Multiple treatment options for vascular patients lead to better results.
When a problem arises in any of our veins or arteries, the ability to transport oxygen- and nutrient-rich blood throughout our body can be seriously impaired, often leading to grave consequences. Blood vessel problems are so common that everyone probably knows someone who has had a blockage or bleeding in the brain, heart, lungs or legs. About six million Americans have weak spots in brain blood vessels that balloon out and fill with blood. If any of these malformations, called aneurysms, rupture, the bleeding can cause permanent disabilities or death.
Norma Wooley, a 55-year-old registered nurse from St. Charles, provides home health care to many patients who are severely disabled due to aneurysms. "I have taken care of a lot of people who have had open-skull brain surgery (craniotomy) to treat an aneurysm," Norma said. "They can have mental deficits and large physical scars. I always thought that these problems happen to my patients, not to me."
But earlier this year, Norma suddenly experienced the worst headache of her life. One side of her face was drooping, she had trouble seeing out of one eye, and was suffering from nausea, vomiting and confusion. She had an aneurysm, and she feared the worst.
"I was in Loyola's neurological intensive care unit when Dr. Whapham told me he could go through an artery in my groin to get a catheter (thin tube) up to my brain," Norma said. "I never knew this was possible, and I'm a nurse. If I didn't have an operation, the aneurysm would either kill me or leave me debilitated, so I said, ‘Sign me up.'"
"We used some of the most advanced imaging technology available in the country to manipulate computer-generated models of Norma's aneurysm from every angle," explained John Whapham, MD, assistant professor, neurology, Loyola University Chicago Stritch School of Medicine (Stritch), director, Neuro-interventional Program. "Our multi-disciplinary team could see that the shape, size and location of her aneurysm made Norma an ideal candidate for this less-invasive surgery, which minimizes potential change to healthy tissue and eliminates the risk associated with open-brain surgery."
Once Dr. Whapham guided the catheter through the artery in Norma's leg to her brain, he filled the aneurysm with tiny platinum coils, cutting the aneurysm off from the circulatory system and removing the risk of a life-threatening rupture.
"God put all of us in the right place at the right time, and I feel blessed that I have this second chance at living," Norma said.
Leg Pain that Wouldn't get Better
At around the same time that Norma first experienced her symptoms, Ray Kasperski started feeling pain in his legs when he walked more than a block or two. This is particularly troublesome when your work as a regional manager of 19 steakhouses in six states requires frequent travel. "The pain was so bad that I had a hard time walking through an airport in one shot," Ray remembered. "If just one leg hurt, I might have thought I pulled a muscle. But with both calves hurting, I decided to see a doctor."
That decision led to a series of events that potentially saved Ray's life and returned the 59-year-old Orland Park resident to a more active lifestyle.
Doctors told Ray that his pain was due to peripheral artery disease (PAD), the medical term for blockages in arteries in his legs. Ray came to Loyola for a second opinion and was examined by a team of interventional cardiology and vascular surgery specialists. "From my very first interactions at Loyola, I was more comfortable there," Ray said. "The doctors were very competent and very direct about the benefits and the risks of different treatments. They listened to my concerns."
It's worth noting that just as the risk factors for PAD (smoking, high blood pressure, diabetes, high cholesterol, family history) are the same as those for coronary (heart) artery disease, the same procedures treat both diseases. Angioplasties involve a catheter-based balloon opening up the blocked blood vessel, typically followed by implanting a wire stent to keep the artery open. Bypass surgeries involve grafting healthy blood vessels to arteries above and below the blockage, allowing blood to bypass the problem and restore blood flow in the heart or leg.
"We have a very comprehensive and collaborative approach to patient care," said Robert Dieter, MD, RVT, FACC, assistant professor, medicine, Stritch. "We looked at Ray as an individual to determine how to best treat him. Loyola is set up for that type of process."
The physicians decided that the best approach would be for Dr. Dieter to perform angioplasty on one leg and for the vascular surgery team to perform bypass surgery on the other leg, which was not suitable for the less-invasive angioplasty procedure.
"It's always nice to have two sets of minds come together," said Richard Hershberger, MD, assistant professor, surgery, Stritch. "Ray needed two procedures because the problems in each leg were different. We did the bypass surgery because we felt angioplasty wouldn't have held up for a long time. That would have been unacceptable for Ray and his needs. Dr. Dieter and I feel that our collaboration led to a better and longer-lasing outcome for Ray."
Ray quit a two-pack-a-day smoking habit and now exercises on a new treadmill. Norma walks an hour daily with a neighbor, eats healthier foods, some from her own garden, and tries to control her weight. By adopting these important lifestyle changes, Ray and Norma are lowering their risks of vascular problems, which helps them and their families look forward to the years ahead.
Where to Learn More
For more information or to schedule an appointment, please visit www.LoyolaMedicine.org/VascularRisk or call (888) LUHS-888 (888-584-7888).
Specialists Collaborate to Heal Foot Sores
Vascular problems can prevent foot sores or ulcers from healing. In severe cases, patients may lose their lower limbs. Approximately 100,000 amputations related to peripheral artery disease (PAD) occur in the United States annually. Helping PAD patients avoid amputation is another area in which Loyola specialists frequently collaborate. Ronald Sage, DPM, professor, orthopaedic surgery and rehabilitation, LUC Stritch School of Medicine, division director, podiatry, was treating Betty Span for problems in both feet when he identified poor circulation as the underlying cause of her health troubles. Dr. Sage referred Betty to Robert Dieter, MD, RVT, FACC, assistant professor, medicine, Stritch, who performed several imaging tests that helped him diagnose Betty’s PAD.
Dr. Dieter reviewed her case with Dr. Hershberger. Together they developed a treatment plan to re-open Betty’s arteries and provide enough blood and oxygen to heal the wounds. Dr. Dieter used new minimally invasive technology, a vibrating catheter and laser to clear the blockage in her arteries and Dr. Hershberger prepared to perform bypass surgery, if necessary.
Fortunately, no further intervention was needed. “I feel a lot better now,” Betty said. “All the doctors and nurses at Loyola treated me very well. They cared about me as a person.”
LOYOLA UNIVERSITY HEALTH SYSTEM
