not a gait or balance disorder common in older adults and that she should see the physician team at the Marquette General Heart Institute.
The Marquette Heart Team brings cardiologists, cardiothoracic surgeons and other medical staff to provide a comprehensive range of care from cardiac stress tests, to bypass surgery to vein care and surgery.
"I saw Dr. Curtis Marder, who did a test right in the exam room, and determined that I needed to see Dr. (William) Bill Jean right away," explained Sandra.
After reviewing tests, Dr. Jean, an interventional cardiologist, determined that despite her healthy lifestyle, Sandra had peripheral artery disease and she would need a trans-catheter procedure her right leg.
PAD is a common circulatory problem in which plaque builds up inside the arteries and obstructs blood flow to the lower limbs and feet. PAD is one of the most common cardiovascular diseases, affecting 5-12 million Americans.
Factors that increase your risk of developing PAD include:
- Obesity (body mass index over 30)
- High blood pressure
- High cholesterol
- Family history of PAD, heart disease or stroke
- 50 years of age and older
Patients who develop PAD usually notice hip, leg or calf pain when walking (claudication). This pain occurs because the peripheral arteries are not able to deliver enough blood flow to the surrounding muscles. As PAD advances, it can cause severe foot or toe pain when stationary. More severe symptoms, such as skin changes on the feet or legs, may be a sign of advanced PAD.
In many cases, when caught early enough, the first step in treating PAD is exercise, a healthy diet and quitting tobacco usage. But for people like Sandra who already have a healthy lifestyle, a trans-catheter procedure was the first step.
According to Sandra, "Dr. Jean would say, 'You don't smoke, you've exercised your whole life, and yet you still ended up with PAD.' So it was nothing I did wrong. I did all the right things. But it still happened."
Several procedures were required to reopen Sandra's arteries to allow proper blood flow to her right leg: balloon angioplasty, stenting and atherectomy.
With angioplasty, the blocked artery is widened with a medical "balloon." The balloon presses against the inside wall of the artery to open it and improve blood flow. To prevent the artery from narrowing again, a tiny metal stent is placed across the artery wall. The success of this procedure is dependent on the size of the blood vessel, length of blood vessel and amount of blockage in the vessel.
Sandra then received a drug-coated (drug eluting) stent, the first patient in the Upper Peninsula to receive this breakthrough treatment for PAD. This metal mesh stent, which was previously just used in coronary arteries, contains a drug that helps prevent recurrent narrowing of the arteries in the thigh.
"Sandra couldn't walk and was experiencing pain even while resting so we had to restore blood flow to the foot," Dr. Jean said. "Below the stent site there were blockages in the more distal, smaller vessels. An atherectomy procedure was used in this area, as these are too small for stents.
An atherectomy is a procedure that utilizes a catheter with a sharp blade on the end to remove plaque from a blood vessel. The catheter is inserted into the artery through a small puncture in the artery and it's performed under local anesthesia. The catheter is specially designed to collect the removed plaque in the chamber of the tip, which allows removal of the plaque as the device is removed from the artery. The process can be very effective in removing a significant amount of disease from the artery.
"Today we have a variety of treatment options for PAD patients," said Dr. Jean. "It wasn't too long ago that amputation was the norm. Now we're able to save limbs and we have the innovative technology to do that right here in the Upper Peninsula."
An atherectomy is especially helpful for treating blockages in arteries that occur around branches or in vessels that are not easily treated with stents. In Sandra's case, the procedure was successful and she was soon back to her daily walking and fitness routine.
Unfortunately, Sandra soon began to experience familiar symptoms, this time in her left leg. A return visit to Dr. Jean verified that she did, in fact, have PAD in the left leg.
"This occurrence with is quite common in both legs with PAD patients," Dr. Jean explained.
After her positive experience with the PAD treatment in her right leg, Sandra is confident and positive. She is determined to return to her active lifestyle after her left leg circulation is restored. In early November, Dr. Jean performed an interventional procedure on Sandra's left leg.
Many people experience mild symptoms or no symptoms at all and therefore don't report it to their physicians. Because PAD often goes undetected and if untreated can lead to heart attack and stroke, screenings are recommended for the following:
- Those over the age of 70
- Those over 50 with a history of diabetes or stroke
- Those under 50 with diabetes, PAD risk factors like obesity or high blood pressure.
For Sandra, it was her healthy walking habit that allowed her to detect an issue with her legs. If you have leg pain, numbness or other symptoms, don't dismiss them as a normal part of aging. Make an appointment with your doctor.
- Marquette General Hospital