Minimally invasive procedures give Beacon retiree with peripheral artery disease a new lease on life

Lila Artley has a new spring in her step. This is a big improvement from the painful leg cramps that had been getting worse and worse over the past several years for the recently retired Beacon medical receptionist.

“My right calf felt like it was going to explode when I did too much walking,” she said. “It hurt that bad.”

She had also noticed that she couldn’t feel a pulse in her right foot, but she figured her muscles were simply aching due to lack of exercise.

During a routine visit, Artley mentioned the increase in pain to her primary care provider, who also couldn’t find a pulse in her foot. She was referred to Beacon’s vascular specialists, providers who diagnose and treat problems with the arteries, veins and lymphatic system.

The diagnosis

The problem turned out to be peripheral artery disease (PAD). PAD most often develops as a result of atherosclerosis: a hardening of the arteries that occurs when fat, cholesterol, calcium and other substances in the blood build up to form plaque inside the arteries. The plaque narrows the artery, slowing the flow of blood—in Artley’s case, to the lower legs—which can cause pain, sores or even dead tissue. The worst cases can lead to gangrene and amputation.

Artley had a consultation with Dr. Michael Ginsburg, Beacon Medical Group Interventional Radiology and Vascular Specialists. He told her that her symptoms of thigh and calf pain with walking that were relieved by rest were classic for PAD.

However, she was also experiencing additional symptoms of tingling, burning and numbness in her foot and toes even while resting. These represented the beginning stages of a more serious and severe form of PAD called critical limb-threatening ischemia (CLTI).

“Patients with CLTI may present with ischemic rest pain, which is pain across the foot while at rest that can be relieved temporarily by hanging the leg over the bed or getting up to walk around,” Dr. Ginsburg said. Other conditions can mimic this pain, including neuropathy, arthritis and gout.

In patients like Artley, peripheral neuropathy — a common complication of diabetes — can distort the perception of pain, Dr. Ginsburg said.

“Due to peripheral neuropathy, and because PAD can frequently occur without symptoms, it tends to be under-diagnosed, under-treated and ‘under-appreciated’ in the U.S.,” he said.

An estimated 8.5 million Americans, most over the age of 40, have PAD. The condition is closely linked to leg pain, ulcers and amputations — especially in patients with diabetes — so early detection for those at risk is extremely important to save limbs and lives.

Next steps

Dr. Ginsburg ran some additional tests, including an ultrasound to pinpoint the blockages in Artley’s legs and determine the best treatment options.

Artley learned she had five different blockages across both legs.

“It was intense,” she recalled. If she didn’t have the problem taken care of, she could lose a toe, her foot or even her leg.

Dr. Ginsburg’s priority when treating patients with PAD is to help them understand their risk factors and involve them in their care and treatment. These risk factors include smoking, diabetes, high blood pressure, high cholesterol, obesity, lack of physical activity and poor diet.

By building trust and educating patients, he puts them in a better position to make informed decisions that will improve their health. Given that people with PAD have a higher risk of heart attack and stroke, Dr. Ginsburg emphasizes a treatment plan that will improve overall cardiovascular health, including making lifestyle changes such as eating a healthier diet, exercising more and quitting smoking.

He said it’s also important for patients to take recommended medications to help lower their cholesterol, control blood pressure and manage blood sugar levels.

When these actions fail to improve symptoms, or when a person has severe PAD, surgery is needed.

A treatment plan

Having multiple blockages, as Artley did, is actually a common occurrence in patients who have CLTI.

“When PAD and the extent of vascular blockage is as severe as seen in Ms. Artley’s case, we occasionally have to approach treatment in a staged fashion,” Dr. Ginsburg said. Multiple techniques can be used to treat the problem, including minimally invasive options that allow the patient to avoid major surgery.

These “revascularization” procedures include balloon angioplasty, atherectomy and stenting. All three procedures are performed inside the artery using a long, thin tube called a catheter. The physician inserts the catheter via a small cut in the groin, foot or arm, then guides it through the person’s artery to the blockage.

During a balloon angioplasty, the physician then presses the plaque against the sides of the blood vessel with a balloon. An atherectomy involves actually removing the plaque by cutting or scraping it with a laser or tiny blade on the end of the catheter. A stent, or mesh wire tube, may be used after either procedure to support the vessel and keep it open.

“We live a very exciting era,” Dr. Ginsburg said. “Due to continued improvements in imaging and catheter-based technologies, we now can offer our PAD patients minimally invasive alternative treatment options that once required major open surgery. Every patient’s treatment plan is individualized based on their overall health, symptoms, severity of limb threat and anatomic pattern of disease, all of which are critical factors in defining the best strategy.”

Dr. Ginsburg was able to treat Artley with several minimally invasive procedures to open up the blockages in her right leg. She didn’t have to stay overnight in the hospital for any of the procedures, and her daughter was there to help and take her home after a brief recovery.

Now, with the procedures done and a ten-inch stent holding one artery open, her leg is feeling much better.

“Dr. Ginsburg is very kind and soft-spoken. He explains everything in full detail. He looks me in the eye and explains what I need to do,” she said.

She added that it’s a relief to be able to get this kind of high-quality care locally. “I worried about having to travel. I know people who have to go to Chicago or Cleveland for procedures. Yet Dr. Ginsburg never once made me feel like he couldn’t take care of me,” Artley said.

It has been an added bonus that Dr. Ginsburg’s office is just a short walk away from hers – although, after 33 proud years at Beacon, Artley recently happily retired.

Time will tell whether she’ll need treatment in her left leg, as well. But she knows she’s in good hands.

“I trust him. I appreciate all he’s done,” she said about Dr. Ginsburg. “I can’t praise the team enough, really. I’m feeling very blessed.”

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Click here to read more about the Beacon Vascular and Interventional Radiology team who cared for Steve Dewey. Our collaborative multi-specialty team provides preventative, medical, surgical, and endovascular treatments to improve vascular health and treat peripheral and cerebral vascular disease.

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